Medicare Preventive Services Guide

Summary: Medicare preventive services can often get confused with annual physicals. While there are several examples of preventive services Medicare can provide, including the Welcome to Medicare visit, annual physicals are slightly different. However, options are available. Estimated Read Time: 16 mins

Table of Contents:

1. Your Guide to Medicare Preventive Services
2. Welcome to Medicare Visit
3. Medicare Annual Wellness Visit Requirements
4. Does Medicare Cover Physicals?
5. Why Doesn’t Medicare Cover Annual Physicals?
6. Medicare Preventive Services Checklist
7. Does Medigap Cover Annual Physicals?

Medicare preventive services typically come at no cost. These services benefit all people on Medicare, regardless of if they have Medicare Advantage or Original Medicare. Medicare encourages beneficiaries to be proactive with their care by scheduling yearly appointments, known as your Medicare Annual Wellness Visit, to prevent significant health risks.

But there can be some confusion regarding coverage for certain healthcare services. Much of which surrounds your “Welcome to Medicare” visit and the access to medical physicals.

Although Medicare preventive care services are available, depending on the coverage you have will dictate how your benefits cover these expenses. This is because while the federal government offers Original Medicare (Medicare Part A and Part B), additional benefits are available from private insurance companies.

Below, we’ll explore the preventive services Medicare benefits will cover, a checklist to help you keep track of the services you receive, and how you can ensure that you’re covered for the healthcare services you need.

Your Guide to Medicare Preventive Services

Medicare preventive services consist of a multitude of health screenings. These include lab tests, exams, immunizations, health monitoring programs, counseling, and more. During your Annual Wellness Visit and “Welcome to Medicare” visit, your doctor reviews the results of these screenings.

Medicare covers several types of appointments for preventive services, which are listed below. Beneficiaries use these services to stay on top of their health and receive valuable information from their doctor regarding their family health history.

However, while most Medicare preventive services are available at no cost to you, coverage for treatment needed following test results may vary. Medicare Part A and Part B cover healthcare treatments that take place in an inpatient or outpatient setting, but only if they are deemed medically necessary by your healthcare provider.

Below, we discuss the types of preventive services Medicare covers and how to utilize them.

Welcome to Medicare Visit

Regarding Medicare preventive services, your “Welcome to Medicare” visit, or Initial Preventive Physical Exam (IPPE), is an introductory appointment available to all Medicare beneficiaries within your first year of enrolling. This preventive appointment costs you nothing if your doctor or qualified healthcare provider accepts Medicare assignment.

You can expect your doctor to give you advice and counseling to help you prevent disease, improve your overall health, and discuss ways to stay well. To help you stay better prepared, there’s even a “Welcome to Medicare” visit checklist available on a few important things to bring to your appointment:

• You’ll want to bring your medical and immunization records for your doctor to view.
• Additionally, if you have anything that can help showcase your family health history, or if you can simply tell your doctor, bring them along.
• Last but certainly not least, you’ll want to bring information on what you’re taking. This includes prescription drugs, over-the-counter drugs, vitamins, and supplements. Be sure to provide your healthcare provider with information regarding how often you take them and why.

This information is going to be helpful for you and your healthcare provider to more accurately plan your healthcare.

Your “Welcome to Medicare” visit must have seven particular elements that will go into your healthcare appointment. This includes a physical, but not an extensive one, which we’ll get to below.

Here are the seven different elements you’ll experience with your healthcare provider. Though their order may vary, you will experience each of these during the duration of your visit:

Reviewing Your Medical History

The first thing you can typically expect is going over your medical history, hence the importance of the information above. Information is key, and this will set the tone for how the rest of your visit will go. This will focus on your physical health but can also devolve into your mental health history as well.

Depression Assessment

Looking at your risk for depression and reviewing your mental health needs will be an important part of your “Welcome to Medicare” visit. You’ll note that many Medicare preventive services exist for both physical and mental healthcare as well.

There is no single method of checking for depression, but rather many different techniques approved by the Centers for Medicare & Medicaid Services (CMS). But because some ways may be a bit too extensive for your “Welcome to Medicare” visit, your doctor may use discretion as to which standardized screening test they use.

Assessing Your Functionality

It’s important to understand where you stand with your ability to conduct everyday activities. This includes your ability to hear, move around without falling, or just conduct everyday activities, including driving or using the phone.

The key here is to evaluate how safe it is for you to function in everyday life. There are a lot of different ways your healthcare provider can measure such metrics, but as long as it is a CMS-approved screening used by professional medical groups nationwide, these tests are acceptable.

Known as your instrumental activities of daily living (IADLs), if there are limitations for you that exist, further evaluation may become necessary. Fortunately, if you need additional evaluation, Medicare preventive services benefits are available to help you cover these costs.

A Physical but Not an Extensive One

When it comes to preventive services not covered by Medicare, under normal circumstances, Original Medicare benefits won’t cover an annual physical. Part of this is likely due to the extensive nature of true physicals and the amount of testing that is required.

But when you receive your “Welcome to Medicare” visit, you’ll undergo a physical exam, but it won’t have the full range of medical tests you can expect at an annual physical. This is when you’ll assess your body’s metrics, such as your weight, height, vision, and blood pressure.

Checking Your Heart

Undergoing an electrocardiogram (ECG or EKG) is a typical part of your “Welcome to Medicare” visit. However, not every healthcare facility has this ability, and you may need to conduct this check at another facility. Should an additional facility become necessary, Medicare preventive services benefits will cover you all the same.

Counseling and Education

Once you’ve undergone testing, have discussed your medical information with your healthcare provider, and have been assessed, your doctor will review your health risks based on this data. This will provide you time to better understand where you will need to go from here and if you will need a referral due to lingering health concerns.

Reviewing Medicare Preventive Services and Your Written Plan

The final step for your “Welcome to Medicare” visit is receiving an actionable plan for your healthcare moving forward. This is when you’ll continue reviewing your health information and assess the various Medicare preventive services available to you as a beneficiary.

Your healthcare provider will not only make a plan in theory, but you’ll receive a written copy that will be used when receiving Medicare preventive services. This is a great resource and should accompany you on future healthcare visits as they arise.

Medicare Annual Wellness Visit Requirements

Your Medicare Annual Wellness Visit (AMV) is your yearly check-in to discuss your health and wellness with your healthcare provider. This visit is free of charge, as is the case with Medicare and preventive care in most cases if you’ve had Part B benefits for at least 12 months and your doctor is part of the Medicare program.

If you didn’t take advantage of your “Welcome to Medicare” visit when you first enrolled, you can still attend your Medicare AMV. While your Medicare Annual Wellness Visit is not physical, it’s still an important component in keeping you well. Here’s what to expect during your Medicare AMV:

• Known as a Health Risk Assessment (HRA), you’ll fill out a medical questionnaire for your healthcare provider to better understand what type of healthcare best suits your needs.
• This means you’re going to provide information such as your weight, height, blood pressure, medical history, a list of medications you are taking, etc., and then your healthcare provider will help you with personalized care and planning for the future.
• Routine tests to look for potential ailments such as memory loss, dementia, and other cognitive-related healthcare features are also a part of your Medicare AWV. Should anything be found, again, a personalized plan is developed for your needs.

CMS preventative services allow your Medicare Annual Wellness Visit the opportunities to develop your Personalized Prevention Plan (PPP). This means your healthcare providers remain up-to-date on the current status of your health and the plan in place to help provide you with the right solutions.

Does Medicare Cover Physicals?

No, Medicare does not cover routine physicals, and they are not a part of your Medicare AWW nor your “Welcome to Medicare” visit. However, if you exhibit symptoms that necessitate that kind of screening, Medicare will cover it.

Medicare does not pay for physicals, which involve a variety of physical tests such as lung exams and reflexes. However, it’s important to break down what that means because exceptions do apply:

• Original Medicare is provided by the federal government. Therefore, does Medicare pay for physicals? No.
• Medicare Supplement plans are only supplemental coverage for Original Medicare benefits and won’t cover routine physicals because Part A and Part B won’t either.
• The other exception for Medicare to cover healthcare that would be parallel to that of an annual physical is services deemed medically necessary by your doctor.

Why Doesn’t Medicare Cover Annual Physicals?

It’s difficult to pinpoint an exact reason why Medicare doesn’t cover annual physicals, but there are some considerations:

• For starters, although annual physicals are preventive care, they do require a notable amount of medical tests. Because there are more tests, the costs would be much greater for the federal government’s healthcare program.
• Since 2005, the “Welcome to Medicare” visit has served as a preventive healthcare assessment that beneficiaries can enjoy when enrolling. Therefore, the program may not feel it necessary to cover annual visits based on the data collected here and during your Annual Wellness Visits.

But remember that these limitations apply to both Original Medicare and Medicare Supplement benefits.

Medicare Preventive Services Checklist

Created by CMS, the Medicare Preventive Services Checklist allows beneficiaries to keep track of the services that should be performed at their preventative appointments.

The checklist provides a list of all Medicare preventative services. But remember that not every person will need to complete all the items on the checklist each year. Be sure to speak with your doctor to understand which preventative services are right for you.

Below are the items you’ll find on the Medicare Preventive Services Checklist:

“Welcome to Medicare” Visit

You’ll be provided a one-time Welcome to Medicare Preventive Visit—within the first 12 months, you have Medicare Part B (medical insurance). But remember, your IPPE is not the same as a physical.

Annual Wellness Visit

Beneficiaries receive this visit 12 months after their “Welcome to Medicare” preventive visit or 12 months after their Medicare Part B effective date. Again, in the same way that your IPPE isn’t the same as an annual physical, neither is your yearly wellness visit.

Alcohol Misuse Screening and Counseling

Getting help for the misuse of alcohol is one of the many Medicare preventive services available for beneficiaries. Medicare benefits will pay for screening and counseling resources for those that meet the program’s criteria, helping you springboard your health and grow in your sobriety.

Bone Mass Measurements

Even if you are not suffering from Osteoporosis, bone mass measurements can be important preventive care Medicare provides as seniors lose the ability to replenish bone density as they age.

Cardiovascular Disease Screening Tests

Screening for cardiovascular disease can be critical for seniors, and Medicare benefits provide coverage when medically necessary. As the leading killer of all Americans, heart disease is a serious threat. Screening can help save lives and is one of the most valuable preventive services covered by Medicare.

Cervical Cancer Screening

Cervical cancer screening is another Medicare preventive service that can help save your life. Early detection is key when it comes to treating cancer and seniors facing this disease.

Counseling to Prevent Tobacco Use

Also known as smoking cessation treatments, receiving counseling to prevent tobacco use can help you achieve your goals and create a path to better health. It’s no secret that tobacco usage is not exactly a health benefit, and Medicare can help you kick the habit while creating positive health habits.

Depression Screening

For seniors battling with depression, undergoing a screening can help provide a path to better mental health. The Medicare Preventive Services Checklist provides a variety of services that account not only for the physical ailments you might face but also your mental health needs as well.

Diabetes Screening

Just like cancer or other diseases, diabetes is best fought when it’s detected earlier. The sooner, the better for seniors, and by screening for diabetes, you and your healthcare team can devise a plan that helps you manage your condition and improve your health.

Diabetes Self-Management Training

Knowing where you stand with diabetes is only part of the battle. You’re also going to need the tools to manage your condition. Again, your test provides you with viable options, but Medicare preventive services don’t end there. If you have prediabetes or diabetes, Medicare benefits will help you with training to live a better life.

Flu-Shot and Administration

Receiving a flu shot continues to be an annual recommendation for seniors in the United States that typically occurs every fall. If you qualify for Medicare Part B, your vaccination is covered, as is its administration, so long as your doctor accepts Medicare assignment.

Glaucoma Screening

Most healthcare involving your vision will need alternative coverage if you’re a Medicare beneficiary, and yet, some exceptions exist. Screening for glaucoma is a prime example of such exceptions and one of the many Medicare preventive services helping you stay on top of potential issues before they develop into larger ones down the line.

Hepatitis B Screening

Although a hepatitis B screening (HBV screening) can come much earlier in life, it’s recommended that all adults receive one at least once in their lifetime. If your healthcare provider recommends a need for an HBV screening, your Medicare benefits will cover you, provided you meet the guidelines.

Hepatitis B Prevention

In addition to your HBV screening, you are also provided benefits for hepatitis B vaccination and administration. Medicare preventive services are all about managing healthcare risks, and by receiving the hepatitis B vaccine, you’re helping fight against contracting the infection.

Hepatitis C Screening

Similar to the benefits you’ll receive involving hepatitis B, you’ll also receive coverage for a hepatitis C screening. However, as there is no vaccine yet developed for the infection, your benefits will only cover a screening until a medical breakthrough occurs and CMS approves further coverage.

HIV Screening

Testing for STDs and STIs is available, especially for HIV. There are ways to manage HIV and prevent the development of AIDS. Your benefits help you cover HIV screening to better assess your sexual health.

Intensive Behavioral Therapy (IBT) for Cardiovascular Disease

One of the leading contributors to cardiovascular disease is obesity. The idea behind IBT is to develop better habits involving eating and exercise. Putting together a game plan and executing these new habits through therapy can help you lose weight and avoid complications like heart disease.

IBT for Obesity

While cardiovascular disease is an ongoing concern for anyone with obesity, several other health problems can arise. This includes an increased risk of stroke, hypertension, and much more. Preventing these ailments can be aided by avoiding obesity. Therefore, Medicare preventive services are available for IBT.

Lung Cancer Screening

A variety of cancer screenings are available, but there are annual lung cancer screenings available for those who qualify. You’ll need to meet health and age requirements, but Medicare preventive services offer annual screenings for lung cancer when ordered by your healthcare provider.

Mammography Screening

Among the CMS preventive services available are mammograms. You can receive screening to help you detect breast cancer soon and, like other forms of cancer, create a plan earlier to help manage and overcome the deadly disease.

Medical Nutrition Therapy

If you are battling obesity, a nutritionist can help you create a diet that manages your weight in a healthy manner. But even if you are not obese, there are certain health conditions, such as diabetes, kidney disease, or if you have had a kidney transplant in the last 36, that can also qualify through Medicare for receiving assistance from a nutritionist to help improve your condition.

Medicare Diabetes Prevention Program (MDPP)

Preventing the onset of type 2 diabetes is possible, and the MDPP provides beneficiaries with meaningful behavior changes that can improve their health. There are guidelines that apply, but the MDPP is available through Medicare Part B or Medicare Advantage.

Pap Tests Screening

Pap tests or pap smears are Medicare preventive services that aim to help prevent cervical cancer. Discovering whether or not cancerous cells are present sooner is key for treatment and your overall health.

Pneumococcal Shot and Administration

Several different illnesses can stem from contracting pneumococcal disease, including meningitis and pneumonia. To avoid these healthcare risks, there are vaccines available to help you prevent such complications altogether. Your Medicare benefits will pay for the vaccine and its administration.

Prolonged Preventive Services

There are preventive services Medicare will approve, but they may take a bit longer than an initial visit in an outpatient setting. These are known as prolonged preventive services, and they require you to have direct contact with your healthcare provider beyond your initial visit.

Prostate Cancer Screening

Undergoing a PSA test can help men detect whether or not they have prostate cancer, and Medicare covers such testing. This can be especially helpful for men who have undergone surgery or therapy to remove prostate cancer once before, as it may return following a procedure.

STI Screening and High-Intensity Behavioral Counseling to Prevent STIs

Sexual health at any age is important to maintain, and up to two counseling sessions per year are available for Medicare beneficiaries. You’ll simply meet with your healthcare provider for around 30 minutes with the opportunity to speak on concerns you may have involving STIs.

Screening Pelvic Exams

As mentioned before, pap smears are covered by Medicare benefits, and such tests are typically conducted during a pelvic exam. Medicare preventive services are available for your sexual health, including pelvic exams as a whole.

Ultrasound AAA Screening

Abdominal aortic aneurysms can affect anyone, but men ages 65 years and older have an especially high risk. If left unchecked, it may become life-threatening, but if you are dealing with such issues, your Medicare coverage provides a once-in-a-lifetime benefit to screen for risks via ultrasound.

Medicare Preventive Services Chart

If you’re looking to learn more about any of these Medicare preventive services, you can do so by clicking the appropriate links above. Alternatively, or if you do not see your specific service listed, the Medicare Preventive Services Chart from CMS is available.

Does Medigap Cover Annual Physicals?

No, because Medicare preventive services don’t include annual physicals, don’t expect your Medigap plan to cover them either. Medicare Supplement plans are supplemental coverage, and their benefits kick in to help cover the costs left over when using Original Medicare benefits. Therefore, there is no way to use these benefits for physicals.

Therefore, you’ll want to assess the whole of your healthcare and budget needs with a licensed Medicare agent before enrolling in coverage just for the possibility of covering your annual physical.

How to Get Full Coverage for Preventive Services with Medicare

Most Medicare preventive care services have 100% coverage if your doctor accepts Medicare assignment. However, some diagnostic services require out-of-pocket costs. For situations such as these, Medigap coverage will help you cover the leftover expenses you might incur.

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