Many seniors are surprised to find out Medicare does not cover physicals. We regularly receive calls from clients wondering why they were billed for something that is usually considered a preventative service. While Medicare does want you to see your primary care provider, incorrect coding for a visit can result in surprise bills.
Let’s look at what Medicare does and does not cover:
“Welcome to Medicare” Visit – Seniors are eligible for this visit one time within the first 12 months they are enrolled in Part B. This visit is quite thorough; the doctor reviews family history, current health conditions, and prescriptions. The doctor also establishes a baseline for blood pressure, vision and weight. Sometimes, certain screenings and shots are ordered. There is no copayment for this visit, and the Part B deductible does not apply.
“Annual Wellness” Visit – This is what most people think of when they hear the term “annual physical,” although this visit is mostly about prevention. While assessing overall health and well-being, doctors want to develop and update a personalized prevention plan. Medicare covers this visit once every 12 months (11 full months must have passed since your last visit). Occasionally, doctors will run tests that fall outside the bounds of this regular visit, which could be billed.
“Annual Physical” – Physicals are generally full, head-to-toe exams. Doctors listen to heart and lungs, feel neck and abdominal area, test reflexes, and more. This exam is more thorough than the “wellness visit,” and these appointments are not covered by Medicare or a Medicare Supplement.
Differentiating between these visits and the way they are medically coded can help prevent surprise bills. When you call your doctor to schedule an appointment, make sure you talk through exactly what you’ll need, knowing that a “physical,” will likely involve more screening and will be your financial responsibility. I always recommend asking your doctor exactly what Medicare will cover and confirming costs up front.
My team would love to come alongside and assist you in your Medicare journey. We’ve been blessed to be able to help thousands of seniors in Denton and Tarrant County. Our services are always free, so don’t hesitate to call 800-750-2407 or swing by 2604 Long Prairie Road, Suite 100 in Flower Mound.
God Bless.
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