Medicare covers many preventive services. However, it does not typically cover annual physical exams.
Medicare primarily covers healthcare services to diagnose and treat medical conditions.
At times, Medicare also covers preventive services, such as annual wellness visits. However, it does not usually cover other types of visits, like annual physical exams.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
A person is eligible for one initial preventive physical examination (IPPE), also known as a Welcome to Medicare physical exam, within the first 12 months of enrolling in Medicare Part B.
Medicare enrollment typically begins when a person turns 65 years old. People may qualify at an earlier age if they have specific disabilities or health conditions, according to the Centers for Medicare & Medicaid Services (CMS).
Some of the tests that the IPPE includes are:
- medical history reviews
- preventive services education
- social health history reviews
This medical exam is free, as long as the healthcare professional performing the exam accepts the assignment. This means that they:
- accept payment directly from Medicare
- agree to receive no more compensation than the Medicare preapproved amount
- agree not to bill a person for any more than the deductible and coinsurance
Medicare Part B also covers annual wellness visits (AWV) at no extra cost, providing the medical professional accepts the assignment.
The following are the types of healthcare professionals who can perform an AWV:
- physician or doctor
- nurse practitioner, certified clinical nurse specialist, or physician assistant
- health educator, registered dietitian, or other health professionals whom a doctor directly supervises
Medicare covers an AWV once every 12 months. The services that a doctor may perform include:
- setting up a personal prevention plan
- completing a health risk assessment
- updating a personalized protection plan
Medicare Part B also covers some other preventive services. Examples include:
- bone mass measurements
- colorectal cancer screening
- depression screening
- diabetes screening
- glaucoma screening
- medical nutrition therapy
- prostate cancer screening
- breast cancer screening
An AWV does not include lab tests or electrocardiograms, but a healthcare professional may perform these or other tests during the same visit. If the doctor includes additional services in the bill they send to Medicare, an individual may have to pay any applicable payments, copayments, or deductibles.
If a person wishes to know whether Medicare covers a particular test or service, they should contact Medicare at 800-633-4227 or go to Medicare.gov.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare has specific rules for preventive care, including what tests the coverage includes and excludes.
Medicare covers one IPPE within someone’s first year of Part B coverage. Medicare also covers one AWV each year.
When a person schedules an AWV, they should specify the type of appointment that they require. This may help them avoid any unwanted personal costs.
If an individual does not know whether their plan will cover their appointment, they should contact Medicare in advance.
