Medicare Part B covers one preventive physical exam per year at no cost to you

Medicare Part B pays for an annual wellness visit — a preventive physical that includes a health assessment, screening for chronic conditions, and a plan for follow-up care. You pay nothing for this visit if your doctor accepts Medicare assignment. The visit must happen at a doctor's office or outpatient clinic, not in a hospital emergency room or urgent care center.

This is different from a diagnostic physical, which Medicare covers under different rules. A diagnostic physical happens when you have symptoms or a known condition that needs evaluation. Medicare Part B covers diagnostic visits at 80 percent of the approved amount after you meet your annual deductible — you pay the remaining 20 percent plus any difference between what your doctor charges and what Medicare allows.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower. Medigap plans often cover the 20 percent coinsurance. Medicare Advantage plans vary — some cover preventive physicals with no copay, others charge a small copay, and some require you to use in-network doctors.

Key Takeaways

  • Your annual wellness visit is free under Medicare Part B if your doctor accepts Medicare assignment, with no deductible to meet first.
  • Diagnostic physicals — when you have symptoms or a condition — are covered at 80 percent after your Part B deductible, and you pay 20 percent coinsurance.
  • You must see a doctor who accepts Medicare; if they do not, you may pay the full bill and receive no Medicare reimbursement.
  • Medicare Advantage and Medigap plans change your out-of-pocket costs, so check your plan documents or call your plan before scheduling.
  • The preventive physical does not include certain screenings like routine eye exams or dental cleanings, which have their own coverage rules.

What the annual wellness visit includes

The preventive physical covers a review of your medical history, measurement of height and weight, blood pressure check, and a cognitive assessment. Your doctor will also review your current medications and any supplements you take, screen for depression and cognitive impairment, and discuss preventive services you may need based on your age and risk factors.

The visit includes a personalized prevention plan — a written summary of what screenings, tests, or follow-up care your doctor recommends. This plan is yours to keep and take to other appointments. The visit typically lasts 20 to 30 minutes.

What the annual wellness visit does not include: treatment of an existing condition, lab work beyond what is needed for screening, imaging like X-rays or ultrasounds, or procedures. If your doctor finds something during the physical that needs further testing or treatment, that becomes a separate diagnostic visit with its own coverage rules.

How to schedule and what to bring

Call your primary care doctor's office and ask to schedule your annual wellness visit. Tell them you have Medicare and want to use your one free preventive physical. Some offices call it a "Medicare wellness visit" or "preventive physical" — the name varies, but the coverage is the same.

Bring your Medicare card and any insurance card for a Medigap or Medicare Advantage plan. Bring a list of all medications and supplements you take, including over-the-counter drugs and vitamins. If you have had recent lab work done elsewhere, bring those results so your doctor does not repeat unnecessary tests.

If you have not seen this doctor before, arrive 10 to 15 minutes early to complete new-patient paperwork. Ask the front desk to confirm that your doctor accepts Medicare assignment before you leave — this ensures you will not receive a surprise bill.

The difference between preventive and diagnostic physicals

A preventive physical is scheduled when you are well, to catch problems early. Medicare covers one per year at no cost. It focuses on screening and health planning, not on treating a specific complaint.

A diagnostic physical happens when you have symptoms, a new diagnosis, or a chronic condition that needs evaluation. Your doctor may order lab work, imaging, or other tests as part of the visit. Medicare covers diagnostic physicals at 80 percent after your Part B deductible. You pay 20 percent coinsurance, plus any balance-billing if your doctor does not accept Medicare assignment.

You can have both in the same year — one preventive visit at no cost, and separate diagnostic visits as needed. However, if you schedule a preventive visit and your doctor discovers a problem during that visit, the visit itself remains free, but any follow-up testing or treatment is billed separately under diagnostic rules.

What you pay depends on your plan type

If you have Original Medicare only (Part A and Part B with no supplemental plan), your annual wellness visit costs nothing. Diagnostic physicals cost you 20 percent of the approved amount after you meet your annual Part B deductible, which is $240 in 2024 (this amount changes each year).

If you have a Medigap plan, it typically covers the 20 percent coinsurance on diagnostic visits, so you pay little or nothing. Your preventive visit remains free. Check your plan documents or call your Medigap insurer to confirm what they cover.

If you have a Medicare Advantage plan, costs vary widely. Some plans cover preventive physicals with no copay. Others charge a copay of $10 to $50. Some require you to use in-network doctors or get a referral. Call your plan's member services number before scheduling to learn what you will owe.

What happens if your doctor does not accept Medicare

If your doctor does not accept Medicare assignment, they can charge you the full amount they bill — there is no limit. Medicare will still pay its share (80 percent for diagnostic visits, 100 percent for preventive visits), but you receive the payment as a reimbursement, not a credit at the doctor's office. You must pay the doctor's full bill upfront.

Before your visit, ask the doctor's office whether they accept Medicare assignment. If they do not, ask what they charge for a physical and whether you can receive a written estimate. You can then decide whether to proceed or find a doctor who accepts Medicare.

To find doctors who accept Medicare in your area, use the Medicare Physician Compare tool on Medicare.gov or call 1-800-MEDICARE.

Screenings and tests covered separately

Some screenings are covered under their own Medicare rules, not as part of your annual physical. These include mammograms (once per year for women 40 and older), colorectal cancer screening (starting at age 50), prostate cancer screening for men, and bone density scans for women at risk of osteoporosis. Your doctor may recommend these during your physical, but they are scheduled and billed separately.

Routine eye exams and dental cleanings are not covered by Medicare Part B. Medicare Part A does not cover them either. If you need vision or dental care, you must pay out of pocket or purchase a separate vision or dental plan.

Lab work ordered during your physical — such as blood tests or urinalysis — is covered at 80 percent after your deductible if it is medically necessary. Routine lab work for screening purposes (like cholesterol screening) is often covered at 100 percent with no deductible.

Frequently Asked Questions

Can I have my annual wellness visit and a sick visit in the same year?

Yes. Your one free preventive physical is separate from diagnostic visits. If you get sick or develop a new symptom, you can see your doctor for that problem, and it is billed as a diagnostic visit under the 80 percent coverage rule. You still have your annual wellness visit available.

What if I have not seen a doctor in several years?

You can still schedule your annual wellness visit. There is no requirement to have seen a doctor recently. However, if you are new to a doctor's practice, they may want to do a more thorough initial evaluation, which might be billed as a diagnostic visit instead of a preventive one. Ask the office in advance what to expect.

Does Medicare cover a physical for a job or insurance process?

No. Physicals required for employment, life insurance, or other non-medical purposes are not covered by Medicare. You must pay out of pocket for these. Your annual wellness visit is for your own health assessment, not for third-party requirements.

If my doctor finds something during my free physical, do I have to pay for treatment?

The preventive physical itself remains free. Any follow-up testing, imaging, or treatment is billed separately under diagnostic rules — you pay 20 percent coinsurance after your deductible. Your doctor should discuss this with you before ordering additional tests.

Can I use my annual wellness visit with a telehealth doctor?

Yes, if your doctor offers telehealth visits and accepts Medicare. The coverage rules are the same. However, some telehealth platforms do not accept Medicare, so confirm before scheduling. Call your doctor's office or check their website to see if they offer Medicare-covered virtual visits.