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Does Medicare Cover Annual Physicals?

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Medicare covers an annual wellness visit, but it does not cover a full physical exam. Confused? You’re not alone.

What’s the difference? In this MedicareWire article, we’ll explain the difference between an annual wellness visit and a full physical, as well as how Medicare covers them.

Key Takeaways

  • Medicare’s annual wellness visits are done to provide your doctor with a general understanding of your current health.
  • An annual physical is more in-depth than annual wellness visits, checking every aspect of your health to diagnose potential health problems.
  • In addition to the annual wellness visit, Medicare fully covers the cost of many preventive care services that you require.
  • If your doctor determines that you need a full physical exam, Medicare will not cover the $10 to $200 cost for the service.

Annual Wellness Visit vs. Annual Physical

During a Medicare annual wellness visit, your doctor’s office will conduct routine measurements of your height, weight, body mass index (BMI), and blood pressure. They will also go over your personal medical history, family medical history, and risk factors for preventable diseases. An annual physical exam is more extensive.1Medicare.gov, “Yearly ‘Wellness’ visits“, Accessed December 2, 2021

In addition to what’s covered on a wellness visit, an annual physical generally includes a vital signs check, lung exam, head and neck exam, and a check of your reflexes. A physical exam helps your healthcare provider discover potential health issues before they become full-blown diseases.2Adena.org, “Annual Physicals“, Accessed December 2, 2021

The purpose of Medicare’s annual wellness visit is to paint a picture of your current state of health and to create a baseline for future treatment options. Additional tests or lab work that may be required because of the findings of your annual wellness visit are billed separately by your doctor.1Medicare.gov, “Yearly ‘Wellness’ visits“, Accessed December 2, 2021

Additional Tests Covered By Medicare

Medicare Part B covers many other preventive services at no cost such as cancer screenings, bone density measurements, and flu shots. In addition to the yearly wellness visit, here are the services your healthcare providers can have covered for you by Medicare Part B:3Medicare.gov, “Preventive & screening services“, Accessed December 2, 2021

  • Abdominal aortic aneurysm screening
  • Alcohol misuse screenings & counseling
  • Bone mass measurements (bone density)
  • Cardiovascular disease screenings
  • Cardiovascular disease (behavioral therapy)
  • Cervical & vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screenings
  • Diabetes screenings
  • Diabetes self-management training
  • Glaucoma tests
  • Hepatitis B Virus (HBV) infection screening
  • Hepatitis C screening test
  • HIV screening
  • Lung cancer screening
  • Mammograms (screening)
  • Nutrition therapy services
  • Obesity screenings & counseling
  • One-time “Welcome to Medicare” preventive visit
  • Prostate cancer screenings
  • Sexually transmitted infections screening & counseling
  • Shots:
    • COVID-19 vaccines
    • Flu shots
    • Hepatitis B shots
    • Pneumococcal shots
  • Tobacco use cessation counseling

How Do I Get a Full Yearly Physical Exam?

Consult with your doctor about getting an annual physical. It is likely your doctor will check up on your health history and may recommend some of the covered services listed above, but most healthy people will not benefit from a full physical every year. Should your doctor decide to order a full physical examination for you, you can expect the cost to range from $10 to $200 since Medicare coverage will not apply.4Heritageucpc.com, “Annual Physical Exam Cost“, Accessed December 2, 2021

Summary

Unfortunately, if you wanted Medicare to cover a full annual physical for you, that is not the case. However, Medicare will absolutely cover an annual wellness visit for you, as well as a plethora of other preventive screenings, tests, shots, and services that you need. Talk with your doctor about your health and they can help you get the health risk assessments you need to monitor and maintain your overall health.

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