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Dear Connie,
I’m 65 and recently signed up for Medicare.
I’m still trying to figure out what’s covered and not. It’s very confusing. I’m wondering, does Medicare cover annual physicals? It’s been a few years since I’ve had one, so I’d like to.
Three years since a physical,
James from Kerrville, Texas
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Local, licensed insurance agents with 25+ years of experienceDear James,
Welcome to Medicare! We understand it can be confusing when you’re acclimating to a new system. And Medicare can be confusing at any stage. We’re happy that you’ve asked us to join your Medicare journey.
Since you recently joined Medicare, I’m curious whether you’re interested in a Welcome to Medicare exam or an Annual Physical. There is a nuanced difference between the two.
Agent tip:
“The difference between a Welcome to Medicare, Annual Wellness Visit, and a physical exam is that Medicare Part B won’t cover a diagnostic physical exam because it’s not a Medicare preventative visit.“
A Welcome to Medicare exam will review your medical and social history, including education and preventative services counseling.
During a Welcome to Medicare visit, they’ll:
To provide you with this plan, you should come prepared with your medical records, including immunizations, your medical and family history, and a list of prescription drugs, over-the-counter drugs, and vitamins.
Original Medicare Part B (medical insurance) covers a “Welcome to Medicare” exam in the first 12 months of enrolling in Part B. Medicare Part B also includes an “Annual Wellness Visit” after you’ve been enrolled in Medicare for 12 months or more. These two visits are very similar.
If you’d like to schedule a “Welcome to Medicare” or “Annual Wellness Visit,” you should mention that when you call your doctor’s office.
Free, unbiased serviceCompare all major plans and carriers Local, licensed insurance agents with 25+ years of experienceYou should call to schedule an Annual Physical if symptoms need diagnosing. Medicare’s physical exams often include checking your lungs, heart, neck, and abdomen. The physical will often include laboratory tests, such as urine and blood samples.
These diagnostics are not taken during an Original Medicare Part B “Welcome to Medicare” or Medicare Wellness Visits. So, if you have symptoms that need to be checked, request a physical exam when you call to make an appointment with your Primary Care Physician (PCP).
A physical exam will often check the following:
The difference between a Welcome to Medicare, Annual Wellness Visit, and a physical exam is that Medicare Part B won’t cover a routine physical exam because it’s not a Medicare preventative visit. It’s diagnostic. The out-of-pocket costs from a physical exam depend on the diagnostic tests run and the exam’s extent. You may need to pay the Part B deductible ($257 in 2025), plus a minimum 20% coinsurance for Medicare-approved doctor services, outpatient therapies, and Durable Medicare Equipment (DME).
There are two ways to reduce your out-of-pocket costs for a physical exam. Enrolling in a Medicare Supplement (Medigap) or Medicare Advantage plan. Because Original Medicare doesn’t have a cap on out-of-pocket costs, many people enroll in one of these plans.
A Medigap plan can help you pay for part or all of your out-of-pocket costs, while a Medicare Advantage plan offers all the benefits of Medicare Part A and B, plus more. Many Medicare Advantage plans provide additional benefits such as dental, hearing, vision, and yearly physical exams.
A local licensed agent can help you find a plan in your area that includes physical exams and other benefits that you’re seeking. Call (623) 223-8884 to speak with a Connie Health agent. We are here to help you throughout your Medicare journey. If you have additional coverage questions, don’t hesitate to reach out.
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Original Medicare Part B covers most preventative measures; their annual physicals are considered diagnostic, not preventative. This is why Original Medicare does not cover them.
If you don’t have any symptoms that need diagnosing, you can get an Annual Wellness Visit, which Original Medicare covers. These preventative visits will review the following:
You should call to schedule an Annual Physical if symptoms need diagnosing. The diagnostic physical will often include laboratory tests, such as urine and blood samples.
For a diagnostic annual exam, you will need to pay the Medicare Part B deductible ($257 in 2025), plus 20% coinsurance on Medicare-approved amounts. Original Medicare has no cap on out-of-pocket costs, so coinsurance costs can add up.
Most Medicare beneficiaries enroll in either a Medicare Supplement or Medicare Advantage plan to shield themselves from the high out-of-pocket costs of Original Medicare. If you’d like to review your plan options and see whether a Medicare Supplement or Medicare Advantage plan is right for your health and budget, call (623) 223-8884. A local licensed Connie Health agent would be happy to help.
No, Original Medicare Medicare Part B does not cover or pay for annual diagnostic physicals. However, they will cover an Annual Wellness Visit that is preventative. During these visits, you’ll be examined for overall signs of existing health issues and the following:
You should call to schedule an Annual Physical if symptoms need diagnosing. The diagnostic physical will often include laboratory tests, such as urine and blood samples.
For a diagnostic annual physical, you will pay the Medicare Part B deductible ($257 in 2025) plus 20% coinsurance for Medicare-approved amounts. There is no cap on out-of-pocket expenses and those can add up.
Most Medicare beneficiaries enroll in a Medicare Supplement or Medicare Advantage plan to shield themselves from high out-of-pocket costs. If you’d like to see whether a Medicare Supplement or Medicare Advantage plan is right for your health and budget, call (623) 223-8884. A local licensed Connie Health agent would happily compare your Medicare plan options.
The “Welcome to Medicare” physical exam is covered within the first 12 months of enrolling in Medicare Part B. This one-time preventive visit provides a great opportunity to discuss your health history, current conditions, and future care planning with your doctor.
The best part? There’s no cost for this visit if your doctor accepts Medicare. However, keep in mind that if additional tests or services are performed during the visit that isn’t considered preventive, you may have to pay the Medicare Part B deductible ($257 in 2025) and 20% coinsurance of the Medicare-approved amount. There is no maximum for out-of-pocket coinsurance costs.
Most Medicare beneficiaries enroll in a Medicare Advantage or Medicare Supplement plan to protect themselves from high out-of-pocket costs. Call (623) 223-8884, and a local licensed Connie Health agent can help you decide whether a Medicare Advantage or Medicare Supplement plan is right for your health and budget needs.
The Welcome to Medicare visit is designed to provide a comprehensive overview of your current health and help you plan for your future healthcare needs. However, it’s worth noting that this initial preventive visit does not typically include lab tests. Instead, it focuses on reviewing your medical and family history, creating a personalized prevention plan, and performing routine measurements like height, weight, and blood pressure.
If your healthcare provider determines additional tests or screenings are needed based on your health history, they may recommend specific lab work. These additional tests would typically be subject to standard Medicare Part B coverage rules. You would pay the Medicare Part B deductible ($257 in 2025) plus a 20% coinsurance. There is no cap on out-of-pocket costs and coinsurance.
Because there isn’t a cap on out-of-pocket costs, most Medicare beneficiaries enroll in a Medicare Advantage or Medicare Supplement plan. These plans can help shield you from unforeseen and high out-of-pocket costs. Call (623) 223-8884, and a local licensed Connie Health agent can help you decide whether a Medicare Advantage or Medicare Supplement plan is right for your health and budget needs.
Read more by Jasmine Alberto
I am a Spanish-speaking Texas Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2007. I am on the the Advisory Committee for Foster Grandparents, Senior Companions, and RSVP Houston. I enjoy traveling, a backyard BBQ, and volunteering in my community.
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