Does Medicare Cover Annual Physicals? ā Overview
Medicare mainly covers the cost of healthcare services that are used to diagnose and treat medical conditions.
Sometimes, Medicare also covers preventive services, such as annual wellness visits. However, annual wellness visits are different from annual physical exams.
In this article, we shall learn the details of wellness visits covered by Medicare.
What is an Annual Physical Examination?
Annual physical examinations are yearly visits to your doctor. These visits are meant to ensure that you are overall healthy and have not developed any medical conditions/disorders since your last examination.
Annual physical exams can be beneficial for adults of all health statuses to monitor their health and catch potential issues early. Still, people who have a complex medical history and those who want to feel assured of their good health can benefit greatly from this type of exam.
Physical examinations are a great way to detect, prevent and treat numerous medical ailments and illnesses in the human body.
Medicare Coverage for Initial Physical Examination
A person qualifies for the initial preventive physical examination (IPPE).
This is also known as a Welcome to Medicare physical exam. This physical exam is conducted within the first 12 months of enrolling in Medicare Part B.
Enrollment in Medicare usually begins when you turn 65. People may qualify at an earlier age if they have specific disabilities or health conditions.
Some of the tests in an IPPE include:
#1. Preventive service education
#2. Medical history review
#3. The social health history review
The Welcome to Medicare preventive visit (IPPE) is covered without cost to the patient for Medicare Part B beneficiaries, if the healthcare provider accepts assignment.
Medicare Coverage for Annual Visits
Medicare Part B covers one annual wellness visit each year at no cost to the beneficiary if the healthcare provider accepts Medicare assignment.
As per the Centers for Medicare & Medicaid Services (CMS), the types of healthcare professionals who can perform Medicare-sponsored annual wellness visits include:
#1. Doctor or physician
#2. Licensed nurse practitioner
#3. Certified clinical nurse specialist
#4. Physician Assistant
#5. Health educator
#6. Registered dietician
#7. Other licensed health professional directly supervised by a physician
Medicare covers the cost of AWV once every 12 months and provides the following services:
#1. Completing a health risk assessment
#2. Setting up a personal prevention plan
#3. Updating a personalized prevention plan
Some other preventive services covered by Medicare Part B include:
#1. Colorectal cancer screening (available starting at age 45; frequency varies by test type)
#2. Bone mass measurements (once every 24 months for qualified at-risk individuals)
#3. Diabetes screening (up to 2 screenings per year for those at risk)
#4. Depression screening (covered once per year in a primary care setting)
#5. Medical nutrition therapy (covered for people with diabetes or kidney disease with a doctorās referral, including initial and yearly follow-up counseling)
#6. Glaucoma screening (once every 12 months for high-risk individuals; 20% coinsurance after deductible applies)
#7. Breast cancer screening (mammogram every 12 months for women age 40 and over; covered at 100% if provider accepts assignment)
#8. Prostate cancer screening (annual PSA blood test for men age 50+ is covered at 100%; digital rectal exam requires 20% coinsurance after deductible)
While an AWV typically doesnāt include ECGs or lab tests as part of the visit, these services may be ordered separately based on medical necessity and could incur costs. However, the healthcare professional may advise these tests during the same visit.
In such a case, you may have to bear the cost of additional services in copayments, deductibles, and coinsurance.
To learn more details about whether Medicare covers annual physicals, you can visit the official Medicare website at www.medicare.gov or call directly at 1-800-MEDICARE.
Why Does Medicare Not Cover Annual Physicals?
The main reason Medicare does not cover annual physicals is the difference between the two.
Medicare does not cover annual physical exams as defined by a comprehensive physical examination and various tests; instead, it covers an annual wellness visit, which focuses on prevention and planning for healthcare needs.
The annual wellness visit includes a review of your medical and family history, developing or updating a personalized prevention plan, and may include screenings, preventive services, and educational information, not just routine measurements.
Wellness visits are meant to improve your overall health by looking at your medical history and status. Physical exams are more hands-on, whereas annual visits are more hands-off when evaluating.
Conclusion
Medicare has strict rules regarding coverage for preventive care. This includes the list of tests that are included and excluded.
Generally, Medicare covers one IPPE during your first year with Medicare Part B. Original Medicare also covers the cost of one Annual Wellness Visit (AWV) every year you are enrolled in the program.
When you schedule an AWV, you should specify the type of appointment you require. This way, you can avoid several unwanted personal costs for the process.
If you are unsure of your planās coverage, it is advisable to contact Medicare beforehand.
See Also
Does Medicare Cover Shingles Shots
Does Medicare Cover Cataract Surgery
Does Medicare Cover Hearing Aids
Does Medicare Cover Chiropractic
