Physical exams differ from Medicare Wellness Visits in that your doctor focuses on what’s wrong instead of what’s right. Each is important, depending on the situation.
A physical exam helps your doctor determine what the problem is and how to treat it. If you’re sick or in pain, you want to get better.
An annual wellness exam helps your doctor understand what’s working for you and how to support your health and well-being in the future.
Services of physical exam and a Medicare wellness visit
See the chart below for a list of some of the services that may be covered in both a physical exam and a Medicare wellness visit.
A physical exam may cover some services that are not covered by a Medicare wellness visit
| Physical Exam | Medicare Wellness Visit |
| Take a look at your medical and family history | Take a look at your medical and family history |
| Routine measurements such as height, weight, and blood pressure should be taken | Routine measurements such as height, weight, and blood pressure should be taken |
| Preventable diseases can be assessed by assessing risk factors | Maintain a list of medical providers and prescription drugs |
| Vital signs and reflexes should be checked | Cognitive wellness test |
| Submit urine and blood samples for testing | Health advice tailored to your needs |
| Examine the lungs, head and neck, abdomen, and nervous system | Schedule preventative screenings |
How does a physical exam work?
A physical exam is a health assessment that looks for health problems in your body.
Doctors use their senses to assess your health, primarily sight, touch and hearing. Based on what they learn, they may recommend tests to reveal or rule out possible health issues.
Some of the things your doctor may do during a physical examination are listed below.
- Check your body for signs of existing health problems
- Check your eyes, ears, nose, and throat for potential problems
- Detect irregular sounds in your heart and lungs
- Feel for abnormalities on your body by touching it
- Reflexes and motor function tests
- Examine the pelvis and the rectal area
- Take your height, weight, and blood pressure measurements
Annual physicals are not covered by Medicare. The exam and any tests ordered by your doctor are separate services, and each may have costs associated with it.
How does a Medicare Wellness Visit work?
A Medicare Wellness Visit, also referred to as a wellness exam, is an assessment of your overall health and well-being. The primary objective is to develop or update your personalized prevention plan. Once you have had Medicare Part B for a minimum of 12 months, you are eligible for a wellness visit once every 12 months (11 full months must have passed since your last visit).
In order to determine your risk of common preventable health problems such as heart disease, cancer, and type 2 diabetes, your primary care provider uses information from your visit combined with your medical record. Your doctor creates a personal prevention plan that includes a list of screenings you need to take based on what’s learned.
Some of the things your doctor may do during a wellness exam are listed below.
- Review your health risk assessment (questions you answered about your health).
- Make sure your medical history and family history are accurate
- Keep a record of your current prescriptions and providers
- Your height, weight, and blood pressure should be measured and documented
- Keep an eye out for signs of memory loss, dementia, or frailty
- Keep a record of your health risk factors and treatment options
- Personalized health advice
- Create a screening schedule (like a checklist) for the preventive services you should receive
You do not have to pay a copay or deductible for an annual wellness exam or many preventive screenings covered by Medicare Part B. While a wellness exam is not mandatory, there are many good reasons to have one every year, even if you have to pay a portion of the cost of certain tests and services.
How does a “Welcome to Medicare” visit work?
This visit is known as an Initial Preventive Physical Exam (IPPE). You are eligible for this benefit once within the first 12 months of enrolling in Medicare Part B.
- The “Welcome to Medicare” visit: what to expect
- Your provider will do the following during the visit.
- Examine your medical and family history, current health conditions, and prescriptions.
- Get a baseline for your care by checking your blood pressure, vision, weight, and height.
- Stay up-to-date with preventive screenings and services, such as cancer screenings.
- Depending on your general health and medical history, order further tests.
- There is no copayment or Part B deductible for your “Welcome to Medicare” visit.
After the visit, your provider will give you a personalized prevention plan or checklist with screenings and preventive services recommended for you. You may be required to pay a co-payment for the recommended services when you get them. You may also have to pay your Part B deductible.
Is it necessary to have a physical every year?
A number of doctors have questioned the value of physical exams in recent years due to over-testing, false positive results, and unnecessary costs. According to your health needs, coverage, and budget, you should decide if you want to get an annual physical exam. However, you should take advantage of your Medicare benefits and schedule a Medicare Wellness Visit every year.
