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Does Medicare Cover An Annual Physical?

Welcome to Medicare check-up and your yearly wellness visitSenior Woman Getting Medicare Physical not as comprehensive as you would think

Any medical professional will tell you that one key to staying healthy is getting an annual physical. Diagnosing symptoms early and receiving helpful advice related to your lifestyle can eliminate or prolong illness or degenerative conditions.

When you become eligible for Medicare and enroll in Part B you have one year to receive a Welcome to Medicare Physical Exam. But this one time check-up should not be confused with an annual physical.

When you think of an annual physical you generally think of a comprehensive head to toe exam. Your welcome to Medicare Check-up and Annual Wellness visit is not nearly as comprehensive.

During a physical you may receive testing or other labs to determine your state of health and you may receive a gynecological exam or prostate exam (you know which one you get!). But don’t expect these tests or procedures to be covered during your Welcome or Yearly visits.

This article will address what you can expect when you receive your Medicare-covered exams.

Welcome to Medicare physical exam

It’s important to schedule your Welcome to Medicare exam soon after you enroll in Part B. You must receive your exam in the first 12 months of having Part B. If you are seeing a new doctor you should bring all your medical records including a list of medications that you are currently taking.

The exam is designed to allow the doctor to gather information so you can be advised about any lifestyle changes or screenings that you may need. The scope of the exam is limited and if additional screening or testing is recommended it will not be considered to be part of the one time exam.

Here’s what to expect at your Welcome Exam:

  • Your height and weight will me measured to determine your BMI
  • Your blood pressure will be measured
  • Your vision will be checked (basic exam)
  • The doctor will review your medical history
  • Referrals will be given if any additional testing is required

As you can see, this is merely a cursory visit. This visit is more of a fact finding exercise for your doctor to recommend lifestyle changes or additional testing. You will not be required to pay the Part B deductible, but if you are enrolled in original Medicare you will be required to pay 20%.


Yearly Medicare wellness visit

If you have had Part B longer than 12 months you can schedule a yearly wellness visit. The Medicare yearly wellness visit is not much different from the Welcome to Medicare visit. This visit is designed to update a personalized plan based on your current health in order to prevent disease and keep you healthy.

If your doctor accepts Medicare assignment, you will not have to pay for your yearly wellness visit. But, if additional tests or services are required during the same visit that are not covered as preventative benefits, you may have to pay the Part B deductible and 20% coinsurance.

If you are insured through a Medigap policy (depending on the plan) you may not have any out-of-pocket expense for additional services, as the Medigap policy will pay your share. In the event that you are enrolled in a Medicare Advantage plan, you should check the plan’s Summary of Benefits to determine if you will incur any costs for additional services.

It’s good to know what is covered and what is not covered for both the Welcome to Medicare Exam and the Medicare Yearly Wellness Exam so you can be prepared for any additional expenses. So if you are new to Medicare, get the ball rolling and schedule your first exam.

 

3 comments

  1. My only caution is that the Annual Wellness Visit (AWV) is NOT a physical exam. The intro to Medicare does much more “physical” type stuff than does the AWV. The only things done similar to a physical during the AWV is height, weight, and vital signs.

  2. I am looking for cost of coverage that would help pay for my prescriptions and pay toward my deductable for any operations I might require in the future.
    I now have AARP Medicare Complete thru United Health Care.

  3. Wayne, I would speak with an agent who is familiar with plans available in your area.

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