Did you realize? Medicare doesn’t cover a physical exam

A friend who’s recent to Medicare asked me if Medicare covers annual doctor visits. I told him, “No, that’s not the case.” The Social Security law is obvious prohibits Medicare from paying for annual physical exams.

Every week later he told me I used to be fallacious. He found evidence that Medicare actually covers these exams. “Physical exams, right there, on that HHS.gov websitein the list of services covered by Part B.” (Health and Human Services is an agency of the federal government that administers health and human services programs, including Medicare.)

I replied that I wasn’t fallacious, HHS just cut the title for a preventive service that Medicare covers.

The Affordable Care Act introduced the primary preventive physical examination. This preventive service for Medicare recipients isn’t much like a physical exam. There isn’t any palpation (feeling with fingers or hands), no auscultation (hearing body sounds) and no percussion (tapping body parts). all essential components of a physical examination. And unlike annual checkups, you will only receive a single visit throughout the first 12 months of enrolling in Part B.

Because “physical examination” is within the title, there was and continues to be considerable confusion. Medicare now calls this service a “Welcome to Medicare” screening visit..

More concerning the welcome visit

The Welcome to Medicare visit is a review of your medical and social history and a consultation about preventive services. Special, This visit includes:

• Measurements of height, weight and blood pressure
• A calculation of body mass index
• An easy eye test
• A review of risk aspects for depression, functioning and safety levels, and current opioid prescriptions
• Screening for visual acuity and possible substance use disorders
• Education, advice and referral based on the previous components and
• End-of-life planning (if the patient consents).

Annual Medicare Wellness Visit

Medicare offers a second preventative visit; this takes place every 12 months. While it could occur annually, this visit can be not a physical exam. The purpose is to update the personalized prevention plan. The components include:

• A review of the medical and family history
• Height, weight, blood pressure and other routine measurements
• Detection of cognitive impairment
• Personal health advice
• Updating the list of current providers, suppliers, prescriptions and health risk aspects and
• Advance care planning.

Both visits involve a plan for screenings, vaccinations and other preventative services, including:

• Flu and COVID vaccinations
• The Respiratory Syncytial Virus (RSV) vaccine (now covered without cost sharing under Part D Prescription Drug Coverage).
• Annual mammogram
• Prostate cancer screening and
• Colonoscopy.

Medicare covers many other preventive services designed to assist beneficiaries stay healthy, often without cost sharing. You can find the list here.

Take-away points

First, a couple of points concerning the two wellness visits.

• There are not any costs for the initial welcome or annual wellness visits.
• However, if the doctor mentions a medical problem, corresponding to increased blood pressure, do not be surprised when you receive a bill. This is since the visit is taken into account a diagnosis and a cost-sharing fee (deductible and/or co-payment) applies.
• If you may have original Medicare, search for providers that accept Medicare orders.
• Once you have chosen a Medicare Advantage plan, you may schedule your appointments with in-network doctors, more than likely your primary care doctor.

And here’s what my friend and it’s worthwhile to learn about annual physical exams.

• Even if Medicare doesn’t cover it, you’ll be able to still have a physical exam. However, be mindful that you might have to pay for parts or the entire thing. Part B, for instance, would cover an EKG or chest X-ray for medical reasons, corresponding to cardiac arrhythmia or severe pulmonary congestion, with the same old cost sharing.
• Some Medicare Advantage plans offer routine physical exams, generally performed by your primary care doctor. For more information, see the plan’s proof of coverage.
• Regardless of the problem, you have to be aware that what you read on a web site is probably not accurate. Double check your insurance coverage before proceeding.