Annual physicals were the old school way doctors monitored patient health. Today's providers prefer the proactive approach of a yearly wellness visit.
There's a lot to learn when you first enroll in Medicare. You probably already know the fundamental differences between Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and Medicare Part D (prescription drugs). But do you know whether Medicare Part B covers annual physicals?
We'll dive into this topic. But before we answer, "does Medicare pay for annual physicals?" you need to know the differences between Medicare's initial preventive physical examination, Medicare's annual wellness visit, and an annual physical. Knowing the differences between these three types of exams could save you from having a frustrating experience at your doctor's office.
What is an initial preventive physical examination for Medicare?
An initial preventive physical examination (IPPE) is better known as the "Welcome to Medicare" visit. The IPPE is a service provided to those newly enrolled in Medicare. You can schedule this preventive visit once within the first 12 months you are covered by Medicare Part B.
To get the most out of this visit, bring your medical and immunization records, family health history, and a list of prescription drugs, over-the-counter drugs, vitamins, and supplements you currently take.
During the IPPE, your healthcare provider will review your medical and social history related to your health. They will record your height and weight and calculate your body mass index. They will take your blood pressure and give you a simple vision test.
This visit will also include education and counseling about the following services:
- Health screenings
- Flu and pneumococcal shots
- A review of your risk for depression
- A safety review
- A discussion about creating advance directives
At the end of your visit, you will receive a written, personalized prevention plan letting you know which screenings, shots, and other preventive services you need.
Original Medicare (Medicare Parts A & B) will cover 100% of the cost of your Welcome to Medicare visit – as long as your healthcare provider accepts Medicare assignment. The Medicare Part B deductible does not apply to this service.
Again, the IPPE is a one-time opportunity within your first year of having Medicare. In subsequent years, you can schedule an annual wellness visit.
What is an annual wellness visit for Medicare?
The annual wellness visit is very similar to your Welcome to Medicare visit. If you're within your first 12 months with Medicare, you have the IPPE. After that, as the name implies, you get the annual wellness visit once every 12 months.
During your annual wellness visit, your healthcare provider will develop or update your personalized plan to help prevent disease or disability based on your current health and risk factors.
You can schedule your annual wellness visit after you have been enrolled in Medicare Part B for 12 months – or 12 months following your IPPE visit. You are eligible for another annual wellness visit every 12 months.
Your provider will ask you to complete a Health Risk Assessment for this visit. Answering these questions helps your healthcare provider develop a personalized plan to help you stay healthy.
During this visit, your healthcare provider will record routine measurements, including height, weight, and blood pressure. They will review your current prescriptions and perform a cognitive assessment. (If your doctor thinks you may have cognitive impairment, they may recommend that you schedule a separate visit to check for conditions like dementia, depression, anxiety, or delirium.)
Assuming your provider accepts assignment, Original Medicare covers the full cost of your yearly wellness visit with no coinsurance or copay. You also don't have to meet your Medicare Part B deductible before Medicare will pay this service.
What is an annual physical exam?
During an annual physical exam, a healthcare provider such as a doctor or nurse practitioner examines you to look for health problems – even if you don't have a specific complaint or risk factor.
Your physician will check your body for signs of existing health issues using four assessment techniques: observation, palpitation, percussion, and auscultation.
An annual physical also often includes urine and blood tests and a test of motor function and reflexes.
Please understand that if you have unexplained symptoms, you need to request a physical exam from your primary care physician. However, Original Medicare will not cover your physical exam at 100% because an annual physical is considered a diagnostic visit. Medicare only covers preventive services at 100%.
That doesn't mean you don't have coverage for doctor appointments to diagnose issues. It just means you have to schedule the appointment specifically for the issue you're experiencing – not as an annual exam.
Medicare's IPPE and annual wellness visits are preventive healthcare visits. A wellness visit provides a snapshot of your current health to be used as a baseline for future yearly visits.
What you need to know about Medicare and annual physicals
Let's circle back to the original question, "does Medicare pay for annual physicals?" The precise answer to this question is, "No." Original Medicare does not pay for annual physical exams. However, Medicare does provide an annual wellness visit with your physician. The reason is simple: Wellness visits are a proactive way to maintain your health. They set up preventive screenings and monitor your health to take care of any problems early, when they're easier (and cheaper) to treat.
How to schedule your appointments
When you schedule any visit with your primary care physician, you need to be precise with your language and understand the service you will receive.
If you feel fine, schedule an annual wellness visit (or an IPPE if you are new to Medicare). You won't have any out-of-pocket costs for this visit and will learn about preventing disease.
Schedule a physical exam if you have health concerns or feel something might be wrong. When you make the appointment, though, be careful to explain the symptoms you're experiencing.
In other words, don't ask for a yearly checkup. Instead, be specific. Unexpected weight gain? Tell the person making the appointment exactly that. Suddenly getting headaches every other day? Then make your appointment about discovering the cause of your headaches.
Your out-of-pocket costs will depend on the exam and tests required. You may need to pay the Part B deductible ($226 in 2023) plus a minimum 20% coinsurance for Medicare-approved services and outpatient therapies. It's also important to note that original Medicare doesn't have a cap on out-of-pocket costs.
There are two ways to reduce out-of-pocket costs for a physical exam – Medicare Supplement Insurance or Medicare Advantage plans.
More commonly known as Medigap, Medicare Supplement plans help cover your out-of-pocket costs when you have Original Medicare (Parts A and B). Benefits vary, but all Medigap plans cover at least half of your Part B coinsurance.
Medicare Part C (Medicare Advantage) includes Part A and Part B benefits, with most plans also including Part D prescription drug coverage. Around 99% of Medicare Advantage plans also cover dental, hearing, vision, and gym memberships. Talk to your plan provider to see if there's coverage for annual physicals in addition to wellness exams.
Comparing Medicare plans is easy with our Find a Plan tool. Just enter your zip code to review benefits and costs of Medicare plans in your area.