Does Medicare cover a routine complete physical exam?
Medicare will not pay for a routine physical exam, but there are other options such as a Medicare Preventive Visit or an Annual Wellness Visit.
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I recently enrolled in Medicare Parts A and B and will remain in Original Medicare. I have not had health insurance for many years and haven’t seen a doctor in ages. I called a physician’s office and told the receptionist that I would like to make an appointment for a complete physical exam because I haven’t seen a doctor in a long time. She told me that this would not be covered by Medicare. Is she correct?
Still Learning about Medicare
Dear Still Learning,
If you told the doctor’s receptionist that you want a complete head-to-toe physical examination, she is correct. Medicare does not pay for a routine physical exam.
Medicare does, however, cover two types of preventive and wellness visits — a one-time “Welcome to Medicare Preventive Visit” and an “Annual Wellness Visit.”
Welcome to Medicare Preventive Visit: You can get this only within the first 12 months after you are enrolled in Medicare Part B. It typically includes the following:
• Certain screenings, shots and referrals for other care, if needed;
• Height, weight and blood pressure measurements;
• A calculation of your body mass index;
• A simple vision test;
• A review of your potential risk for depression and your level of safety;
• An offer to talk with you about creating advance directives;
• A written plan letting you know which screenings, shots and other preventive services you need.
The visit is a great way to get up to date with your doctor about how to stay healthy. It is not a requirement that you have a “Welcome to Medicare Preventive Visit” to be eligible for “Annual Wellness Visits.”
Annual Wellness Visit: If you have had Medicare Part B for longer than 12 months, you can get this yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. The visit typically includes the following:
• Review of medical and family history by your completion of a questionnaire called a “health risk assessment;”
• A list of current physicians and prescriptions;
• Height, weight, blood pressure and other routine measurements;
• An assessment to detect any cognitive impairment;
• A screening schedule (or checklist) for appropriate preventive services;
• Advance care planning;
• A list of risk factors and treatment options for you.
You pay nothing for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your doctor or other qualified health care provider accepts assignment. Also, the Part B deductible doesn’t apply. However, you may have to pay co-insurance, and the Part B deductible may apply if your doctor or other health care provider performs additional tests or services during the same visit. These additional tests or services aren’t covered under the preventive benefits.
For a guide to the preventive services covered by Medicare, go to medicare.gov/pubs/pdf/10110.pdf or request publication 10110 from: Centers for Medicare & Medicaid Services; 7500 Security Boulevard; Baltimore, MD 21244-1850.
SHINE (Serving Health Insurance Needs of Elders) is an award-winning statewide volunteer program that provides free, unbiased and confidential counseling and information for people on Medicare, their families and caregivers. SHINE is a program of the Florida Department of Elder Affairs and is administered in partnership with the state’s 11 Aging and Disability Resource Centers (ADRCs). In Brevard County, our ADRC is the Senior Resource Alliance, located in Orlando. SL
To contact a SHINE volunteer counselor for confidential and unbiased assistance, call the Elder Helpline toll-free at 1-800-963-5337 or call 321-752-8080 locally. SHINE has 12 counseling locations throughout Brevard County. Counselors can assist you by telephone or in person. To find a SHINE counseling site near you, go to floridaSHINE.org or call the telephone numbers listed above.