Medicare does not pay for the type of comprehensive exam that most people think of as a “physical.” But it does cover a one-time “Welcome to Medicare” checkup during your first year after enrolling in Part B and, later on, an annual wellness visit that is intended to keep track of your health.
The initial “Welcome to Medicare” visit with your doctor aims to establish the state of your health when you enter the program and provide a plan of future care. During the visit, the doctor will record your vital information (height, weight, blood pressure, body mass); review your personal and family health history; check risk factors that could indicate future serious illnesses; recommend tests and screenings that could catch medical issues early and provide a checklist of preventive services (such as mammograms and vaccinations) to help you stay healthy; offer you the option of discussing end-of-life issues, including information on how to make advance directives that you could use to name someone who would make medical decisions on your behalf if you became too ill to make them yourself; and provide counseling and referrals as appropriate.
During an annual wellness visit, the doctor measures your height, weight, body mass and blood pressure, and may listen to your heart through your clothes. The rest is a discussion of your own and your family’s medical history, any physical or mental impairments, and risk factors for potential diseases such as diabetes and depression. The visit provides a snapshot of your current health as a baseline for future yearly visits, and is intended as a preventive service — a way of catching potentially serious health issues early. Your doctor can develop a personalized health plan for you, check that you are up to date with preventive tests such as cancer screenings and flu shots, and may refer you for some tests, many of which Medicare provides for free.
Both services are optional. You do not need to have had a “Welcome to Medicare” checkup to qualify for later wellness visits, but Medicare won’t pay for a wellness visit during your first 12 months in Part B.
Both services are free of charge (no deductible, no copay) if the following conditions are met:
If you’re enrolled in the original Medicare program: You need to go to a doctor who accepts “assignment” — meaning that he or she accepts the Medicare-approved payment as full compensation.
If you’re enrolled in a Medicare Advantage plan (such as an HMO or PPO), you need to go to a doctor in the plan’s provider network.
But make sure that you ask specifically for either of these services by name. If you ask for a “physical,” Medicare will not cover it and you’ll be responsible for whatever the doctor charges — which could amount to hundreds of dollars.