Does Medicare Cover Physicals?

Learn if Medicare will cover your physical examination

by Ray Wilson+ on Mar 24, 2016 | 5 Comments

When you become Medicare-eligible your health care coverage can change quite a bit and you may be wondering if Medicare covers medical physicals. While this seems like there should be a simple answer to this question, there actually is not. Read below for how it works.

Does Medicare Cover Medical Physicals?

Medicare does not technically cover medical physical exams. They do, however, cover preventive “wellness exams”. Don’t get caught up in the language of “physical”. Medicare covers an annual Medicare Wellness exam that will takes measurements, gives your scheduled screenings, and reviews other health issues, such as personal risk factors. This exam is at no cost to you, as long you don’t require additional diagnostic testing or more frequent screenings than approved by Medicare. The important thing to remember that your wellness exam does not do every screening each year.

For example:
Cholesterol screenings are only scheduled once every 5 years under Medicare. If your doctor or other health care provider request that you have more frequent screenings, you may have to pay your Part B deductible, copays, and coinsurance.

Does Medigap Cover Physicals?

Medigap does not cover physicals, either. Remember, don’t get caught up on the word physical. Medicare picks up the costs of your annual wellness exam. Most Medigap will cover the cost of Part B deductible, copays, and coinsurance, you have additional screening as explained above

In the example above, if further cholesterol diagnostic testing and/or more frequent screenings are necessary, your Medigap will pay all or part of these costs (as long as Original Medicare approves the testing).

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Physicals?

Probably not. But the thing is Medicare Advantage may choose to cover your care differently than Original Medicare. With that said, it is probably still unlikely that Medicare Advantage will cover a “physical”, but will probably just cover the costs of your annual wellness exam. You will most likely still be on the same schedule for preventive screenings.

Learn More about Medicare AdvantageGet a MA Quote

Next Steps
To learn more about Medigap and Medicare Advantage call a Senior65 agent at 800-930-7956.

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Reader Comments and Questions

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By Debbi on June 06, 2018

I recently lost my health insurance coverage and cannot get part b until July 2019. I have medicare part A. Am I covered for a "wellness exam" or yearly physical. I cannot get my yearly prescription for Synthroid until I have this exam.

Debbi
Wellness exams are only covered under Medicare Part B. If you recently lost credible coverage you shouldn't have to wait until July 2019 for Part B. Contact our office and we can discuss your case as well as help you look into Medicare Part D (or any additional coverage you might want).
-Michelle from Senior65.com


By Mary on July 03, 2017

I had breast cancer but have not had a pap test since 2014 right before I went on Medicare. Will Medicare now pay for it? I worry about not getting them since I have had cancer and have a strong family history of cancer including 2 sisters and 2 brothers.

Mary,
Medicare covers paps. You will want to contact them directly for your schedule of tests and exams.
-Amy from https://www.senior65.com/


By Timothy on March 25, 2016

I thought there was a more comprehensive visit when you first join Medicare. Am I wrong?

Timothy,
You are not wrong! There is a Welcome to Medicare visit that helps you with the business of Medicare and offers specific screenings for new enrollees.
-Chris from https://www.senior65.com/


By Jency on March 25, 2016

Going off the pap question, what about breast exams and mammograms? How often are they given? I bet prostate exams are given more often than paps!

Jency,
Breast exams are given in the same frequency as your pap (once every 24 months). Medicare covers mammograms once every 12 months. And, you're right, prostate exams and antigen tests are given more often than paps, they are given once every 12 months.
-Amy from https://www.senior65.com/


By Lacey on March 24, 2016

Are you pap smears covered every year?

Lacey,
Pap smears are covered once every 24 months, unless you have an abnormal pap smear. In that case, they are offered once every 12 months. You may have to pay copays, coinsurance, and deductibles if you need to go more often. Medigap can cover these costs. Please call one of our licensed independent insurance agents at 800-930-7956 to help find a Medigap plan in your area.
-Amy from https://www.senior65.com/



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