Every year I hear the same story. Someone books their “Medicare physical,” gets blood work and a full exam, and then gets a bill they did not expect. The reason is simple: the Medicare Wellness visit and a physical are two different things, and Original Medicare only pays for one of them.
Here is the difference, what each one costs, and how to book the right one.
The short answer
- Yearly Wellness visit: a planning conversation about your health. Medicare Part B covers it once every 12 months at no cost when your doctor accepts assignment.
- Routine physical: a hands-on exam, often with routine blood work. Original Medicare does not cover it, so you pay the full bill.
What the yearly Wellness visit includes
The Wellness visit is mostly questions and planning, not an exam. Medicare lists what the doctor covers:
- A health questionnaire you fill out, covering your health, habits, and daily activities
- An update of your medical history, family history, and medicines
- A list of the doctors and other providers who care for you
- Weight and blood pressure (height and body mass index at the first one)
- A check for memory or thinking problems
- A depression screening
- A review of fall risk, hearing, and safety at home
- A written schedule of the screenings you should get over the next 5 to 10 years
- A review of any opioid prescriptions, and a screening for substance use
- Advice and referrals based on your risks
- A conversation about an advance directive, if you want one
When you can get it
You can get your first yearly Wellness visit once you have had Part B for more than 12 months. After that, you can have one every 12 months.
In your first 12 months on Part B, you get the one-time Welcome to Medicare visit instead. You cannot have a Wellness visit within 12 months of your Welcome visit.
What a routine physical includes
A routine physical is what most people picture when they think of a checkup. The doctor listens to your heart and lungs, checks your body from head to toe, and often orders routine lab work like a cholesterol panel or blood sugar test, even when you have no symptoms.
Original Medicare does not cover routine physicals. If you book one, you pay for it yourself. A Medicare Supplement plan will not help here either, because Supplement plans only pay toward services Medicare covers.
Many Medicare Advantage plans do cover a yearly routine physical. If you have an Advantage plan, check your plan’s Evidence of Coverage or call the plan before you book.
How a free visit turns into a bill
The Wellness visit itself is free when your doctor accepts assignment. Charges show up when other care happens in the same appointment:
- You bring up a health problem. If you ask about a new symptom or adjust a medicine, the office can bill that part as a regular office visit.
- The doctor orders lab work or tests. Tests ordered to check a problem are billed separately.
- The visit is booked as a physical. If the office codes it as a routine physical, Original Medicare will deny it and you get the bill.
For care that Part B covers, you pay the Part B deductible of $283 for 2026 if you have not met it, then 20% of the Medicare-approved amount. A Medicare Supplement plan may pay some or all of that 20%.
Many recommended screenings are still free
The screening schedule from your Wellness visit points you to preventive services Medicare covers on its own schedule. Many of them, such as a yearly flu shot, a screening mammogram, and cardiovascular blood screening every 5 years, cost nothing when your provider accepts assignment. Ask your doctor which of your screenings fall into that group.
How to book the right visit
- Use the exact name. Ask for your “Medicare annual Wellness visit.” Do not ask for a physical.
- Confirm the doctor accepts Medicare assignment.
- Ask what will be billed besides the Wellness visit, before the appointment.
- Bring a list of medicines and supplements and the names of your other doctors.
- Book a separate visit for health problems if you want the Wellness visit to stay at no cost. Some offices handle both in one day, so just ask how they will bill it.
Common questions
Is the Medicare Wellness visit the same as a physical?
No. The Wellness visit is a planning visit built around questions, basic measurements, and a screening schedule. A physical is a full hands-on exam, usually with routine lab work. Original Medicare covers the Wellness visit but not the physical.
Can my doctor see me for a health problem on the same day?
Yes. Many offices do both in one appointment. The Wellness part stays at no cost, and the problem-focused part is billed as a regular office visit with your normal Part B cost sharing.
Is blood work part of the Wellness visit?
No. Routine labs are not part of the visit. Some screening blood tests are covered on their own schedule, such as cardiovascular screening every 5 years, and diabetes screening if you have certain risk factors. Labs ordered to check a symptom or manage a condition are billed under Part B.
Will a Medicare Supplement plan pay for a yearly physical?
No. Supplement plans only pay toward services Original Medicare covers, and routine physicals are not one of them. Some Medicare Advantage plans do cover a yearly physical.
How often can I get the Wellness visit?
Once every 12 months, starting after you have had Part B for more than 12 months and at least 12 months after your Welcome to Medicare visit.
Does your plan cover what you actually use?
If a yearly physical matters to you, that is worth weighing when you compare coverage. Some Medicare Advantage plans include it, while Original Medicare with a Supplement plan does not. Our Medicare Advantage help and Medicare Supplement help pages lay out the tradeoffs.
The Medicare Clarity Score takes about three minutes and flags coverage gaps and overpayment risks in your current plan. You can also call Scott at 512-844-3983 to talk it through. There is no cost and no pressure.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not affiliated with or endorsed by the federal government or the federal Medicare program.