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

Medicare Part B pays for a yearly "Welcome to Medicare" preventive visit if you are new to Medicare, or an annual wellness visit if you have had Medicare for more than 12 months. Both visits are covered at 100 percent with no copay, coinsurance, or deductible — you pay nothing out of pocket. The visit must take place at a doctor's office or clinic that accepts Medicare.

The scope of these visits is narrower than a traditional physical. Medicare covers a health risk assessment, a review of your medical and family history, measurements like blood pressure and weight, and a personalized prevention plan. The doctor may order certain screening tests as part of the visit, but a full head-to-toe physical with extensive lab work is not the standard Medicare covers.

If you need a more comprehensive physical — one that includes a detailed examination of specific body systems or additional testing beyond what Medicare defines as preventive — you may be charged for the extra services. Your doctor should tell you in advance if any part of the visit will not be covered by Medicare.

Key Takeaways

  • Medicare Part B covers one preventive visit per year at no cost to you, whether it is called a "Welcome to Medicare" visit or an annual wellness visit.
  • The covered visit includes a health assessment, medical history review, vital signs, and a prevention plan — not a full physical examination.
  • Screening tests ordered during the visit (such as blood work or EKG) are usually covered separately under Medicare Part B preventive services.
  • If your doctor performs services beyond the standard preventive visit, you may owe a copay or coinsurance for those extra services.
  • You must see a doctor or clinic that accepts Medicare for the visit to be covered at no charge.

What is included in the Medicare-covered preventive visit

The annual wellness visit covered by Medicare Part B includes a comprehensive health risk assessment. Your doctor will ask about your current health, past medical conditions, medications you take, family history, and lifestyle habits such as smoking or alcohol use. This information helps your doctor identify health risks specific to you.

The visit also includes measurement of vital signs — blood pressure, weight, and height — and a review of your ability to perform daily activities. Your doctor may ask about falls, memory problems, depression, or difficulty with hearing or vision. Based on this assessment, your doctor creates a personalized prevention plan that lists which screening tests and preventive services are right for you over the next year.

Screening tests ordered during the visit — such as a blood glucose test, cholesterol panel, or colorectal cancer screening — are covered separately under Medicare Part B preventive services. These tests are covered at no cost to you when ordered as part of your prevention plan. However, if your doctor orders tests that are not considered preventive (for example, testing for a specific symptom or complaint), those may be subject to your Part B deductible and coinsurance.

The difference between a preventive visit and a sick visit

Medicare distinguishes between a preventive visit and a sick visit, and the difference affects what you pay. A preventive visit is one where you come in for a routine checkup or screening with no specific complaint. A sick visit is one where you see the doctor because you have a symptom, injury, or illness that needs treatment.

If you schedule an annual wellness visit but mention a new symptom or problem during the appointment, your doctor may need to bill part of the visit as a sick visit. For example, if you come in for your annual checkup and mention knee pain, the doctor may examine your knee and order an X-ray. That portion of the visit may be billed separately and subject to your Part B deductible and coinsurance.

To avoid surprise charges, tell your doctor's office before the visit if you have any specific health concerns you want addressed. The office can then schedule enough time and let you know upfront if any part of the visit will be billed differently. You can also ask your doctor to separate the preventive portion from any sick-visit services and bill them accordingly.

How to schedule your Medicare preventive visit

Contact your primary care doctor's office or any doctor who accepts Medicare and ask to schedule your annual wellness visit. You do not need a referral. If you do not have a primary care doctor, you can find one through the Medicare provider search tool on Medicare.gov, or call 1-800-MEDICARE to ask for a list of doctors in your area who accept Medicare.

When you call to schedule, let the office know you want your annual wellness visit covered by Medicare. Some offices may ask you to complete a health questionnaire before the visit to speed up the appointment. Bring your Medicare card and any insurance documents with you.

If you have both Medicare and a Medigap or Medicare Advantage plan, your preventive visit is still covered at no cost. Medigap plans cover your Part B coinsurance, and Medicare Advantage plans must cover preventive services at no cost just as Original Medicare does.

What happens if you have not had a preventive visit in several years

If you are new to Medicare or have not had an annual wellness visit since you enrolled, you are still may have access to to one covered visit per year going forward. There is no penalty for missing previous years, and you do not need to make up missed visits. You can schedule your first covered preventive visit at any time.

If you are new to Medicare (within your first 12 months of coverage), your first visit is called a "Welcome to Medicare" preventive visit. After 12 months, it becomes an annual wellness visit. Both are covered at no cost, and the services included are similar.

Additional preventive services covered by Medicare

Beyond the annual wellness visit, Medicare Part B covers many other preventive services at no cost. These include cancer screenings (mammogram, colonoscopy, Pap test), cardiovascular screening (EKG, stress test), bone density screening, diabetes screening, and vaccinations (flu, pneumonia, shingles, COVID-19). Each service has age and frequency requirements set by Medicare.

Your personalized prevention plan created during your annual wellness visit will list which of these services are recommended for you based on your age, health history, and risk factors. You can then schedule these services with the appropriate provider, and they will be covered at no cost as long as they are ordered as preventive services.

If you have questions about which preventive services are covered for you, ask your doctor during your wellness visit or call 1-800-MEDICARE. You can also visit Medicare.gov and search for "preventive services" to see the full list of covered screenings and tests.

Frequently Asked Questions

Do I have to pay anything for my annual wellness visit?

No. Medicare Part B covers the annual wellness visit at 100 percent with no copay, coinsurance, or deductible. You pay nothing as long as you see a doctor who accepts Medicare and the visit is billed as preventive. If your doctor performs additional services beyond the standard preventive visit, those may be subject to your Part B deductible and coinsurance.

Can I have more than one preventive visit per year?

Medicare covers one preventive visit per year. If you need to see your doctor more often for other reasons, those visits would be billed as sick visits and subject to your Part B deductible and coinsurance. However, preventive screening tests (such as colonoscopy or mammogram) are covered separately and follow their own frequency rules.

What if my doctor wants to do a full physical with extensive lab work?

Medicare's preventive visit does not include a full head-to-toe physical or extensive lab panels. If your doctor recommends tests beyond what Medicare defines as preventive, you should ask in advance whether those tests will be covered. Some may be covered as preventive services; others may require you to pay a copay or coinsurance.

Does my Medicare Advantage plan cover the annual wellness visit?

Yes. Medicare Advantage plans must cover all preventive services that Original Medicare covers, including the annual wellness visit, at no cost to you. Some Medicare Advantage plans may offer additional preventive services beyond what Original Medicare covers.

What if I miss my annual wellness visit one year?

You can schedule your preventive visit at any time during the year. There is no penalty for missing a year, and you do not lose your benefit. You are may have access to to one covered preventive visit per calendar year going forward.