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Does Medicare Pay for an Annual Physical?


Medicare Annual Wellness Visit vs. an Annual Physical

Medicare will cover an annual wellness visit, but not an annual physical.  "Well," you might ask "what's the difference?"  During a Medicare annual wellness visit, the provider will measure height, weight, body mass index (BMI), and blood pressure.  The provider will also go over your medical history, family medical history, and any potential risk factors for preventable diseases such as Type II diabetes and depression.

An annual physical is a more extensive exam than a Medicare Annual Wellness Visit. In addition to these services, a typical annual physical might also include services such as a vital signs check, lung exam, head and neck exam, abdominal exam, neurological exam, and a check of your reflexes.  Any blood work or lab tests that may be part of a physical exam, are also not included under a Medicare Annual Wellness Visit.

The purpose of the annual wellness visit under Medicare is to paint a picture of your current state of health and to create a baseline for future care.  Any additional tests or labs that may be required as a result of the findings of your annual wellness visit would be billed separately by your doctor and would fall under a different benefit than your annual wellness visit.  Medicare also covers a number of other preventive services at no cost such as preventive cancer screenings, bone density measurement, and flu shots.

Annual Physical

  • Doctor will measure height and weight

  • Doctor will take your blood pressure

  • Doctor will measure BMI

  • Doctor will review your medical and family history

  • Doctor will assess your risk factors for preventable diseases

  • Doctor will check vital signs

  • Doctor will perform head and neck exam

  • Doctor will perform lung exam

  • Doctor will perform abdominal exam

  • Doctor will perform neurological exam

  • Doctor will test your reflexes

  • Doctor may submit urine and blood samples for lab testing

Medicare Wellness

  • Doctor will measure height, weight, blood pressure and other routine measurements

  • Doctor will review your medical and family history

  • Doctor will assess your risk factors and treatment options

  • Review Health Risk Assessment questionnaire

  • Updating list of providers and prescriptions

  • Looking for signs of cognitive impairment

  • Doctor will set up a screening schedule for appropriate preventive services

The Medicare Wellness exam includes the assessments, but none of the "physical" tests where the doctor has to physically touch you.  Under Medicare, a doctor will only perform these types of services if there is a specific diagnosis or symptom which necessitates that type of examination. Other preventive services will be scheduled, but not performed, during your wellness visit.

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