Medigap Annual Wellness Exam Costs Explained

Have a Medicare Supplement? Learn what your yearly exam costs!

by Katie Banks+ on Jan 12, 2018 | 5 Comments

Does Medigap cover preventive testing and all preventive out-of-pocket charges? That is the $100,000 question. Since we know how important preventive care is to your health, we have created this quick rundown of how it works.

Medicare Annual Wellness Exam

The first thing everyone needs to know is that Original Medicare DOES NOT cover “Physicals.” Medicare offers a free “Welcome to Medicare Screening” and an Annual Wellness Exam, but not Physicals. Usually 100% of Medicare’s Annual Wellness Exam is usually covered by Original Medicare Part B. These are the main services offered during your annual exam:

1) An Office visit where your doctor will:

  • Take height, weight, blood pressure, and other routine measurements
  • Detect any cognitive impairment
  • Offer personalized health advice
  • Review of your medical and family history
  • Provide a list of risk factors and treatment options for you


2) Certain screenings and test based on frequency or your age:

  • Lipid blood panel to check cholesterol every 5 years
  • Colorectal cancer screenings every 12 to 120 months (depending on the test)
  • Mammogram screenings once a year
  • See a list of other Medicare preventive screenings

Medicare Annual Exam’s Costs

For most of the above, you won’t need to worry about out-of-pocket costs, because Original Medicare’s Part B has you covered. However, if you happen to need more frequent testing than outlined above, it is consider a diagnostic exam, and you could be charged the Part B deductible, copays, excess charges and coinsurance.

This happens more often than you think.  For example, if your doctor wants you to have your cholesterol checked every year, then you would have to pay those fees 4 out of 5 years.

The good news: The majority of Medigap plans pay all of your Part B coinsurance and copays*. However, only Medigap Plan F will cover your Part B excess charges and your part B deductible. So, if you end up need diagnostic testing, with Plan F you should have no out of pocket expenses.

Learn More about Medigap Get a Medigap Quote

*Plans K and L make you pay 50% and 75% of these costs, respectively. Plan N requires you to pay a $20 copay per doctor’s office visit.

Next Steps

If you have Medicare and Medigap, call your doctor and set up your annual exam. If you don’t have Medigap yet, call one of our Senior65 licensed independent insurance agents at 800-930-7956.

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Reader Comments and Questions

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By Pablo on March 29, 2019

I have Medigap Plan F with United American Insurance. Went to a diagnostics lab and they say my Medicare/Medigap do not pay for Thyroid and T4 exams. Is this correct? Thanks

Pablo,
With the exception of foreign travel emergency, if Medicare does not cover it, then neither will Medigap. You should contact your plan/agent to clarify how that works. If you are currently working with us, please give us a call.
-Chris from Senior65.com


By Francis on January 17, 2019

Without my realizing it my doctor conducted my annual wellness visit three days shy of a calendar year. Medicare denied the bill and the doctor billed me for the higher non-Medicare cost. Was I negligent? Or is this the physician's mistake I shouldn't have to pay for?

Hello Francis,
We're sorry to read that. It is probably best if you contact Medicare directly with this issue.

-Chris from Senior65.com


By don on March 24, 2018

I was given a "wellness exam" by my doctor when I turned 65. I asked the nurses doing it before they started if this would be covered by medicare and they said yes it would be. 9 months later I get a bill for $161 stating that the initial exam was not covered. I have Medicare Part B and Part F. Should I have to pay this bill? I told them up front that I was not going to take it if it was not covered.

Don,
You shouldn't have to pay it. According to Medicare "You pay nothing for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply." -Michelle from Senior65.com


By Sandra on February 25, 2018

I have medigap plan N. I understand I will pay $20 deductible for a doctor visit. Is this also true if it is a wellness visit?

Sandra,
There should be no charge for wellness.
-Eric from Senior65


By Bruce Ross on May 19, 2016

My cholesterol is high! 245. I have to get it tested each year. I turn 65 in September. So, I'll have to pay out of pocket for my cholesterol testing each year unless Medicare pays? That seems unfair! Are they trying to kill us?!

Bruce,
We totally understand your concern. If you need more frequent lipid testing, Medigap has you covered. All Medigap plans pay all or part of your copays and coinsurance, and if you're concerned about covering your Part B deductible you should enroll in Medigap Plan C and F. To learn more about how Medigap covers your out of pocket costs call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/



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