Does Medicare Cover Annual Physicals? – 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.
Most healthy adults are not required to undergo annual physical exams. 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 with disabilities may qualify earlier, depending on their health condition.
Some of the tests in an IPPE include:
#1. Preventive service education
#2. Medical history review
#3. The social health history review
This physical exam is free of charge, provided the healthcare professional performing the exam accepts the Medicare assignment.
Medicare Coverage for Annual Visits
Medicare Part B also covers annual wellness visits (AWV) free of charge if the healthcare provider accepts the 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. Clinically-attached healthcare professional working as a consultant
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 personalized protection plan
Some other preventive services covered by Medicare Part B include:
#1. Colorectal cancer screening
#2. Bone mass measurements
#3. Diabetes screening
#4. Depression screening
#5. Medical nutrition therapy
#6. Glaucoma screening
#7. Breast cancer screening
#8. Prostate cancer screening
An AWV does not include electrocardiograms (ECGs) or lab tests. 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 application payments.
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 800-633-4227.
Why Does Medicare Not Cover Annual Physicals?
The main reason why Medicare does not cover annual physicals is the difference between the two.
To put it in simple words, annual physicals involve an examination by a doctor and blood and other tests. In contrast, an annual visit does not involve a physical exam.
It is a routine check to measure your height, weight and blood pressure.
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.
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. Conventional Medicare also covers the cost of 1 AWC 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 plan’s coverage, it is advisable to contact Medicare beforehand.