Medicare covers annual wellness visits but does not cover routine physicals. The AWV is available to all Medicare enrollees after their first 12 months of coverage and then once every year. The AWV includes a review of your health history, risk assessments and a plan to prevent future illness, but it doesn’t involve the kind of “physical” exam where the doctor touches you, obtains blood work or runs diagnostic tests. Since the AWV focuses on prevention, copays and deductibles do not apply. However, some doctors may combine the AWV with diagnostic services that address specific health concerns. These are not part of the AWV and are subject to the Part B deductible and copays.

An ABN is a form that a health professional gives you to read and sign before a treatment or service is provided because they believe Medicare might not cover the prescribed or requested service. By signing the ABN, you are agreeing to pay for the service yourself if Medicare doesn’t cover it. The notice describes the service, an estimate of how much it will cost, and why your doctor thinks Medicare won’t pay for it. You can still ask your doctor to send a bill to Medicare, even after signing an ABN, to see if Medicare will pay. If the claim is denied, you can appeal. ABNs are only for people in original Medicare. Medicare Advantage plans handle coverage decisions through their own process.

Your primary insurance pays first. If your spouse’s employer has 20 or more employees, the job-based plan will be your primary coverage. If the employer plan has fewer than 20 employees, Medicare will be your primary payer and the work insurance will pay second. If you are unsure of the insurance plans connected to your Medicare account, log in to your medicare.gov account and check under the Profile symbol to see all the insurance plans linked to your Medicare number, or call the Benefits Coordination & Recovery Center at 855-798-2627.

Yes, if you’re enrolled in either a Medicare Part D drug plan or a Medicare Advantage plan with drug coverage you won’t have to pay more than $2,000 out-of-pocket for covered prescription drugs in 2025. Only the costs of covered drugs (drugs listed on your plan’s formulary) count toward the $2,000 cap. Monthly plan premiums, over-the-counter drugs and the cost of drugs not covered by your plan do not count toward the limit. Some drugs, such as those given in a doctor’s office or outpatient center (cancer treatments or injectables), are covered by Medicare Part B and their costs won’t count toward the Part D drug cap.