Many people transitioning to Medicare Part B mistakenly believe it covers a comprehensive “yearly physical” similar to commercial health plans. Medicare does cover preventive care services, but the terminology and structure differ significantly from a traditional physical exam. These services are structured as a one-time initial assessment followed by recurring annual visits, focusing on prevention rather than a hands-on diagnostic exam.
The Critical Distinction: Annual Wellness Visit vs. Yearly Physical
Medicare Part B does not cover a traditional, comprehensive, head-to-toe physical examination. This type of visit often includes diagnostic blood work and a hands-on examination of body systems, focusing on diagnosing and treating current health issues. This approach contrasts with Medicare’s focus on preventive care.
Instead of a routine physical, Medicare covers the Annual Wellness Visit (AWV), a recurring preventive service. The AWV is primarily a planning and risk assessment session designed to help beneficiaries stay healthy and prevent disease. The difference is significant because the AWV typically does not include the physical tests, such as checking reflexes or performing a detailed physical assessment, that are characteristic of a standard physical.
Understanding the “Welcome to Medicare” Visit
Before accessing the recurring Annual Wellness Visit, beneficiaries are eligible for the one-time “Welcome to Medicare” Preventive Visit. Officially called the Initial Preventive Physical Examination (IPPE), this benefit must be used within the first 12 months of enrolling in Medicare Part B. The IPPE establishes a baseline health assessment for the new enrollee.
Despite its name, the IPPE does not include an extensive hands-on exam, focusing instead on health promotion and disease detection. Key components include reviewing medical and social history, measuring vitals (height, weight, blood pressure), and a visual acuity screen. The visit also includes assessing functional ability, safety level, and potential depression risk factors. The provider uses this information to educate, counsel, and refer the beneficiary for appropriate screenings and other covered preventive services. If appropriate, the beneficiary may also receive a once-in-a-lifetime screening electrocardiogram (ECG) during this initial visit.
What the Annual Wellness Visit Actually Includes
The Annual Wellness Visit (AWV) is the recurring yearly benefit available after the initial 12 months of Part B coverage. This visit focuses on creating or updating a personalized prevention plan based on the patient’s current health and risk factors. The AWV requires the patient to complete a Health Risk Assessment (HRA), which gathers information on demographic data, health status, and psychosocial/behavioral risks. The healthcare provider performs routine measurements, including height, weight, body mass index, and blood pressure.
The visit involves reviewing and updating the patient’s medical and family history, current medications, and a list of all current healthcare providers. The provider also assesses the patient’s cognitive function, depression risk factors, and functional ability and safety (e.g., risk of falling). A major outcome is the creation of a written 5-to-10-year screening schedule for appropriate preventive services, such as immunizations and cancer screenings. The AWV is a planning and assessment session and does not involve a hands-on physical exam or routine blood tests unless medically necessary and ordered separately.
Patient Costs and Coverage Rules
Both the “Welcome to Medicare” visit and the Annual Wellness Visit are generally covered at 100% by Medicare Part B, provided the provider accepts assignment. Patients typically pay nothing for these preventive services, and the Part B deductible does not apply. The frequency rule allows for only one AWV every 12 months, and it cannot occur within 12 months of the initial IPPE or a previous AWV.
A financial risk arises if additional services are performed during the preventive visit. If the provider performs diagnostic tests, such as routine blood work, or addresses a specific ailment, the patient will incur standard Part B deductibles and copayments for those extra services. These additional services are billed separately and are subject to the usual 20% coinsurance and the Part B deductible. Patients should clarify with their provider beforehand to ensure only covered preventive components are performed to avoid unexpected costs.