People With Medicare

Medicare Question of the Month

Each month, our expert showcases a Medicare question submitted by one of our readers. You may submit a question at any time and get a personal response.

April 2012 Question:

Does Medicare cover an annual physical?

Answer:

Medicare does not cover complete physical examinations.  However, Medicare does cover annual visits with your doctor.  During these visits, your doctor obtains basic measurements, and you and your doctor discuss your health and plan to help keep you healthy during the next year and into the future. 

To get ready for the visit, you complete a Health Risk Assessment, which is a questionnaire about your health status. Your assessment responses - along with the measurements your doctor takes during your visit - help to inform the plan you and your doctor develop to keep you as healthy as possible and make sure you get the medical care, preventive and screening services, medicines, and self-care support you need. 

When you first join Medicare, you can get your Welcome to Medicare visit at any time during your first 12 months on Medicare. During this visit, your doctor learns about your medical history and checks your blood pressure, vision, weight, and height. Your doctor will also recommend and either perform or refer you to get any preventive services you need, like screenings and shots.  Learn more about the Welcome to Medicare visit.

Starting 12 months after your Welcome to Medicare visit, you can schedule your first Annual Wellness Visit.  After that, you can get an Annual Wellness Visit every 12 months. During the Annual Wellness Visit, your doctor will check your blood pressure, weight, height, and assess your body-mass index.  You and your doctor review your health, your medicines, and any treatments you receive.  You and the doctor create a plan to keep you healthy, including any screenings and shots you may need over the next year, and look ahead to your needs in the next 5 to 10 years. If your doctor finds it necessary, he may refer you to other doctors, or may give you a vision test, an Electrocardiogram (EKG), or any other needed test. Learn more about the Annual Wellness Visit.

You will not be charged for your Welcome to Medicare visit and Annual Wellness Visits; these services are fully covered by Medicare so there are no deductible charges or co-insurance paid by you. Sometimes one of these visits may be combined with other Medicare services for which cost-sharing does apply.  For example, if your doctor takes your blood pressure during the Welcome to Medicare visit and it's really high, the doctor should determine a treatment plan to bring your pressure down.  That service is not considered a part of the visit, so you could be charged the regular Medicare Part B 20% co-insurance amount for that part of your interaction with the doctor.  It's not unusual for doctor visits to include more than one service.  For Medicare, some may be free of cost-sharing while others might cost you.

Do you want more information? You can get personalized help with your Medicare questions. Get help in your local area through your State Health Insurance Assistance Program. This service is unbiased, supported by the Medicare program and free to people with Medicare.  A trained counselor can review Medicare rules with you and help you get the services you need.

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