Though Medicare doesn’t pay for the type of comprehensive exam that most people think of as a “physical,” it does cover a one-time Welcome to Medicare checkup during your first year after enrolling in Part B. After that, it covers annual wellness visits scheduled to keep track of your health.
Medicare defines a routine physical exam as one that’s performed without a relationship to treatment or diagnosis of a specific illness, symptom, complaint or injury.
Federal law specifically prohibits Medicare from covering routine physical exams. However, Medicare coverage has expanded to pay for the following checkups and preventive care in specific circumstances:
- The one-time Welcome to Medicare checkup, introduced in 2005, is covered in the first 12 months after signing up for Medicare Part B.
- Medicare covers an annual wellness visit every 12 months after your first year with Medicare Part B. This annual visit was added to Medicare Part B coverage by the Affordable Care Act and became available without deductibles or copayments starting in 2011.
- Coverage for several preventive services without any out-of-pocket costs also was added through the Affordable Care Act, including many screenings and vaccines. You may need to meet age or risk requirements for some of these services to be covered.
How is a physical different from Medicare’s wellness exam?
In an annual physical, a doctor examines you, may do bloodwork and other tests and looks for problems even though you don’t have a specific complaint or risk.
The Welcome to Medicare checkup and annual wellness visit focus more on preventive care. Your doctor can review your risk factors, develop a personalized health plan for you, check that you’re up to date with preventive tests such as cancer screenings and flu shots and may refer you for other tests. The items included in the two types of visits are slightly different.
The Welcome to Medicare checkup is an introduction to Medicare and its covered benefits and focuses on health promotion, disease prevention and detection to help you stay well. It’s an opportunity for your doctor to assess your health and provide a plan for care. Your doctor may do the following during this visit:
- Ask about your personal and family health history.
- Assess your potential for depression.
- Calculate your body mass index (BMI) and document your blood pressure, height and weight.
- Check risk factors that could indicate serious illnesses.
- Determine your ability to function independently and your level of safety, such as how well you perform activities of daily living and your risk of falls.
- Offer to talk about advance directives, such as a health care proxy that lets you designate someone else to make medical decisions on your behalf if you can’t. They could cover a living will that specifies your preferences for medical treatment at the end of your life.
- Provide a simple vision test.
- Recommend tests, screenings and other preventive services that you may need to stay healthy.
- Review any current opioid prescriptions and screen for potential substance use disorders.