Medicare didn’t stop paying for physicals — it never paid for them in the first place. The belief that coverage was dropped at some point is a common misunderstanding about when Medicare stopped paying for physicals: the exclusion for “routine physical checkups” has been written into federal law since the program was created, and it still sits in 42 U.S.C. § 1395y(a)(7) alongside the exclusions for eyeglasses and hearing aids.1Office of the Law Revision Counsel. 42 USC 1395y – Exclusions From Coverage and Medicare as Secondary Payer What Medicare does pay for are two structured preventive visits and a long list of individual screenings, and knowing the difference is what keeps you from a surprise bill.
Why Routine Physicals Aren’t Covered
Medicare pays for services that are “reasonable and necessary for the diagnosis or treatment of illness or injury.” A routine physical is performed without any specific symptom or illness driving the visit, so it sits outside that framework by definition.1Office of the Law Revision Counsel. 42 USC 1395y – Exclusions From Coverage and Medicare as Secondary Payer Private insurance and most employer plans handle annual physicals differently, which is where the confusion starts.
Instead of paying for a head-to-toe exam, Medicare channels its prevention dollars into two visit types: the one-time Welcome to Medicare preventive visit and the recurring Annual Wellness Visit. Both are covered at no cost to you when your provider accepts assignment, a change that took effect in 2011 when the Affordable Care Act eliminated cost-sharing for recommended Medicare preventive services.2Centers for Medicare & Medicaid Services. Background – The Affordable Care Act’s New Rules on Preventive Care Neither one is a physical.
The Welcome to Medicare Preventive Visit
Within your first 12 months of enrolling in Medicare Part B, you can schedule a one-time Welcome to Medicare visit, formally called the Initial Preventive Physical Examination. Medicare pays for one per lifetime.3Centers for Medicare & Medicaid Services. Initial Preventive Physical Exam You pay nothing if your provider accepts assignment, and the Part B deductible does not apply.4Medicare. Welcome to Medicare Preventive Visit
Your provider reviews your medical and social history, current medications, and lifestyle habits, then takes basic measurements: height, weight, body mass index, blood pressure, and a visual acuity screening.3Centers for Medicare & Medicaid Services. Initial Preventive Physical Exam You’ll also get education and counseling about which preventive services to schedule going forward.
One benefit is unique to this visit. Your provider can refer you for a one-time screening electrocardiogram, and if the referral happens during the Welcome to Medicare visit, Medicare covers the EKG, though you’ll pay 20% of the Medicare-approved amount after meeting the Part B deductible.5Medicare. Electrocardiogram (EKG or ECG) Screenings The opportunity for that screening EKG referral disappears after this visit.
The Annual Wellness Visit
After your first 12 months on Part B, you’re eligible for an Annual Wellness Visit once every 12 months. You don’t need to have had the Welcome to Medicare visit first.6Medicare. Yearly “Wellness” Visits You pay nothing when your provider accepts assignment, and the Part B deductible doesn’t apply.
The point of the visit is to build or update a personalized prevention plan. You’ll fill out a Health Risk Assessment questionnaire. Your provider reviews your medical and family history, current prescriptions, and list of providers, and takes routine measurements like height, weight, and blood pressure.6Medicare. Yearly “Wellness” Visits A cognitive assessment looks for signs of dementia, including Alzheimer’s disease. If impairment is detected, Medicare covers a more detailed cognitive evaluation that includes a functional assessment, safety evaluation, and care planning.7U.S. Dept. of Health & Human Services. Cognitive Assessment and Care Plan Services
You leave with a screening schedule: a personalized checklist of preventive services you should receive over the next 5 to 10 years based on your health and risk factors.2Centers for Medicare & Medicaid Services. Background – The Affordable Care Act’s New Rules on Preventive Care What you don’t get is a physical exam. No listening to your heart and lungs, no palpating your abdomen, no reflex checks.
How People End Up With Surprise Bills
Here’s where things go wrong. You book what you think is a free annual checkup. Your doctor listens to your heart, presses on your abdomen, orders bloodwork, and two weeks later a bill for a few hundred dollars arrives. The visit crossed from a wellness visit into a physical, and Medicare doesn’t pay for that portion.8Centers for Medicare & Medicaid Services. Medicare Wellness Visits
Even without a full physical, the bill can grow. If you mention a new knee pain or ask about a suspicious mole, your provider may address those concerns during the visit. That’s often good medicine, but it triggers a separate office visit charge. Cost-sharing applies to that added service, meaning you’ll owe a copay or coinsurance, and the Part B deductible may kick in.6Medicare. Yearly “Wellness” Visits
Go into the Annual Wellness Visit knowing what it is and isn’t. Update your history, get your cognitive screening, and talk through the prevention plan. If you have active health complaints, consider scheduling a separate appointment so you’re not caught off guard by a split bill. Ask the office in advance whether anything planned for the visit falls outside the wellness codes.
Preventive Screenings Medicare Does Cover
People who want a physical usually want reassurance that nothing is wrong. Medicare covers a long list of individual screenings that do that work, many with no cost-sharing at all. Each screening has its own eligibility rules and frequency limits.
Commonly used covered screenings include:9Medicare. Preventive and Screening Services
- Mammograms: a baseline screening for women 35–39 (once in your lifetime) and annual screening mammograms for women 40 and older.
- Colorectal cancer screenings: screening colonoscopies every 10 years (every 2 years if high risk), stool DNA tests every 3 years, and annual fecal occult blood tests.
- Cardiovascular disease screenings: cholesterol and lipid-level blood tests every 5 years.
- Diabetes screenings: up to two blood glucose tests per year if you qualify.
- Lung cancer screenings: annual low-dose CT scans for eligible beneficiaries.
- Depression screenings: once per year.
- HIV screenings: annually for those aged 15–65, or at any age if at increased risk.
- Prostate cancer screenings: annual PSA blood test and digital rectal exam for men over 50.
Medicare also covers vaccinations (flu, pneumococcal, COVID-19, hepatitis B), glaucoma screenings for high-risk individuals every 12 months, hepatitis B and C screenings, and counseling for alcohol misuse, obesity, and tobacco use.10Medicare. Your Guide to Medicare Preventive Services Between the Annual Wellness Visit and these individual screenings, Medicare picks up much of what a traditional physical would catch. You just receive each service under its own coverage rules rather than bundled into one exam.
Medicare Advantage and Routine Physicals
Everything above applies to Original Medicare (Parts A and B). If you’re in a Medicare Advantage plan (Part C), a routine physical may be included. Advantage plans must cover everything Original Medicare covers, and they’re allowed to offer extra benefits on top.11Medicare. Medicare and You Handbook 2026
Many Advantage plans include routine physicals along with vision, hearing, dental, and fitness benefits. The specifics vary by plan, including how often you can get a physical and what cost-sharing applies. If a traditional annual physical matters to you, check your plan’s evidence of coverage document or call the plan directly.
Paying for a Physical Out of Pocket
If you’re on Original Medicare and want a comprehensive physical anyway, you’ll pay the full cost yourself. Prices vary by location, provider, and what tests are included, but a new-patient comprehensive wellness exam with common lab work and an EKG typically runs between $350 and $500 nationally. Some providers offer cash-pay discounts, and community health centers tend to charge less.
Ask the billing office for an upfront estimate that itemizes each component before you schedule. A routine physical means different things to different practices, and what gets ordered during the visit drives the final cost. It’s also worth asking whether any tests your doctor wants to run might qualify as medically necessary diagnostic services, which Medicare would cover separately from the physical itself.