Medicare covers one free preventive physical exam per year, called the "Welcome to Medicare" visit if you're new, or the Annual Wellness Visit if you've had Medicare for over a year
Medicare Part B pays for these visits at no cost to you — no copay, no coinsurance, no deductible. A doctor or nurse practitioner performs a health assessment, reviews your medical history, checks your blood pressure and weight, and discusses preventive care you may need. The visit is meant to catch health problems early, not to treat an existing illness.
The catch is that this covers the preventive exam itself. If your doctor finds something during that visit and decides to treat it — say, they discover high blood pressure and start medication, or they find a skin growth that needs removal — that treatment visit is billed separately and may have a copay or coinsurance depending on what's done.
Key Takeaways
- Medicare Part B covers one preventive physical exam per year at no cost, whether it's your first year on Medicare or your tenth.
- The visit includes a health assessment, vital signs check, and discussion of preventive screenings you may need, but does not include treatment of new problems found during the exam.
- If your doctor diagnoses a condition during the preventive visit and treats it the same day, you may owe a copay or coinsurance for the treatment portion.
- You must see a Medicare-participating provider to receive the free coverage; out-of-network doctors may bill you the full cost.
- Routine physical exams for work, school, sports, or insurance purposes are not covered by Medicare.
The Welcome to Medicare Visit versus the Annual Wellness Visit
If you're newly enrolled in Medicare Part B, you're may have access to to a Welcome to Medicare preventive visit during your first year of coverage. This visit includes a complete health history, physical exam, and a review of your risk factors for disease. Your doctor may order lab work or screenings based on what they find.
After your first year on Medicare, you switch to the Annual Wellness Visit each year. This visit is similar but focuses on updating your health history, checking vital signs, and reviewing which preventive services you've had and which you may still need. Both visits are covered at no cost under Part B.
You can have only one of these preventive visits per calendar year. If you've already had a Welcome to Medicare visit, you cannot also have an Annual Wellness Visit that same year. Plan the timing so you get the most benefit from the coverage.
What's Included and What's Not
The preventive visit itself — the exam, the assessment, the time with the doctor — is free. Medicare also covers certain screenings and tests ordered during that visit if they're considered preventive, such as blood work to check cholesterol or blood sugar, or an EKG if your doctor thinks you're at risk for heart disease.
What Medicare does not cover during a preventive visit is treatment of any condition your doctor finds. If your blood pressure is high and your doctor prescribes medication, the medication and any follow-up visit to adjust it are billed separately. If your doctor removes a mole or treats an infection discovered during the exam, that treatment is billed as a separate office visit with its own copay or coinsurance.
Routine physical exams for employment, school enrollment, sports participation, or insurance underwriting are not covered by Medicare at all. These are considered non-preventive and you would pay out of pocket.
How to Schedule Your Preventive Physical
Call your primary care doctor's office and ask to schedule your Annual Wellness Visit or Welcome to Medicare visit. Tell them it's a preventive visit covered by Medicare Part B. The office should know how to bill it correctly so you don't receive a surprise bill.
Make sure your doctor is a Medicare-participating provider. You can check this on Medicare.gov by using the "Care Provider Search" tool, or call 1-800-MEDICARE to confirm. If your doctor does not participate in Medicare, they can charge you the full cost of the visit even if you have Part B coverage.
Bring your Medicare card and any insurance cards you have. If you have a Medigap or Medicare Advantage plan in addition to Part B, let the office know so they bill the right plan. Arrive a few minutes early to update your health history and medications if anything has changed since your last visit.
What Happens If Your Doctor Finds a Problem
During your preventive visit, your doctor may discover a health issue that needs follow-up or treatment. Common examples include high blood pressure, elevated cholesterol, abnormal blood sugar, or a suspicious skin growth. Your doctor will discuss next steps with you.
If the doctor treats the condition during the same visit — for instance, removing a skin tag or prescribing blood pressure medication — that treatment is billed separately from the preventive visit. You may owe a copay (usually $15 to $50) or coinsurance (usually 20% of the cost) depending on what was done and your specific Part B coverage.
If your doctor wants to do more testing or refer you to a specialist, those visits and tests are also billed separately. Ask your doctor's office what you might owe before you leave, so there are no surprises later.
Medicare Advantage Plans and Preventive Visits
If you have a Medicare Advantage plan (Part C) instead of Original Medicare Part B, your plan still must cover the preventive visit at no cost. However, the details may differ slightly. Some Advantage plans cover additional preventive services beyond what Original Medicare covers, or they may have different copays for follow-up treatment.
Check your plan's summary of coverage or call the plan's customer service line to understand what your preventive visit includes. If you're unsure whether your plan is an Advantage plan or Original Medicare, your Medicare card will say "Medicare Advantage" or show only "Part A" and "Part B."
Preventive Screenings Often Covered During or After Your Visit
During your preventive visit, your doctor may recommend screenings based on your age, sex, and health history. Many of these screenings are covered by Medicare at no cost if they're considered preventive. Examples include mammograms for breast cancer, colonoscopies for colorectal cancer, bone density scans for osteoporosis, and blood tests for cholesterol and diabetes.
If your doctor orders a screening during your preventive visit, ask whether it's covered under Medicare's preventive benefit. Most are, but some may have a copay or coinsurance depending on the specific test and your plan. Your doctor's office can often tell you the cost before the test is done.
Frequently Asked Questions
Do I have to use my preventive visit every year?
No. The visit is available to you each year, but you don't have to use it. However, preventive care can catch serious health problems early, so most doctors recommend taking advantage of the free visit annually.
What if I see my doctor for a sick visit and they do a physical exam?
A sick visit — when you go to the doctor because you're ill or have a symptom — is not the same as a preventive visit. It's billed as an office visit for a specific problem and you'll owe a copay or coinsurance. The preventive visit must be scheduled separately and labeled as such.
Can I have a preventive visit if I have a Medigap plan?
Yes. Medigap plans work alongside Original Medicare Part B and do not change your preventive visit coverage. Medicare Part B still covers the visit at no cost, and your Medigap plan may cover some or all of any copays or coinsurance for follow-up treatment.
What if my doctor wants to do extra tests during the preventive visit?
Tests ordered during a preventive visit are covered at no cost if they're considered preventive screenings — such as cholesterol blood work or a mammogram. Tests for a specific symptom or condition found during the visit may be billed separately with a copay or coinsurance.
Does Medicare cover a physical exam for a job or sports?
No. Work physicals, school physicals, and sports physicals are not covered by Medicare because they're not considered preventive care. You would pay out of pocket for these exams.