Medicare is a vital healthcare program, but there’s often confusion about what it covers, including annual physicals.
Does Medicare Cover Annual Physicals?
Many people wonder whether Medicare covers annual physicals. In this article, we’ll clarify the difference between an annual wellness visit and a full physical exam, and we’ll also explain how Medicare and Medicare Supplement Plans can help with the costs.
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 healthcare provider will perform routine measurements like height, weight, BMI, and blood pressure. They will review your medical history, and family history, and assess risk factors for preventable diseases.
However, it’s essential to understand that an annual wellness visit is not as comprehensive as a full physical exam, which includes vital signs, a lung exam, a head and neck examination, and reflex checks. A full physical helps identify potential health issues before they escalate. An annual physical exam is more extensive.1Medicare.gov, “Yearly ‘Wellness’ visits“, Accessed September 26, 2023, 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 September 26, 2021
Medicare Coverage for Preventive Services:
In addition to the yearly wellness visit, Medicare Part B covers a wide range of preventive services at no cost to beneficiaries. These services include cancer screenings, bone density measurements, and flu shots, and much more. Here’s a list of preventive services covered by Medicare Part B:3Medicare.gov, “Preventive & screening services“, Accessed September 26, 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?
If you and your doctor determine that a full annual physical is necessary, you can discuss it during your healthcare visit. It’s important to note that most healthy individuals may not require a full physical every year. However, if your doctor recommends it, be aware that Medicare does not typically cover the cost, which can range from $10 to $200.4Heritageucpc.com, “Annual Physical Exam Cost“, Accessed December 2, 2021
What Medicare Supplement Plans Cover
Medicare Supplements, also known as Medigap plans, can help cover some of the costs that Medicare doesn’t pay. While Medicare covers the annual wellness visit and preventive services, it may not cover the full cost of additional tests or lab work that your doctor may recommend after the visit. Medicare Supplement Plans can help bridge this gap, reducing your out-of-pocket expenses for healthcare.
What Medicare Advantage Plans Cover
Some Medicare Advantage plans cover annual physicals in addition to the wellness visit. At a minimum, all plans must provide all of the same benefits covered by Part A (hospital insurance) and Part B (medical insurance).
Summary
In summary, Medicare does not cover full annual physical exams, but it does cover annual wellness visits and a wide range of preventive services that are crucial for maintaining your health. If you’re concerned about the costs associated with additional tests or lab work, consider enrolling in a Medicare Supplement Plan to help manage those expenses. Ultimately, your doctor can guide you in making the right healthcare decisions based on your individual needs and health history.
By restructuring the article and expanding on the information provided, readers will have a clearer understanding of Medicare’s coverage for annual physicals and the role of Medicare Supplement Plans in managing healthcare costs. Additionally, using subheadings and bullet points can improve the readability of the article.
Citations
- 1Medicare.gov, “Yearly ‘Wellness’ visits“, Accessed September 26, 2021
- 2Adena.org, “Annual Physicals“, Accessed December 2, 2021
- 3Medicare.gov, “Preventive & screening services“, Accessed September 26, 2021
- 4Heritageucpc.com, “Annual Physical Exam Cost“, Accessed December 2, 2021