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Does Medicare Cover A Physical Exam?

Aug 18, 2016

Depositphotos_21581271_original.jpgNew Medicare beneficiaries want to know: Does Medicare cover a physical? No, Medicare does not cover physical examinations. Medicare does offer a “Welcome to Medicare Preventive Visit,” sometimes referred to as the “Initial Preventive Physical Examination.” However, do not mistake this for a physical. It is a free visit that focuses on prevention. Here are the various components.

  • A review the beneficiary’s medical and social history, including past medical and surgical history
  • Family history and events that can increase the beneficiary’s risk
  • Status of preventive screenings and services, including immunizations
  • Current medications and supplements
  • A review ofthe beneficiary’s functional ability, including hearing, activities of daily living, risk for falls, and level of safety
  • An examination of height, weight, body mass index (BMI), blood pressure, and visual acuity
  • History of alcohol, tobacco, and illicit drug use
  • Diet
  • Physical activities
  • Potential risk factors for depression and other mood disorders
  • End-of-life planning (advance directives) with beneficiary’s agreement
  • Education, counseling, and referral based on the visit findings
  • Discussion about Medicare’s preventive services
  • Brief education, counseling, and referral to address any pertinent health issues

The visit may also include performance and interpretation of an electrocardiogram (EKG or ECG). Medicare considers this the “once in a lifetime” screening EKG. If done, Part B deductible and coinsurance can apply.)

This visit is not a head-to-toe examination. The “examination” part is very focused, looking only at a few components. If the visit goes beyond these components or the physician orders any additional services or tests, Medicare Part B deductible and coinsurance can apply.

Those with Original Medicare must see providers who accept assignment in order for visit to be free. Medicare Advantage plan members should consult a plan representative. They will likely have to see in-network providers. But know, Advantage plans are not allowed to charge for any preventive services that Original Medicare covers for free.

For more on Medicare's wellness visit, click on this link —


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