Does Medicare cover annual physical exams? I have gotten a physical every year and would like to find out what Medicare covers when I sign up in a few months.

Medicare will not cover annual physical exams, but it will cover a one-time “Welcome to Medicare” checkup in your first year after enrolling in Part B. Thereafter, Medicare covers yearly wellness visits to keep track of your health. Here is what you should know.

Physical vs Wellness Exam

An annual physical is an overall health check where a doctor examines you, may order blood tests or other diagnostics and checks for health issues, even if you do not have a specific complaint or risk.

In contrast, the Welcome to Medicare checkup and annual wellness visits are centered on preventive care. During these visits, your doctor will review your risk factors, develop your personalized health plan, ensure that you are up to date with preventive tests such as cancer screenings and flu shots and refer you for additional tests if needed. Here is a breakdown of what these exams may include.

Welcome to Medicare Checkup

The Welcome to Medicare checkup is an introduction to Medicare and focuses on health promotion, disease prevention and early detection to maintain your well-being. It gives your doctor the chance to assess your health and provide a plan for care. During this visit your doctor will:

• Record your height, weight, blood pressure measurements to calculate your body mass index (BMI).
• Inquire about personal and family health history.
• Provide referrals for other care as needed.
• Evaluate your risk for depression.
• Conduct a basic vision test.
• Recommend vaccinations, tests, screenings and other preventive services you may need.
• Offer to talk about creating advance directives.

Annual Wellness Visit

This visit includes many of the same components as the Welcome to Medicare checkup. Your doctor will review your medical history, record your vital signs and give you a chance to discuss advance directives. They may also provide the following services:

• Develop a checklist for recommended preventive services for the following year.
• Evaluate health risks and treatment options.
• Perform a cognitive screening to check for early signs of dementia.
• Provide personalized health advice.
• Review your current prescriptions.
• Assess risk factors for opioid problems if you have a prescription for opioids and screen for potential substance use disorders.

Medicare Coverage 

Both the Welcome to Medicare and annual wellness visits are covered by Medicare Part B. To ensure coverage, be sure to ask for the Welcome to Medicare checkup or annual wellness visit when you book the appointment. If not, you may have to pay for the visit. You do not need to complete the Welcome to Medicare visit to qualify for later annual wellness visits. However, keep in mind that Medicare will not pay for a wellness visit during the first 12 months you have Part B. Keep in mind that, at either of these visits, your provider may recommend additional tests or procedures that could incur Medicare’s deductibles, copayments or coinsurance.

If you are enrolled in Medicare Advantage, you will likely need to use an in-network provider for the wellness visits to be covered. Some Medicare Advantage plans also include coverage for annual physicals in addition to the wellness visit. Review your plan for specific details.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of “The Savvy Senior” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.