Does Medicare Cover Physical Exams?

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Medicare is a federal health insurance plan that covers commonly needed medical needs. However, it does not cover all services. Medicare does not cover what most people think of as a routine physical exam. However, it does cover many preventive services that replace the indeed for a physical exam. Read on to learn more about exactly what Medicare covers

What Part B of Medicare Covers

Medicare Part B is the part of Medicare that covers outpatient services. Specifically, it covers preventive services, outpatient services, tests, and equipment. Most doctors’ office visits fall under outpatient services while some visits fall under preventive services. Take a look at exactly what outpatient and preventive services are covered by Part B below. 

Preventive Services 

  • Counseling & Education
    • Alcohol misuse counseling
    • Cardiovascular disease behavioral therapy
    • Diabetes
    • Medical nutrition in patients with renal disease
    • Obesity
    • Smoking cessation
  • Screenings for:
    • Abdominal aortic aneurysm for at-risk patients
    • Alcohol misuse screening
    • Breast Cancer Screening
    • Cardiovascular disease Screening
    • Cervical and Vaginal cancer
    • Colorectal cancer
    • Depression
    • Diabetes
    • Glaucoma
    • Hepatitis B + C
    • HIV
    • Lung Cancer
    • Obesity
    • Osteoporosis via Bone Density tests
    • Prostate Cancer
  • Vaccines

Outpatient Services

  • Advance Care Planning
  • Ambulance services
  • Ambulatory surgical centers
  • Behavioral health integration services
  • Cardiac rehabilitation programs
  • Chemotherapy
  • Chiropractic services (if medically necessary)
  • Chronic care management services
  • Clinical research studies
  • Doctor and healthcare provider services
  • Emergency Department Services
  • Federally qualified health center services
  • Foot exams
  • Home Health Services
  • Kidney disease education
  • Mental Health Outpatient Services
  • Occupational and Physical therapy
  • Opioid use disorder treatment services
  • Outpatient hospital services
  • (Limited) Prescription drug coverage
  • Pulmonary Rehabilitation
  • Rural Health Clinic Services
  • Sexually Transmitted Infection screening and counseling
  • Speech-language pathology services
  • Telehealth
  • Transitional care management
  • Transplants and immunosuppressive drugs
  • Travel health needs
  • Urgently needed care

You will notice that physical exams are not on the above list, so you may be wondering what routine visits are covered under Part B. 

What to Do in the Place of a Physical Exam

While routine physical exams themselves are not covered, there are two types of visits that essentially replace the physical exam that is covered: the Welcome to Medicare appointment and your Annual Wellness visit. 

The Welcome to Medicare visit happens within the first 12 months of having Part B. During that visit, your doctor will record your medical, family, and social history, record your height, weight, and vitals, perform a physical exam, and order lab tests as needed. During this appointment, your doctor will give you a checklist of all the preventive screenings and vaccinations you will need at that point in your healthcare journey.

The Annual Wellness visit happens every year. Much like in the Welcome to Medicare visit, during the Annual Wellness visit your doctor will review your medical, family, and social history, record your height, weight, and vitals, review your current providers and prescriptions, review your schedule for preventive healthcare, and talk to you about your overall health plan. 

To learn more about Part B, contact us at (662) 844-3300 today. 

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Justin Brock

President & CEO of Bobby Brock Insurance