Does Medicare Cover Physicals?

Medicare covers yearly Wellness visits under specific conditions, but beneficiaries must navigate important limits regarding traditional physical exams. Understanding these nuances is crucial for maximizing your Medicare benefits.

Navigating Medicare’s coverage of physicals can be complex, especially when distinguishing between the covered yearly Wellness visits and traditional physical exams that are not included. Many beneficiaries may not realize that while these Wellness visits are designed to promote preventive care at no cost, there are strict eligibility rules and limitations that can affect access, making it essential to understand the specifics to fully utilize these benefits.

Understanding Medicare Part B Coverage for Wellness Visits

Eligibility for Yearly Wellness Visits

To qualify for a yearly Wellness visit, you must have Medicare Part B in effect. This visit can be scheduled once every 12 months, but your first yearly Wellness visit cannot occur within 12 months of your Part B enrollment. Importantly, you do not need to have had a Welcome to Medicare preventive visit to be eligible for the yearly Wellness visit.

Components of the Yearly Wellness Visit

The yearly Wellness visit is designed to develop or update a personalized prevention plan tailored to your health needs. During this visit, routine measurements such as height, weight, and blood pressure are taken, and a cognitive assessment is performed to identify any signs of cognitive impairment. Additionally, there may be an optional Social Determinants of Health Risk Assessment to better understand your social needs and their impact on your health.

Cost Implications for Medicare Beneficiaries

No-Cost Wellness Visits

If your doctor accepts assignment, you will pay nothing for the yearly Wellness visit. Generally, beneficiaries incur no costs for the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) when the clinician accepts Medicare assignment; however, standard Part B cost-sharing may apply to additional tests that are not part of the wellness visit.

Medicare Advantage Plans and Costs

Many Medicare Advantage plans may waive copays and deductibles for wellness visits, making these preventive services even more accessible. Additionally, various preventive tests associated with wellness visits may also be covered without incurring extra costs.

Key Exceptions to Medicare Coverage

Limitations on Physical Exams

It’s crucial to understand that the yearly Wellness visit is not classified as a physical exam. Medicare does not cover traditional head-to-toe annual physical exams, and an Annual Wellness Visit cannot be billed if it occurs within 12 months of a previous AWV.

One-Time Initial Preventive Physical Examination

The Initial Preventive Physical Examination (IPPE) is a one-time benefit available only to new beneficiaries within the first 12 months of enrolling in Medicare Part B. After this initial period, the IPPE cannot be billed or covered again.

Eligibility Criteria for Medicare Wellness Visits

Timing and Frequency of Visits

Beneficiaries become eligible for an Annual Wellness Visit after they have had Medicare Part B for more than 12 months. It is important to wait at least 12 months between wellness visits to comply with Medicare’s eligibility rules.

Recent Updates to Medicare Wellness Visit Policies

Changes from the Affordable Care Act

The Affordable Care Act significantly expanded access to preventive services under Medicare, ensuring that wellness visits remain a core, no-cost benefit. As of 2026, these visits continue to be covered without deductibles or copayments when assignment is accepted.

Ongoing Coverage Confirmation

The Centers for Medicare & Medicaid Services (CMS) maintains clear definitions and coverage rules for different types of Medicare physical exams. The 2026 Medicare & You handbook reaffirms the continued coverage of yearly wellness visits, ensuring beneficiaries have access to these essential preventive services.

Practical Tips for Maximizing Medicare Wellness Visits

Preparing for Your Wellness Visit

To avoid out-of-pocket costs, ensure that your provider accepts Medicare assignment when scheduling your yearly Wellness visit. It’s also important to book your appointment at least 12 months after your last wellness visit and specifically request a Medicare ‘Annual Wellness Visit’ rather than a ‘physical’ to ensure proper billing.

Understanding Covered Services

Before your visit, confirm which services will be covered as preventive. It’s wise to ask your provider about any potential additional charges for services that may not be included in the wellness visit.

Navigating Medicare Wellness Visits for Better Health Outcomes

Utilizing Medicare’s Wellness benefits is essential for maintaining health and preventing disease, as these visits are covered at no cost when eligibility criteria are met. By focusing on prevention and risk assessment rather than traditional physical exams, beneficiaries can take proactive steps toward better health outcomes while staying informed about updates to maximize their Medicare benefits.