Medicare covers one free yearly physical exam, but only if you have not had one in the past 12 months
Medicare Part B pays for one preventive visit per year at no cost to you — no copay, no coinsurance, no deductible. This visit is called the "Welcome to Medicare" preventive visit if you are new to Medicare, or the "Annual Wellness Visit" if you have had Medicare for more than 12 months. The doctor checks your vital signs, reviews your medical history, and screens for common health problems. You pay nothing out of pocket for this visit itself.
The catch is timing: Medicare will only pay for one of these visits in a 12-month period. If you had a preventive visit in January, Medicare will not cover another one until January of the next year. Some seniors schedule their yearly physical to align with their birthday or the start of the calendar year so they remember when they are due.
If you see your doctor for a sick visit — for example, because you have a cough or chest pain — that is a separate visit and does not count as your yearly preventive visit. You may owe a copay for a sick visit even if you have not used your free preventive visit yet that year.
Key Takeaways
- Medicare Part B covers one preventive physical exam per year at no cost to you, with no copay or deductible.
- The visit must be at least 12 months after your last covered preventive visit, or Medicare will not pay for it.
- Your doctor can order lab work and screenings during the visit, but some tests may have separate costs depending on what they find.
- You must see a doctor who accepts Medicare assignment for the visit to be fully covered at no cost.
- Sick visits and preventive visits are counted separately, so a visit for a specific health problem does not use up your yearly preventive visit.
What is included in your covered yearly physical
During your free preventive visit, the doctor will take your blood pressure, check your weight and height, review your complete medical history, and ask about any new symptoms or concerns. They will also perform a basic physical exam and may listen to your heart and lungs. The visit typically lasts 15 to 30 minutes depending on your health history and what the doctor finds.
The doctor can order certain screenings and lab tests during this visit at no additional cost to you. These may include blood work to check cholesterol and blood sugar, a urinalysis, and an EKG if your doctor thinks you need one. However, if the doctor finds something that needs follow-up — for example, abnormal lab results — the cost of treating that condition is separate from the preventive visit and may involve a copay or coinsurance.
Your doctor will also discuss preventive care you may need based on your age and health, such as cancer screenings, bone density tests, or vaccines. If your doctor recommends any of these services during the visit, ask whether Medicare covers them and what your out-of-pocket cost will be before you schedule them.
When Medicare will not pay for your physical
Medicare will not cover a second preventive visit within the same 12-month period, even if you see a different doctor or visit a different clinic. If you have already had a covered preventive visit this year and you return for another routine checkup, you will owe the full cost unless your doctor codes it as a sick visit for a specific medical problem.
Medicare also will not pay if you see a doctor who does not accept Medicare assignment. Before you schedule your physical, confirm that your doctor accepts Medicare and that the visit will be billed as a preventive visit. Call your doctor's office or check their website — most primary care doctors accept Medicare, but some do not.
If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage may be different. Some Advantage plans cover additional preventive visits or offer extra wellness benefits. Check your plan documents or call your plan to find out what preventive visits are covered under your specific plan.
How to schedule your covered yearly physical
Call your primary care doctor's office and ask to schedule your "Annual Wellness Visit" or preventive physical. Tell them you have Medicare and want to make sure the visit is billed as a preventive visit so there is no copay. The office staff should confirm that your doctor accepts Medicare assignment before you come in.
Bring your Medicare card and any other insurance cards you have. If you have a Medicare Advantage plan, bring that card instead of your Original Medicare card. Also bring a list of all the medications you take, including over-the-counter drugs and supplements, because your doctor will review these during the visit.
If you do not have a primary care doctor, you can see any doctor who accepts Medicare for your preventive visit — it does not have to be someone you have seen before. However, having a regular primary care doctor makes it easier to track your health over time and ensures someone knows your full medical history.
What happens if you miss your yearly physical
If you do not have a preventive visit one year, you do not lose the benefit. You can still have a covered preventive visit the next year. However, skipping regular checkups means your doctor may miss early signs of serious health problems like high blood pressure, diabetes, or heart disease. Many chronic conditions have no symptoms in their early stages, so a yearly physical is one way to catch problems before they become serious.
Some doctors recommend more frequent visits if you have chronic conditions like diabetes, heart disease, or lung disease. These follow-up visits are usually coded as sick visits or chronic disease management visits, not preventive visits, and may involve a copay. Ask your doctor how often you should come in based on your health.
Lab work and screening tests during your physical
Your doctor can order routine lab work during your preventive visit at no cost, including blood tests for cholesterol and blood sugar, and a urinalysis. These basic screenings are part of the preventive visit benefit. However, if your doctor wants to order additional tests because of something they find — for example, an ultrasound or advanced imaging — those tests may have a separate cost.
Medicare also covers certain age-based screenings at no cost, such as mammograms for breast cancer, colonoscopies for colorectal cancer, and bone density scans for osteoporosis. Your doctor may recommend these during your preventive visit. Ask your doctor which screenings you need based on your age and health history, and confirm with the office what your out-of-pocket cost will be before you schedule them.
If lab work comes back abnormal, the cost of follow-up visits or treatment for the condition is separate from the preventive visit. For example, if your cholesterol is high, a follow-up visit to discuss medication is usually billed as a sick visit and may involve a copay.
Medicare Advantage plans and preventive visits
If you have a Medicare Advantage plan (Part C), your coverage for preventive visits may be slightly different from Original Medicare. Most Advantage plans cover at least one preventive visit per year at no cost, but some plans offer additional wellness visits or preventive benefits that Original Medicare does not cover.
Check your Advantage plan's summary of benefits or call your plan directly to find out exactly what preventive visits are covered and whether there are any restrictions. Some plans may require you to see a doctor in their network, or they may have different copays for preventive visits than Original Medicare does.
If you are thinking about switching from Original Medicare to an Advantage plan, or vice versa, ask about preventive visit coverage as part of your comparison. The preventive benefits can vary enough to affect your choice.
Frequently Asked Questions
Can I have a physical for a specific health problem and still use my free yearly preventive visit?
Yes. A visit for a specific symptom or health problem is coded as a sick visit, not a preventive visit, and you may owe a copay for it. Your free preventive visit is separate and can be used anytime within the 12-month period. You can have both in the same year without losing either benefit.
What if my doctor wants to see me more than once a year for my chronic condition?
Follow-up visits for a chronic condition like diabetes or heart disease are usually coded as sick visits or chronic disease management visits, not preventive visits. You may owe a copay for these visits. Your free yearly preventive visit is still available to you in addition to these follow-up visits.
Does Medicare cover a physical exam for a job or insurance process?
No. A physical exam required by an employer or insurance company is not a preventive visit and is not covered by Medicare. You would pay out of pocket for this type of exam, or your employer may cover it. Ask your employer or the insurance company whether they will pay for the exam.
What if I have not had a physical in several years?
You can still have a covered preventive visit. Medicare will pay for one physical exam per year going forward. Your doctor may want to do a more thorough exam if it has been a long time, but the cost to you is still zero for the preventive visit itself.
Do I need to fast before my yearly physical?
Ask your doctor's office before your visit. If your doctor plans to do blood work to check cholesterol or blood sugar, they may ask you to fast for 8 to 12 hours beforehand. If you are not fasting, you can eat and drink normally before your appointment.