Medicare covers one free yearly physical exam, but only if you have not had one in the past 12 months

Medicare Part B covers an annual wellness visit at no cost to you — no copay, no deductible, no coinsurance. This visit is different from a traditional physical exam. It focuses on prevention: reviewing your health history, checking your vital signs, and screening for conditions like diabetes, heart disease, and cancer based on your age and risk factors.

The visit must happen at a doctor who accepts Medicare. If your doctor is in-network for your plan, you pay nothing. If your doctor is out-of-network, costs may vary depending on whether you have Original Medicare or a Medicare Advantage plan.

One important limit: you get this visit once per calendar year. If you had one in January, you cannot have another covered visit until January of the next year. Some people confuse this with a traditional physical — the wellness visit is shorter and more focused on prevention screening than on treating existing conditions.

Key Takeaways

  • Medicare Part B covers one free annual wellness visit per calendar year with no copay or deductible.
  • The visit includes health history review, vital signs, and age-appropriate screenings for chronic disease, but not treatment of existing conditions.
  • You must see a Medicare-accepting doctor; out-of-network costs depend on your plan type.
  • Additional preventive services like blood work, cancer screenings, and vaccines are often covered separately at no cost.

What the annual wellness visit includes

The Medicare wellness visit is a structured appointment with specific components. Your doctor will review your complete health and family history, take your blood pressure and weight, and calculate your body mass index. They will also perform a cognitive assessment — a brief mental status check — and review your medications to spot potential problems.

The visit includes personalized screening recommendations based on your age, sex, and health status. For example, a 65-year-old woman might be screened for osteoporosis and colorectal cancer, while a 70-year-old man might be screened for abdominal aortic aneurysm. Your doctor will also discuss preventive care and healthy living, and may refer you for additional screenings or services.

What the visit does not include: treatment of a chronic condition like diabetes or high blood pressure, management of an acute illness, or a detailed physical exam of specific body systems. If your doctor discovers a problem during the wellness visit and needs to address it, that becomes a separate office visit and may have a copay.

Other preventive services Medicare covers at no cost

Beyond the annual wellness visit, Medicare Part B covers many preventive services with no copay or deductible. These include blood pressure checks, cholesterol screening, diabetes screening, colorectal cancer screening (colonoscopy, sigmoidoscopy, or fecal tests depending on age), mammograms for breast cancer, and Pap tests for cervical cancer.

Vaccines are also covered: flu shot, pneumococcal vaccine, shingles vaccine, and others based on your age and health history. Bone density screening (DEXA scan) for osteoporosis is covered for women 65 and older and for men 70 and older, or younger if you have risk factors.

Abdominal aortic aneurysm screening is covered once for men ages 65 to 75 who have ever smoked. Hepatitis C screening is covered once for all adults ages 18 to 79. These services are covered at no cost only when they are preventive — meaning you have no symptoms. If you already have a diagnosis and need monitoring or treatment, different rules explore.

How to schedule your annual wellness visit

Call your primary care doctor's office and ask to schedule your annual wellness visit or preventive care visit. Some offices call it a "Medicare annual exam" or "preventive visit." Tell them you have Medicare and want to use your free yearly benefit.

Bring your Medicare card and any other insurance cards you have. If you have not seen this doctor before, arrive early to complete new-patient paperwork. Bring a list of all medications you take, including over-the-counter drugs and supplements, because the doctor will review them during the visit.

If you have Medicare Advantage (Part C), the process is the same — you still get one free annual wellness visit. Check your plan documents or call your plan to confirm your doctor is in-network, because out-of-network costs vary by plan.

What happens if you see a doctor outside Medicare

If you see a doctor who does not accept Medicare, Medicare will not pay for the visit. You will owe the full cost out of pocket. Some doctors are "non-participating" — they accept Medicare but charge more than Medicare's approved amount. If you see a non-participating doctor, you may owe the difference between what they charge and what Medicare allows.

Before scheduling with any doctor, ask whether they accept Medicare and whether they are a participating or non-participating provider. You can also check the Medicare provider search tool on Medicare.gov to verify a doctor's status.

If you have a Medicare Advantage plan, your network is narrower than Original Medicare. You must see in-network doctors to get the no-cost benefit. Out-of-network visits in a Medicare Advantage plan usually cost more or may not be covered at all, depending on your plan.

The difference between a wellness visit and a sick visit

A wellness visit is preventive — you come in for screening and health maintenance even though you feel fine. A sick visit happens when you have a symptom or condition that needs treatment. Medicare covers both, but the cost structure is different.

If you schedule a wellness visit and your doctor finds something that needs treatment during that visit, the treatment portion becomes a separate sick visit. You may owe a copay for that part. For example, if your blood pressure is high during the wellness visit and your doctor wants to start medication, the medication management becomes a sick visit with a copay.

To avoid surprise costs, tell your doctor at the time of scheduling that you want a wellness visit. If you have specific symptoms or concerns you want addressed, schedule a separate sick visit or mention them at the start of the wellness visit so your doctor can bill appropriately.

Medicare Advantage and Medigap coverage for physicals

If you have a Medicare Advantage plan (Part C), you still receive the free annual wellness visit. Most Medicare Advantage plans also cover additional preventive services at no cost, sometimes more than Original Medicare does. Check your plan documents or call your plan to see what preventive services are included.

If you have a Medigap (supplemental insurance) policy, it does not change your Medicare benefits — you still get the same free wellness visit through Medicare Part B. Medigap helps pay for copays and coinsurance on services Medicare covers, but it does not add new covered services.

Some Medicare Advantage plans offer additional benefits like routine eye exams, dental cleanings, or hearing aids. These are plan-specific and not part of Original Medicare. Review your plan's summary of benefits or call your plan to learn what extra preventive services you have.

Frequently Asked Questions

Can I have a physical exam if I just saw my doctor for a sick visit?

Yes. The annual wellness visit is separate from sick visits. If you saw your doctor in March for a cold, you can still have your free wellness visit later that year. However, you get only one wellness visit per calendar year, so plan accordingly.

What if my doctor wants to do blood work during the wellness visit?

Routine preventive blood work ordered during a wellness visit is usually covered at no cost. This includes cholesterol screening and diabetes screening. However, if your doctor orders tests for a specific diagnosis or condition, those may have a copay. Ask your doctor which tests are preventive and which are diagnostic.

Do I need a referral to see a specialist for a screening?

No. Medicare Part B covers preventive screenings without a referral. If your wellness visit recommends a colonoscopy or mammogram, you can schedule directly with that provider. If you have a Medicare Advantage plan, check whether the specialist is in-network.

What if I turn 65 in the middle of the year — do I get a wellness visit?

Yes. You become may be able to access for Medicare benefits on the first day of the month you turn 65. You can schedule your annual wellness visit anytime after that date. The calendar year resets on January 1, so if you turn 65 in June, you can have one wellness visit in June through December, and another in January of the following year.

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

No. The free annual wellness visit is for preventive health screening only. Physicals required by an employer or insurance company are not covered by Medicare, and you will owe the cost out of pocket.