Medicare Annual Wellness Visit vs. a physical
Many people book their "free Medicare physical" and are surprised by what happens, or by a bill. Medicare covers a yearly Wellness visit to plan your prevention, not a head-to-toe exam. Here is what each visit is, from Medicare's own pages.
| Visit | How often | What it includes | What you pay |
|---|---|---|---|
| "Welcome to Medicare" visit | Once, in your first 12 months of Part B | History review, BMI, a simple vision test, depression risk, a written checklist of screenings and vaccines | Nothing if your provider accepts assignment |
| Yearly Wellness visit | Once every 12 months, after the first year | Health risk questionnaire, height, weight and blood pressure, a cognitive check, an updated prevention plan | Nothing if your provider accepts assignment |
| Routine physical exam | Not a Medicare benefit | A hands-on exam; depends on the doctor | Original Medicare does not cover it; you may pay the full amount |
The yearly Wellness visit
Part B covers it "once every 12 months." Medicare calls it "a conversation-based visit with your doctor or other health care provider to create a prevention plan," and says plainly: "It isn't a routine physical exam." (Medicare.gov)
You fill out a questionnaire called a "Health Risk Assessment." Then, according to Medicare, your provider will: (Medicare.gov)
- take routine measurements "like height, weight, and blood pressure";
- review your medical and family history and your current prescriptions;
- do a cognitive assessment "to look for signs of dementia, including Alzheimer's disease" (what these checks involve: memory screening with the Mini-Cog and MoCA);
- look at risk factors for substance use disorder;
- offer to talk about advance directives;
- give you "a written plan (like a checklist)" of the screenings, vaccines and other preventive services you need;
- order other tests "if necessary, depending on your general health and medical history."
The first yearly visit "can't take place within 12 months of your Part B enrollment" or of your Welcome to Medicare visit. You do not need the Welcome visit first. (Medicare.gov)
If your provider asks about falls or balance, see fall risk screening: questions, tests and results.
The "Welcome to Medicare" visit
This is a one-time visit "within the first 12 months you have Part B." Medicare says it "isn't a comprehensive physical exam." It covers your medical and social history, BMI, "a simple vision test," a review of depression risk, information about screenings and vaccines, and the same kind of written checklist. (Medicare.gov) Medicare suggests bringing medical and immunization records, your family health history, and a list of every medicine and supplement you take. (Medicare.gov)
Where a routine physical fits
Medicare.gov lists "routine physical exams" among the items and services Original Medicare does not cover. It notes that plans such as Medicare Advantage (Part C) "may cover some extra benefits that Original Medicare doesn't cover," so if you have one, ask your plan whether it covers a routine physical. (Medicare.gov)
Why a "free" visit can come with a bill
For both visits, you pay nothing "if your provider accepts assignment," and the Part B deductible does not apply. But Medicare warns that coinsurance and the deductible may apply "if your provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit," and that for services Medicare does not cover, "like a routine physical exam," you may pay the full amount. (Medicare.gov) Medicare also suggests a separate appointment for specific health concerns, so the Wellness visit "stays focused on prevention." (Medicare.gov)
When you book, say you want the yearly Wellness visit (or the Welcome to Medicare visit). If something extra is suggested during the visit, ask whether it is covered before it is done.
What goes on your checklist
The written plan lists the screenings you are due for. For every screening Medicare covers, with who qualifies, how often and the cost, see the Medicare preventive screenings list. For the screenings recommended after 65, and what Medicare pays for each, see preventive screenings for older adults and preventive screenings covered by insurance and Medicare. For the tests a doctor often orders at a checkup, see what tests are in an annual physical. You can also build your own screening plan and bring it along.
Questions people ask
Does Medicare pay for an annual physical?
Original Medicare (Part A and Part B) does not. Medicare.gov lists "routine physical exams" among the services it does not cover. What it covers instead is a yearly Wellness visit, which Medicare describes as a "conversation-based visit" to make a prevention plan.
Is the Annual Wellness Visit the same as a physical?
No. Medicare says the yearly Wellness visit "isn't a routine physical exam." It includes routine measurements such as height, weight and blood pressure, but the focus is a questionnaire, a review of your history and medicines, a memory check, and a written list of the screenings and vaccines you need.
Why did I get a bill after my free Medicare wellness visit?
The visit itself costs nothing if your provider accepts assignment. But if the provider does other tests or services during the same visit that this benefit does not cover, coinsurance and the Part B deductible may apply, and for things Medicare does not cover at all, such as a routine physical, you may pay the full amount.
Do I need the Welcome to Medicare visit before my first wellness visit?
No. Medicare says you "don't need to have had" the Welcome visit to get a yearly Wellness visit. The first yearly visit cannot be within 12 months of starting Part B or of your Welcome visit.
Can I bring up a health problem at the wellness visit?
Medicare suggests booking a separate appointment for specific concerns "so your Wellness visit stays focused on prevention." A problem visit is billed under your regular Part B coverage.