Medicare's yearly "Wellness" visit is a conversation-based visit to create or update a prevention plan, and Medicare.gov says you pay nothing for it if your provider accepts assignment, but it isn't a routine physical exam. Original Medicare doesn't cover routine physicals, so if your provider does one, Medicare.gov says you may have to pay the full amount. The difference often comes down to what happens in the exam room and how the visit is billed.
What happens at a yearly wellness visit?
Medicare.gov describes it as a conversation-based visit with your doctor or other provider. During the visit, your provider will:
- Take routine measurements, like height, weight, and blood pressure.
- Review your health questions and history. You may fill out a questionnaire first.
- Develop or update a personalized prevention plan.
- Give you a written plan, like a checklist, of the screenings, vaccines, and other preventive services you need.
- Review your pain treatment if you use opioids.
- Check for signs of cognitive impairment.
You can get it once every 12 months.
The one-time "Welcome to Medicare" visit is similar. Medicare.gov is clear that it "isn't a comprehensive physical exam" either.
What is a routine physical?
A routine physical is a hands-on, head-to-toe exam. A doctor might listen to your heart and lungs, check your abdomen, test reflexes, and order routine blood work, even if you have no symptoms or complaints.
Medicare.gov says the yearly wellness visit "isn't a routine physical exam," and that if Medicare doesn't cover additional tests or services, like a routine physical exam, you may have to pay the full amount.
How does this show up on my bill?
What you owe depends on how the provider codes the visit.
This table is our general summary, based on Medicare.gov's description of the wellness visit. Your bill and your Medicare Summary Notice show what actually happened.
| What happened | How it may be billed | What you may owe |
|---|---|---|
| Wellness visit only | Yearly wellness visit | Nothing, if the provider accepts assignment |
| Wellness visit plus a routine physical | Wellness visit plus a non-covered physical | The full cost of the physical |
| Wellness visit plus a new health problem looked at | Wellness visit plus a problem-focused office visit | Part B deductible and 20% coinsurance for the office visit part |
| Routine physical only | Non-covered physical | The full cost |
Why do some offices call it an "annual physical"?
Many people and some offices use "annual physical" loosely. When you book, the scheduler might put you down for a physical when you wanted a wellness visit, or the reverse. That one word can change your bill.
Should the office warn me before billing me for a physical?
Some offices give a written notice before services Medicare won't cover, and some don't. Don't count on getting one. The safest move is to ask before the exam starts: "Is anything today going to be billed as a routine physical?"