Does Medicare Cover Annual Physicals?
Key Takeaways
- Medicare covers an Initial Preventive Physical Examination for all new beneficiaries within the first 12 months of joining Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. .
- Medicare does not cover yearly physical exams but does cover a yearly checkup called the annual wellness visit.
- Medicare also includes additional health planning, such as advance care planning and a health risk assessment that are a part of the annual wellness visit.
Does Medicare Pay For Yearly Physical Exams?
A routine physical exam is a procedure, often performed annually, which allows your physician to assess your general health. While most private insurance plans cover yearly physicals, Medicare Part B does not cover a traditional annual physical exam. Instead, Medicare Part B covers a one-time exam called an Initial Preventive Physical Examination (IPPE), as well as an annual wellness visit.
Medicare’s IPPE is a “Welcome to Medicare” preventive visit that is covered one time, within the first 12 months of receiving Medicare Part B coverage. During the physical exam, your doctor will cover the following components to assess your overall health:
- personal medical history
- family medical history
- current medications and supplements, including opioid prescriptions
- dietary habits
- physical activity level and activities
- alcohol, tobacco or drug use
- depression risk factors
- functional ability to perform daily activities
- safety level, including fall risk, hearing impairment and home safety
- physical exam, including height, weight, Body Mass Index (BMI) and blood pressure
- end-of-life planning
- substance use disorder screening
Medicare completely covers the cost of this initial physical exam as long as your doctor accepts Medicare assignment, which means that you will owe nothing out-of-pocket for this service. However, if you receive additional services or testing during your IPPE, you may owe coinsurance or a deductible for these services.[i] If your doctor has recommended that you undergo additional testing, they will write you a referral for these services so that your Medicare Part B plan can cover them.[i]
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Does Medicare Part B Cover Annual Physical Exams?
Medicare Part B does not cover traditional annual physical exams. However, Medicare does cover a yearly service called an annual wellness visit (AWV). At your first AWV, your doctor will cover many of the same components as your IPPE, including:[i]
- personal medical history
- family medical history
- current medications and supplements
- current medical and mental health providers
- height, weight, BMI and blood pressure
- cognitive function assessment
- depression risk
- functional ability
- personal safety level
- substance use disorder screening
Your AWV also includes a questionnaire called a health risk assessment, which helps your physician collect more information about lifestyle and health risks. Generally, the health risk assessment takes less than 30 minutes and covers a variety of topics, including:
- depression, stress, anger, social activity, pain and fatigue levels
- tobacco and alcohol use
- physical activity levels
- general nutrition habits
- sexual health
- home and auto safety
- ability to perform personal activities, such as getting dressed and eating food
- daily living activities, such as laundry, grocery shopping and finances
Medicare Part B covers the full cost of your AWV once every 12 months, which means that you will not owe any copayments, coinsurance or deductibles for this yearly service. If your doctor chooses to perform any additional services or testing, however, you may be responsible for these costs out-of-pocket.
What is the Difference Between a Medicare Wellness Exam and a Physical?
Medicare’s wellness exam includes a handful of the elements that may be found in a standard physical exam, such as a review of your health history and a brief review of your physical health, including height, weight and blood pressure. However, Medicare’s AWV does not include a full physical workup or additional services or lab testing, like a yearly physical might.
Ultimately, the focus of Medicare’s AWV is to review your health history and current lifestyle habits to determine your overall disease risk and help you plan for your future.
When did Medicare stop paying for annual physicals?
Since the introduction of Medicare in 1965, Medicare Part B has never paid for annual physical exams. In fact, it wasn’t until 2011 that Medicare expanded their preventive services to include the AWV for all beneficiaries.[i]
However, since 2003, some Medicare Advantage plans have offered additional services above and beyond those covered by Medicare Parts A and B — including yearly physical examinations for covered beneficiaries.[i]
Do I need a referral to schedule my IPPE or AWV?
Since your annual visit will most likely be performed by your primary care physician, you do not need a referral to schedule your IPPE or AWV. However, these services are only covered by Medicare if your provider accepts assignment. If you do not have a primary care physician, Medicare will still cover your AWV as long as the provider you go to accepts Medicare assignment.
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Sources
- “Welcome to Medicare” preventive visit. Medicare.gov.
- Diagnostic laboratory tests. Medicare.gov.
- Yearly “Wellness” visits. Medicare.gov.
- Advance care planning. Medicare.gov.
- CMS TO EXPAND MEDICARE PREVENTIVE SERVICES AND IMPROVE ACCESS TO PRIMARY CARE IN 2011. CMS.gov.
- Health Plans – General Information. CMS.gov.
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