Original Medicare doesn’t cover annual exams, but it does cover a one-time Welcome to Medicare visit, as well as annual wellness visits. Some Medicare Advantage plans cover annual checkups.
What preventive visits does Original Medicare cover?
However, annual examinations are not covered by Medicare, Medicare Part B covers two types of preventive visits:
During your first year Medicareyou are eligible for a Welcome to Medicare preventive visit.
After you’ve been on Medicare for a full 12 months, you’ll be paid for annual wellness visits (which aren’t the same as a full physical exam).
What is a Welcome to Medicare preventive visit?
A “Welcome to Medicare” preventive visit involves taking your medical (and health-related social) history along with some basic measurements, tests, and services, including:
Measurement of blood pressure.
Height, weight and body mass index.
Pneumococcal and influenza vaccines.
Several medical examinations and referral for necessary treatment.
Depression risk assessment.
Discussion of advance directives, if desired.
A written plan detailing which screenings, vaccinations, and other preventive services are right for you.
Be sure to let your doctor know that the appointment is specifically for a Welcome to Medicare visit so that the staff can file your application properly and you will be covered.
To prepare for your Welcome to Medicare visit, bring a list of any prescription, over-the-counter, nutritional supplements, and vitamins you take, along with your medical records and immunization records, and your family’s health history , if you have access to them. information.
How much does a Welcome to Medicare visit cost?
The Welcome to Medicare introductory visit is free and has no copay as long as your provider accepts the Medicare designation—and the visit is not subject to the Part B deductible.
Keep in mind, however, that if your doctor performs additional Medicare-approved tests or services that are not included in the Welcome to Medicare visit, you may be responsible for your Part B deductible and/or coinsurance. If your doctor recommends or performs services more often than Medicare allows, or that are not covered by Medicare at all during that visit, you may be responsible for some or all of those costs.
What is a Medicare annual wellness visit?
An annual wellness visit is designed to create or update an individualized health plan that can help you prevent or manage illness and disability. This visit should not be confused with a physical examination, which includes a physical examination of the head, neck, lungs, neurological and abdominal cavity, as well as taking blood and urine samples, checking vital signs and reflexes, and assessing risk factors for disease.
A Medicare annual wellness visit includes:
Questionnaire for health risk assessment.
Routine measurements including height, weight and blood pressure.
Review your current prescriptions and healthcare providers.
A review of your medical and family history.
Cognitive assessment to detect Alzheimer’s disease and other forms of dementia.
Schedule of recommended preventive examinations, vaccines and services.
A list of your risk factors and treatment options.
Specific personal health tips.
In addition, if you are currently using prescription opioids, you will be assessed for your risk of opioid use disorder and your pain management and treatment plan will be reviewed. You will be provided with non-opioid alternative therapies and, if necessary, referred to treatment for substance use disorders.
How much does an annual Medicare wellness visit cost?
Your health care visit should be free as long as your health care provider accepts a Medicare prescription. There is no co-pay for annual wellness visits and the Part B deductible does not apply.
However, as with Welcome to Medicare visits, if your doctor performs additional services and tests during your appointment that Medicare does not cover in full or at all, you will be responsible for those costs. Let your provider’s office know that you are scheduling a Medicare wellness visit rather than an annual checkup to avoid getting an unexpected bill.
Are annual checkups covered by Medicare Advantage?
Medicare Advantage plans is required to provide the same level of coverage as Original Medicare, so you will be covered for your introductory visit and annual wellness visits. Because Medicare Advantage plans are offered through private health insurance companies, any additional coverage, as well as specific copays, deductibles, and coinsurance will vary.
A number of Medicare Advantage plans cover annual physicals, some with a $0 copay. Always read plan details and provider networks carefully and compare benefits to make sure you choose the Medicare Advantage plan that’s right for you.
If you have more questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).