Does Medicare Cover an Annual Physical?
Medicare generally does not cover a routine, comprehensive annual physical exam when it is unrelated to a specific illness, symptom, or injury. Under Original Medicare, you may have to pay the full cost of that type of visit if it is not part of a covered preventive service.
Medicare Part B does cover two preventive visits that people sometimes call an annual physical: the one-time Welcome to Medicare visit and the yearly Annual Wellness Visit. Medicare also covers medically necessary visits to evaluate and treat a specific health concern. Understanding the difference can help you avoid unexpected bills.
The Three Types Of Visits To Know
Medicare coverage is easier to understand when you separate these three types of appointments:
- Routine physical: A comprehensive head-to-toe exam without a specific illness, symptom, complaint, or injury. Original Medicare generally does not cover this service.
- Preventive visit: The Welcome to Medicare visit or Annual Wellness Visit. These are covered Part B benefits with a specific purpose and set of services.
- Problem-focused visit: A medically necessary appointment to evaluate or treat a specific concern, such as new pain, shortness of breath, or a change in an existing condition. Medicare generally covers this type of service under Part B, subject to applicable cost-sharing.
The name used when scheduling matters. Ask the provider’s office which type of visit is being scheduled and what services may be included.
What Medicare Does Cover
The Welcome To Medicare Preventive Visit
Medicare Part B covers one Welcome to Medicare preventive visit, also called the Initial Preventive Physical Examination or IPPE. You can receive it once during the first 12 months after your Part B coverage begins.
This visit may include:
- A review of your medical and social history
- A review of your family health history
- Measurements such as height, weight, and blood pressure
- A simple vision test
- Discussion of preventive screenings and vaccines
- Review of possible depression or substance use risks
- Health education and referrals when appropriate
- A written prevention plan
- An opportunity to discuss advance directives
The Welcome to Medicare visit is not a full physical exam. It is designed to establish a prevention plan and help you understand which covered screenings, vaccines, and other services may be appropriate for you.
You pay nothing for the covered visit if your provider accepts Medicare assignment. The Part B deductible does not apply to the preventive visit itself.
The Annual Wellness Visit
After you have had Part B for more than 12 months, Medicare generally covers an Annual Wellness Visit once every 12 months. The visit helps you and your healthcare provider create or update a personalized prevention plan.
The Annual Wellness Visit is conversation-based. It may include:
- A health risk assessment
- A review of your medical and family history
- A review of your current prescriptions
- Routine measurements such as height, weight, and blood pressure
- A cognitive assessment
- Health advice and prevention planning
- A written checklist of recommended screenings and vaccines
- Referrals for other covered preventive services when appropriate
The first Annual Wellness Visit is billed once you are eligible, and later visits may be covered annually after that. You do not need to have a Welcome to Medicare visit before receiving an Annual Wellness Visit. However, your first Annual Wellness Visit generally cannot be scheduled within 12 months of your Part B enrollment or within 12 months of your Welcome to Medicare visit.
Like the Welcome to Medicare visit, the Annual Wellness Visit is not a head-to-toe physical exam. You pay nothing for the covered visit when your provider accepts assignment, and the Part B deductible does not apply to the visit itself.
Specific Preventive Services
Medicare also covers many preventive services separately when you meet the eligibility and frequency requirements. These may include certain cancer screenings, diabetes and cardiovascular screenings, vaccines, and other services.
Coverage and cost rules can depend on the service, your medical history, how often you receive it, and whether your provider accepts assignment. You can review the full and current list on Medicare.gov’s preventive and screening services page.
What Medicare Does Not Cover
A Comprehensive Routine Physical
Original Medicare generally does not cover a comprehensive routine physical exam when it is not related to diagnosing or treating a specific illness, symptom, complaint, or injury. If you request this type of exam, you may be responsible for 100% of the cost.
A Welcome to Medicare visit or Annual Wellness Visit may involve some routine measurements and health questions, but that does not turn the visit into a traditional physical exam.
Tests Without Medical Necessity Or A Covered Preventive Benefit
Medicare does not automatically cover every test ordered during a preventive appointment. For example, broad blood panels, full-body scans, or other tests may not be covered unless they meet Medicare’s rules for medical necessity or fit within a covered preventive service.
If a provider recommends a service Medicare may not cover, ask:
- Why is the test recommended?
- Is it medically necessary?
- Is it part of a covered preventive benefit?
- What might I owe?
- Will I receive an Advance Beneficiary Notice of Noncoverage?
An Advance Beneficiary Notice of Noncoverage, sometimes called an ABN, means the provider believes Medicare may not pay and is asking you to acknowledge that you may be responsible for the cost.
More Frequent Or Additional Preventive Visits
Medicare generally does not cover an Annual Wellness Visit more often than once every 12 months. It also does not cover a second Welcome to Medicare visit.
Non-covered services bundled into the same appointment may generate a bill even when the covered Wellness visit itself costs nothing.
What If You Discuss A Health Problem?
You should tell your healthcare provider about new or ongoing concerns. If your doctor evaluates a specific medical problem during the same appointment, that separate, medically necessary evaluation may be billed separately from the preventive visit.
For example, you may schedule an Annual Wellness Visit and also discuss new dizziness or a worsening chronic condition. If the provider performs a separate evaluation of that concern, the office may bill the problem-focused service in addition to the Wellness visit. Medicare may allow this separate billing when appropriate, and your provider’s billing office can explain how it will be handled.
For Original Medicare in 2026, the Part B annual deductible is $283. After the deductible, you generally pay 20% of the Medicare-approved amount for a covered, medically necessary Part B service. Your exact responsibility may depend on your other coverage, provider participation, and the services provided.
If you have a Medicare Supplement plan, it may help pay some Medicare-approved cost-sharing, depending on the plan. A Medicare Advantage plan has its own cost-sharing and service rules.
Medicare Advantage And Annual Physicals
Medicare Advantage plans must cover Medicare Part A and Part B services, but they may offer extra benefits beyond Original Medicare. Depending on the plan, those extras may include a broader annual physical, fitness memberships, or other wellness services.
These benefits vary by plan, location, provider network, and plan year. They may have their own eligibility rules, copayments, or scheduling requirements. Review your plan’s Evidence of Coverage or ask the plan directly before assuming a traditional annual physical is included.
You can also compare how Medicare Advantage plans handle preventive care, providers, and additional benefits by reviewing our Medicare Advantage services.
Frequently Asked Questions
Does Medicare Cover An Annual Physical?
Original Medicare generally does not cover a routine, comprehensive annual physical when it is unrelated to a specific illness, symptom, or injury. It does cover the Welcome to Medicare preventive visit and Annual Wellness Visit, which are different from a full physical exam.
What Is The Difference Between A Wellness Visit And A Physical Exam?
An Annual Wellness Visit is a conversation-based preventive appointment. It focuses on your health risks, medical and family history, cognitive assessment, routine measurements, and a personalized prevention plan. A physical exam is a more comprehensive examination of your body. Original Medicare generally does not cover a routine physical exam without a specific medical concern.
How Often Is The Wellness Visit Covered?
Medicare generally covers one Annual Wellness Visit every 12 months. Additional visits during the same period may not be covered as Wellness visits.
What Does The Welcome To Medicare Visit Include?
It includes a review of your health and family history, preventive service education, certain measurements and assessments, referrals when appropriate, and a written prevention plan. It is covered once within the first 12 months of Part B enrollment and is not a full physical exam.
Is The Wellness Visit Really Free?
The covered Annual Wellness Visit generally costs you nothing when your provider accepts Medicare assignment. The Part B deductible and coinsurance are waived for the visit itself. You may owe money for additional tests, services, or problem-focused care provided during the same appointment.
What If My Doctor Orders Blood Work Or Extra Tests At That Visit?
Ask whether each test is medically necessary, included in a Medicare preventive benefit, or likely to create a separate charge. Medicare may cover some screenings but not broad testing without a covered reason. Your provider may give you an Advance Beneficiary Notice of Noncoverage if you may be responsible for the cost.
Will I Be Billed If We Talk About A Health Problem?
You may be billed separately if your provider evaluates or treats a specific medical problem during the same appointment. A covered preventive visit and a medically necessary problem-focused service can be billed separately when Medicare’s requirements are met.
Does Medicare Advantage Cover An Annual Physical?
A Medicare Advantage plan may offer an annual physical or other wellness benefits beyond Original Medicare. This depends on the plan. Check the plan’s benefits, network rules, and cost-sharing before scheduling.
Can I Go To Any Provider?
Not always. With Original Medicare, ask whether the provider accepts Medicare assignment and offers the type of preventive visit you need. Medicare Advantage plans generally use plan networks and may have different referral or authorization rules. Confirm the details with your provider and plan.
Get Help Understanding Your Medicare Benefits
Medicare’s preventive benefits can provide valuable support, but the difference between a routine physical, a Wellness visit, and a problem-focused appointment can affect your bill.
We take the time to review what your plan does and does not include, how your providers participate, and how coverage may fit your prescriptions, doctors, and budget. Neuse Consulting Group is based in Wake Forest, North Carolina, and is licensed in 14 states: NC, SC, VA, NJ, WV, PA, NY, TN, GA, FL, OH, AZ, MI, and WI.
You can request a free, no-pressure conversation by calling 984-237-3347 or visiting us at 1956 S. Main St, Wake Forest, NC 27587. We are committed to providing clear, ongoing guidance so you can make informed Medicare decisions throughout the year.
For related information, read Does Medicare Cover Prescription Drugs? and Does Medicare Cover Home Health Care?.