A recent conversation with a friend new to Medicare revealed confusion about whether Medicare covers annual physical exams. Despite common belief, Medicare does not cover traditional annual physical examinations, as mandated by the Social Security Act. However, the friend found information on the HHS.gov website stating that Medicare does cover physical exams, leading to further confusion.
The Affordable Care Act introduced the Initial Preventive Physical Examination as a covered preventive service for individuals with Medicare. This service, also known as the Welcome to Medicare visit, is more of a review of medical and social history with counseling about preventive services rather than a traditional physical exam. It is intended to be a one-time visit within the first 12 months of Part B enrollment.
In addition to the Welcome to Medicare visit, Medicare also offers an annual Medicare Wellness Visit. This visit is not a physical exam but is meant to update the personalized prevention plan for each individual. It includes a review of medical and family history, routine measurements, and health advice to help beneficiaries stay healthy.
Both of these visits include planning for screenings, vaccinations, and other preventive services such as flu and COVID vaccinations, mammograms, and colonoscopies. Most preventive services under Medicare are covered with no cost sharing, allowing beneficiaries to access necessary healthcare services without breaking the bank.
It is important for individuals on Medicare to understand the differences between the two wellness visits and traditional physical exams. While the welcome and annual wellness visits are covered with no cost sharing, any additional medical issues addressed during these visits may result in cost sharing for the beneficiary. It is important to see providers who accept Medicare assignment or schedule appointments with in-network physicians if you have a Medicare Advantage plan. Additionally, it is crucial to verify coverage before proceeding with any healthcare services.
Ultimately, individuals on Medicare can still receive physical exams, but they may have to pay for certain components of the exam. Some Medicare Advantage plans may offer routine physical exams as part of their coverage, so it is important to review the plan’s Evidence of Coverage for more information. It is essential to understand the coverage provided by Medicare and any supplemental insurance plans in order to make informed decisions about healthcare services.
