Medicare will not pay for a routine medical physical

April 10, 2019
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Medicare will not pay for a routine medical physical. However, they do pay for you to see your doctor once per year. During the first 12 months that you have Medicare Part B, you can get a “Welcome to Medicare” preventative visit. The doctor will review your health via an interview. They can also do some preventative covered services like your flu and pneumonia shots. You pay nothing for this visit if your provider accepts Medicare assignment.

If you have had Part B Medicare longer than 12 months, you can get a yearly “Wellness” visit. Make sure that when you are scheduling the appointment, that you specify that you want a wellness visit.

If your doctor or other healthcare provider performs any additional tests or services during either of your Welcome to Medicare or Wellness visits, during the same visit and they are not preventative, you may have to pay coinsurance and the Part B deductible may apply.

My personal doctor actually does the physical and writes off what Medicare does not cover. However, doctors are not obligated to do that by law. So be careful what you ask for. If you schedule an appointment with your healthcare provider and you have a “diagnosis” (something not normal), then the visit and corresponding tests should be approved to be paid. Medicare is starting to deny some routine screening tests such as a vitamin D blood test. If your provider knows that it is not routinely covered by Medicare, then they are obligated to tell you up front. Generally, you will have to sign paperwork stating you are aware that you may be responsible for the bill.

Remember, if Medicare does not approve the charges, then your Medicare supplement will not pay either.

More questions? We would love to hear from you!