Most of us have had experiences with a yearly physical exam. These routine exams are a procedure that allows your provider to assess your general health. Most private insurance plans cover these yearly physicals, however, Medicare Part B does not. Instead, Medicare Part B covers a one-time exam called an Initial Preventive Physical Examination (IPPE), and then afterward, an annual wellness visit.
First, What Does an IPPE Visit Include?
When you first enroll in Medicare, they allow you an IPPE that is covered one time, within the first 12 months of receiving Medicare Part B coverage. This initial physical exam will cover the following items to assess your overall health:
- Record and evaluate your medical and family history, current health conditions and prescriptions.
- Check your blood pressure, vision, weight, and height to get a baseline for your care.
- Make sure you are up to date with preventive screenings and services, such as cancer screenings and shots.
- Order further tests, depending on your general health and medical history.
- You do not pay a copayment for your “Welcome to Medicare” visit. The Part B deductible does not apply to the cost of the visit either.
When the exam is complete, your provider will give you a prevention plan, or list, of screenings and preventive services that are recommended for you. *These services are not part of the “Welcome to Medicare” visit and may require you to pay a copayment when you get them. Your Part B deductible may also apply. *
Physical Exams vs. Wellness Visit
What’s Included in a Physical Exam?
An annual physical exam is an assessment of your body’s overall health. The primary purpose is to look for health issues. The list below shows some of the things your doctor may do during a physical exam (This is not a comprehensive list).
- Visually check your body overall for signs of existing health issues
- Look into your eyes, ears, nose and throat for potential problems.
- Listen to your heart and lungs to detect irregular sounds.
- Check your body for abnormalities.
- Test your motor function and reflexes.
- Perform pelvic and rectal exams.
- Measure your weight, height and blood pressure.
Again, as a rule, Medicare does not cover annual exams. This and any recommended testing or screenings are separate services, so there may be additional costs related to each depending on your Medicare plan.
What’s included in a Medicare Wellness Visit?
A Medicare Wellness Visit (wellness exam) is a review of your overall health and well-being by combining information from your visit with your medical records to assess your risk for common preventable health issues such as heart disease, type 2 diabetes and cancer. The purpose of a wellness visit is to develop a baseline for current well-being and prevent future issues. Medicare covers a wellness visit on time every 12 months (11 full months must have passed since your last visit), once you have had Medicare Part B for 12 months, you are eligible for it. Based on what’s learned, your provider will create a prevention plan including screenings you should have.
Some of the things your provider may do during a wellness exam (this is not a comprehensive list).
- A health risk assessment (questions you answer about your health)
- A review of your medical and family history
- A review of your current prescriptions and providers
- Measure and document your height, weight, and blood pressure
- Look for signs of memory loss, dementia or frailty
- Assess your health risk factors and treatment options
- Provide specific health advice
- Develop a screening schedule for the preventive services recommended for you
Although Medicare Part B covers your annual wellness exam and many preventive screenings with no copay or deductible, if your provider performs additional services and tests during your appointment that aren’t covered, you will be responsible for these costs. Be sure to state clearly to your provider and their office that this is a Medicare Wellness visit and NOT an annual physical to avoid unexpected bills.
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*We do not offer every plan available in your area. Currently, we represent 11 organizations that offer 126 products in your area. You can contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program for help with plan choices.