by Russell Noga | Updated June 21st, 2023
Are you new to Medicare and due for your annual physical?
It’s important to get regular checkups and bloodwork done as you age. However, many seniors put off their yearly physicals due to the high healthcare costs in the United States.
Medicare Parts A & B assist seniors with managing their annual healthcare expenses, covering them for hospital and medical care. However, these policies don’t offer complete coverage of these expenses.
As a result, many seniors opt to go with a Medicare supplement policy (Medigap) to assist them with paying for the remaining 20% of out-of-pocket costs not covered by Original Medicare.
So, do Medicare supplement plans cover annual physicals? Yes, and No.
When Did Medicare Stop Covering Annual Physicals?
Medicare originated in 1965, and it’s never included annual physicals as part of the coverage it offers in Pats A & B. However, this changed in 2011, when Medicare benefits expanded to an “Annual Wellness Visit” (AWV) for all Medicare beneficiaries.
Since the AWV is remarkably similar to an annual physical, Medicare supplement plans (Medigap) don’t cover the costs of yearly physicals outright.
However, there are some instances where these costs may be covered, depending on your Medigap plan type.
What Does Medigap Cover?
The Federal government (CMS) regulates the Medigap industry, ensuring all providers offering these plans have standardized benefits for Parts A & B coverage.
That means the coverage with Medicare Supplement Plan G from one company, for example, is the same across all companies offering this Medigap plan.
All Medigap plans offer the following benefits.
- Part A coinsurance and hospital costs for up to 365 days after using up Medicare benefits.
- Part A hospice care coinsurance or copayment.
- Part B coinsurance or copayment.
- Blood transfusion costs for the first three pints of blood.
Plans F, G, and N offer additional Medicare Parts A & B benefits.
- Part A deductible.
- Part B excess charges (Plan N doesn’t cover these charges).
- Skilled nursing facility care coinsurance.
- 80% of emergency healthcare costs when traveling outside the US for 60 days. ($250 deductible and $50,000 maximum apply).
So, Medigap plans technically do cover annual physicals, depending on which policy you have. For instance, Plans F & G offer comprehensive or near-comprehensive coverage for all Medicare Part B expenses.
So, if you see the doctor and they run a physical on you, the policy covers you for the cost of the consultation and all excess charges involved with your exam.
Does Medicare Part B Provide Coverage for Annual Physical Exams?
Original Medicare Part B doesn’t cover the cost of annual physicals. However, Medicare beneficiaries are entitled to an “Annual Wellness Visit” (AWV) with their physician.
The AWV covers most of the categories you would receive during an annual physical. Some of the services offered in the AWV include the following.
- Recording of your personal medical history.
- Recording of your family medical history
- Review and assessment of the medications and supplements you currently use.
- Review and evaluation of medical and mental health providers.
- Review and assessment of your BMI, weight, height, and blood pressure.
- An evaluation of your cognitive function.
- An examination of your risk for depression and mental health disorders.
- A review of your functional capability.
- A review of your personal safety level.
- Screening for substance use disorder.
The only thing that the AWV doesn’t cover is bloodwork. That’s a critical component of an annual physical, giving physicians a better insight into many health categories, including cardiac function, cancer risk, and other health issues.
However, if you have Medigap Plans F or G, you can visit your physician and have them take your blood for testing, with full coverage of these expenses in your Medigap policy.
The other eight plans available may require copayments, partial coverage, or no coverage for bloodwork screening.
Your doctor uses the information collected during the AWV to recommend preventive screening schedules and provide referrals or healthcare advice relating you your unique healthcare position.
The AWV also involves the process of notifying your doctor about your needs for advance care planning to discuss future health requirements if you become unable to communicate them.
The AWV includes a health risk assessment questionnaire assisting your doctor with analyzing your health risks and lifestyle. Typically, the health risk assessment lasts 20 to 30 minutes and covers the following topics.
- Mental health issues involve stress, depression, anger, fatigue, and pain.
- Social activity and physical activity levels.
- Alcohol and tobacco use.
- Nutritional habits.
- Sexual health.
- Auto and home safety.
- Personal activity performance involves basic activities like eating and dressing.
- Daily activities like grocery shopping, laundry, and finances.
After completing the initial AWV, all follow-up AWVs with your physician include a brief physical exam, followed by updating all information gathered at the previous AWV.
Medicare Part B covers the AWV in full once a year. There are no coinsurance responsibilities, copayments, or deductibles required for this annual service.
If the physician chooses to perform additional testing, you may be responsible for these out-of-pocket costs. However, if you have Medigap Plans F or G, these policies usually cover these costs.
What’s the Difference Between a Physical and a Medicare Wellness Exam?
The AWV exam covers many elements of a standard annual physical. You get a full review of your physical health, including weight, BMI, and blood pressure.
While the AWV doesn’t include bloodwork or other comprehensive testing, it’s a good way to get a snapshot of your annual health and the outlook for the year to come.
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Frequently Asked Questions
Do Medicare supplement plans cover annual physicals?
Medicare supplement plans, also known as Medigap plans, do not directly cover annual physical exams. These plans are designed to help cover certain out-of-pocket costs that original Medicare doesn’t fully cover, such as deductibles, copayments, and coinsurance.
Does original Medicare cover annual physicals?
Original Medicare (Part A and Part B) does cover some preventive services, including certain screenings and vaccinations. However, it does not cover routine annual physical exams, which are considered to be non-preventive or diagnostic in nature.
Are there any exceptions to the coverage of annual physicals under Medicare?
While Medicare doesn’t cover routine annual physicals, there may be exceptions. Medicare will cover a one-time “Welcome to Medicare” preventive visit within the first 12 months of enrolling in Part B. This visit includes a comprehensive review of your health and preventive services.
Can Medicare Advantage plans cover annual physicals?
Medicare Advantage plans (Part C) are offered by private insurance companies and can provide additional benefits beyond original Medicare. Some Medicare Advantage plans may include coverage for annual physicals as part of their plan benefits. It’s important to review the specific details of your plan to understand what services are covered.
What is the purpose of an annual physical?
An annual physical is a comprehensive evaluation of your overall health and well-being. It involves discussions with your doctor about your medical history, lifestyle, and any concerns or symptoms you may have. It also typically includes measurements, screenings, and assessments to detect potential health issues.
If Medicare doesn’t cover annual physicals, should I still get one?
While Medicare doesn’t cover routine annual physicals, it is still important to prioritize your preventive care. Regular check-ups with your healthcare provider can help identify and manage health conditions early on, leading to better outcomes and improved overall health.
What are some preventive services covered by Medicare?
Medicare covers several preventive services, including screenings for cancer, cardiovascular disease, diabetes, and other conditions. It also covers vaccinations, such as the flu shot and pneumococcal vaccines. These services are aimed at detecting and preventing potential health issues.
Can I use my Medicare supplement plan for other types of medical services?
Yes, Medicare supplement plans can help cover various healthcare services, such as hospital stays, outpatient care, skilled nursing facility care, and certain medical supplies. The specific coverage and costs depend on the type of Medicare supplement plan you have.
Are there any other options for covering the cost of annual physicals?
If you want coverage specifically for annual physicals, you may explore wellness programs offered by certain Medicare Advantage plans that include these services. Alternatively, you can pay for the cost of the physical exam out of pocket.
Should I consult my doctor or insurance provider to understand coverage for annual physicals?
It is recommended to consult both your doctor and insurance provider to understand the coverage options for annual physicals. Your doctor can provide guidance on the importance of preventive care, and your insurance provider can explain the specific coverage details based on your plan.
Call Us for Information & Advice on Medicare Supplement Plans
If you want more information on the coverage available in Medigap plans, call our team at 1-888-891-0229. We offer you a free consultation and quote on any Medigap plan.
We’ll recommend the right plan for your healthcare needs and find you the best deal on any plan from leading healthcare insurers in your state.
If you can’t talk right now, leave your details on our contact form, and we’ll get a Medigap expert to call you to discuss your needs. Our website has a tool offering you free automated quotes on any Medigap policy; try it out.
Russell Noga is the CEO of Medisupps.com, an online Medicare Agency and resource center helping Medicare beneficiaries learn about Medicare, Medigap and Part D drug plans, and Medicare Advantage plans since 2009. Russell is licensed in all 50 states and has been featured as a keynote speaker, and author of several publications, along with hosting the very popular Medisupps.com Youtube channel.