Medicare Coverage for Annual Physicals

8 Preventive Screenings Medicare Will Cover
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Help Medicare enrollees stay on top of screenings they're entitled to

Medicare covers a considerable amount of preventive medicine, and beginning in 2011 it will cover even more. Medicare Part B covers a number of important screening tests -- as of January 1, 2011, paying 100 percent of the cost -- if the person you're caring for meets certain conditions. If you know what these tests are, you can make sure she asks her doctor to order the test whenever it's appropriate.

1. Comprehensive physical exam

Medicare covers one general physical exam, called an initial "wellness exam," within six months of the date a person first enrolls in Part B. This exam includes a comprehensive health-risk assessment. Your care receiver should notify her primary care doctor's office when she first enrolls in Medicare Part B and schedule this exam. Thereafter -- beginning January 1, 2011 -- anyone enrolled in Medicare Part B is entitled to one such wellness exam every year.

2. Colorectal cancer screening

Colorectal cancer is a deadly disease that becomes more common as people age. Screening for this cancer is done through several tests, which can be time-consuming and expensive. As a result, they aren't regularly scheduled and must be specially ordered by an older adult's doctor. Medicare Part B will pay for a screening test if her doctor orders it based on medically accepted risk factors. Even without any specific risk factors, most doctors will order a screening -- and Medicare will pay for it -- about every five years for people over 65.

3. A pelvic exam and Pap smear for older women

Medicare Part B covers a pelvic exam and Pap smear for a woman once every three years. If she has any personal or family medical history that places her at higher risk for cervical or pelvic disease, Medicare will cover the exam every year if her doctor provides Medicare with the reason (meaning the risk factor) when submitting the bill to Medicare. She doesn't need to do anything except remind the doctor to schedule the exam for her. Medicare pays the full amount of this exam even if she hasn't yet met her Medicare Part B yearly deductible.

4. Yearly mammograms for women

Every woman who qualifies for Medicare is entitled to a yearly mammogram covered by Medicare Part B. Medicare pays the full amount even if she hasn't yet paid her yearly Part B deductible. If she has the mammogram at a clinic or facility without a doctor's prescription, she has to make sure that the facility participates in Medicare so that Medicare will pay and the facility will accept Medicare's payment as payment in full.

5. A bone density test for women

Women are at much greater risk than men for osteoporosis, a decrease in bone mass that makes the bones fragile and easily broken. The likelihood that a woman will develop the disease increases with her age. If she has been identified by her doctor as being at high risk for osteoporosis, Medicare Part B will pay for a bone density test for her.

Additional screenings Medicare will cover

6. Yearly prostate cancer tests for men

Prostate cancer is a deadly disease that may exhibit no physical symptoms in its early stages. Luckily, initial screening tests for prostate cancer are simple and inexpensive. Medicare Part B will pay for each man to have an annual screening, as well as any follow-up tests if medically indicated.

7. Diabetes screening as needed

If an older adult's doctor says she's at risk for diabetes -- because of being overweight, having a family history of diabetes, or other risk factors -- Medicare Part B will pay for a regular screening test for the disease.

8. Yearly glaucoma tests

Glaucoma is a serious eye disease that can cause blindness. There are good screening tests to spot glaucoma, and Medicare Part B pays for one such test each year.

Joseph L. Matthews

Joseph Matthews is an attorney and the author of numerous books, including Social Security, Medicare, and Government Pensions, Long-Term Care: How to Plan and Pay for It; How to Win Your Personal Injury Claim; and The Lawyer Who Blew up His Desk. See full bio

over 1 year, said...

I am new to Medicare. Had my annual gynecological check up. Medicare paid for my pap but not the office visit to obtain it. Can't have the pap without the visit????

over 2 years, said...

I went in for my 2015 wellness exam and was charged for a blood drawing. I was also charged for a copayment of 15.00 It was not collected at the time I approached the Dr. Window but it was collected in the total coded office visit. When I questioned this, I found out in was built into the total office visit charge. I have a supplement policy called "the advantage plan"

over 4 years, said...

Ihad a Medicare physical and wasn't asked to disrobe. Had on heavy winter clothing. Is this typical? Is it good medicine?

over 4 years, said...

I had to sign a form in the gynecologists office saying I would pay $100+ if I needed to ask any questions not related to the PAP text and breast examination. Or I could come back another day for the other concerns. They say Medicare will only pay for the PAP and breast exam in one visit. Is this true or is my doctor trying to make extra money or get rid of Medicare patients?

over 4 years, said...

My gynecologist office told me that Medicare will not pay for my annual office visit with them and that I would have to go to my Primary Care Providers' office for my annual physical with pap smear, etc. or pay out of pocket for the doctor visit with them. The tests would be paid for by Medicare though. I had to sign an Advance Beneficiary Notice of Noncoverage. I am wondering if this is true or is my gynecologists office just trying to eliminate Medicare patients. They stated that it had something to do with a billing code they cannot use because they could not use the same code as my primary care office uses. I am confused and not real happy about this situation. I have been with this gynecologist's office for many years.

over 4 years, said...

I do not like the goverment to tell me what to do .Obamacare is not for me.

over 4 years, said...

Is my annual physical covered any time during the calendar year or does it have to be at a year from the last physical for Medicare to cover ?

over 5 years, said...

Is there any way for the visiting doctor at my mom's assisted living facility to check and see when she's NEXT eligible for some of these preventive screenings without going through her regular primary doctor? Or is the burden of contacting the primary care doctor and then scheduling preventive care placed on the patient (or in my case, the patient's family)?

about 6 years, said...

i am 53 yrs old...I taught emotionally disturbed students for 25 yrs w/ VBCPS. I also coached BB and track. I have had Type one diabetes for 39 yrs . Began passing out -in the classroom and was put on permanent disability in 2006. through VRS. SS disabilty turned me down. Can I apply for additional funds from retirement or ss at this time? Thank u. Janet Allen

over 6 years, said...

The initial physical exam that Medicare covers is not called "wellness exam". It is called the "Welcome to Medicare" exam, and it is very thorough, more so than the usual annual exam. It includes a echo-cardiogram screening check for enlarged aorta, for example. My initial wellness exam last year was actually a physical exam, but that was only because the mistake in the 2011 Medicare manual suggested that it should be. I took the real "wellness exam" today and found it somewhat useful - they took my blood pressure sitting, standing, and after running down the hall twice. They evaluated my possibility of falling. After the wellness exam, I scheduled my usual physical checkup. The doctor will be somewhat better informed. Somewhat.

almost 7 years, said...

Thank you for letting me get this information. This is my first time and it is helping me with information that I am going to need. Again, thank you, Robert

about 7 years, said...

Hi n3697k, great questions! If you'd like you can ask your question in our Ask & Answer section located here: ( I hope that helps! -- Emily

about 7 years, said...

it appears that some facilities will do an annual physical with no charge to the patient and some will not ..does part f cover anything in that regard? is this discretionary?

about 7 years, said...

What I need to know about essential screenings for my health.

about 7 years, said...

The entire article was first rate. Yes, I get the fat book every year but have never sat down to read it. It's far too much and 90 percent or more doesn't apply to everyone. Your short paragraphs with concise explanations,, makes it easy to remember, and I'm making a smaller list I can display on the fridge until I remember all the changes. you listed. Thank your editors - this piece is most helpful.

about 7 years, said...

Hi bjb1, These screenings are absolutely recommended for you as well! We also have two great articles about screenings that men and women should get. 15 Medical Test Every Man Should Have: ( 15 Medical Test Every Woan Should Have: ( I hope that helps answer your question! -- Emily

about 7 years, said...

what do you suggest for the caregiver

over 7 years, said...

none at this time