Medicare's coverage for annual physical exams?
In the complex world of medical insurance, understanding Medicare coverage for preventive and physical examinations is crucial for seniors. Here's what you need to know.
Firstly, it's important to clarify that Medicare **does not cover routine annual physical exams** beyond the Initial Preventive Physical Examination (IPPE, also known as the "Welcome to Medicare" visit) and the Annual Wellness Visits (AWV). These services are focused on preventive health planning rather than comprehensive physical exams.
The IPPE is a one-time preventive visit during the first 12 months of Medicare Part B enrollment. This visit includes medical history reviews, preventive services education, social health history reviews, and is free, as long as the healthcare professional performing the exam accepts the assignment.
The Annual Wellness Visits (AWV), on the other hand, are yearly visits aimed at developing or updating a personalized prevention plan. During an AWV, a doctor may set up a personal prevention plan, complete a health risk assessment, and update a personalized protection plan. Medicare Part B covers these visits at no extra cost, provided the medical professional accepts the assignment.
However, if you want a traditional annual physical exam beyond these Medicare-covered preventive visits, it is usually considered a diagnostic or non-covered service by Medicare. Therefore, you will likely be responsible for out-of-pocket costs for such exams under Medicare Part B. These costs often include a coinsurance of 20% after meeting the yearly deductible (which is $257 in 2025 for most people).
It's worth noting that Original Medicare has no annual out-of-pocket maximum for services not covered, which means you could potentially face full charges if a service is not covered at all.
Healthcare professionals who can perform an AWV include physicians, nurse practitioners, certified clinical nurse specialists, physician assistants, health educators, registered dietitians, or other health professionals under a doctor's supervision.
To avoid unwanted personal costs, a person should specify the type of appointment they require when scheduling an AWV. If a healthcare professional includes additional services in the bill they send to Medicare, an individual may have to pay applicable payments, copayments, or deductibles.
For more resources to help navigate the complex world of medical insurance, visit the Medicare hub. If a person is unsure whether their plan will cover a specific test or service, they should contact Medicare at 800-633-4227 or visit Medicare.gov.
In conclusion, while Medicare covers preventive visits aimed at wellness and risk assessment, it does not cover routine comprehensive physical exams annually. If you pursue an annual physical exam outside of Medicare’s preventive coverage, expect to pay significant out-of-pocket expenses, including deductible and coinsurance, or full charges if not covered at all.
- In the complex world of medical insurance, seniors need to understand that Medicare does not cover routine annual physical exams beyond the Initial Preventative Physical Examination (IPPE) and the Annual Wellness Visits (AWV).
- The Annual Wellness Visits (AWV) are aimed at developing or updating a personalized prevention plan and are covered by Medicare Part B at no extra cost, as long as the healthcare professional performing the exam accepts the assignment.
- If you want a traditional annual physical exam beyond these Medicare-covered preventive visits, it is usually considered a diagnostic or non-covered service by Medicare, therefore, you will likely be responsible for out-of-pocket costs under Medicare Part B.
- Healthcare professionals who can perform an AWV include physicians, nurse practitioners, certified clinical nurse specialists, physician assistants, health educators, registered dietitians, or other health professionals under a doctor's supervision.
