Original Medicare and Annual Physicals vs Wellness Exams

Original Medicare does not cover routine annual physical exams, which are traditional "head-to-toe" checkups, but it does cover a free annual wellness visit (AWV) to create a personalized prevention plan. The first year, you are covered for a "Welcome to Medicare" preventive visit, followed by yearly wellness visits.
Key Differences and Coverage:
  • Annual Physical Exam: Not covered by Original Medicare. This is a comprehensive, hands-on exam that may involve diagnostic tests not deemed "preventive".
  • Annual Wellness Visit (AWV): Covered at 100% if the provider accepts assignment. This is a review of your health history, risk factors, and safety, not a physical exam.
  • "Welcome to Medicare" Visit: A one-time, initial preventive physical exam (IPPE) available within the first 12 months of having Part B.
What to Expect at a Wellness Visit:
  • Review of medical and family history.
  • Measurement of height, weight, and blood pressure.
  • Review of cognitive function to detect memory loss or dementia.
  • Creation of a screening schedule for preventive services.
  • Personalized health advice and risk factor reduction.
Important Tips:
  • Schedule by Name: When booking, specifically ask for a "Medicare Annual Wellness Visit" to avoid it being coded as a non-covered, routine physical.
  • Costs: While the visit itself is free, you may pay coinsurance for, or deductible may apply to, additional tests or services ordered during the visit that are not part of the preventative service.
  • Medicare Advantage: Some Medicare Advantage plans (Part C) may cover routine annual physicals, unlike Original Medicare.
For more details on Medicare coverage of preventive services, visit the CMS Medicare Wellness Visits page.
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