When you enroll in Medicare, it is natural to think they would cover a physical exam. Unfortunately, you would be out of luck if you expect them to pay for it. They will not pay for a physical checkup of the kind you are probably expecting.
Medicare does cover a lot of medical services. When Medicare was created, the documents that declared its services stated that they cannot cover a complete physical exam.
Instead of a full physical exam, they offer a Welcome to Medicare checkup. This checkup is very limited in scope and is just a wellness check.
The Welcome to Medicare Checkup
Compared to a complete physical exam, the wellness check only covers the basics and cannot be called a physical checkup. The purpose of the Welcome to Medicare checkup is to get a basic understanding of your health. According to the AARP, the physician will want to learn about the following:- Your medical history and your family’s medical history.
- Get some basic measurements: your body mass index, height, weight, and blood pressure.
- Talk about any risk factors that might reveal the presence of a serious illness.
- Find out about your stability and ability to function normally (will look for your ability to make decisions, handle finances, signs of dementia, etc.).
- Give a simple vision test.
- See if depression is present or if there is a risk for it.
- Check your prescriptions and look for opioids and possible substance abuse.
- Recommend screenings and various preventive services.
- Find out if the individual has an advance directive in place or a living will—and discuss them if the individual wants to know more.
A Physical Exam Contains More
When you get a complete physical exam, the doctor will do more than the tasks previously mentioned. MayoClinic says that you can also expect:- a check of your vital signs
- a discussion of health issues
- a look at your prescriptions
- a physical exam
- questions about your daily activities, relationships, and your environment at home
With Medicare, You Must Pay for a Complete Physical If You Want One
Because Medicare will not pay for a complete physical—at least not all of it—it is up to you to foot the bill. Medicare will cover the cost of a Wellness visit, which you can get every year. You must wait for one full year before you can get your first one.If the doctor accepts Medicare, a Wellness visit will not cost you anything, but you must have Medicare Part B to get the visit. Medicare.gov says that you may have to pay if the doctor performs additional tests during your visit that are not part of the exam’s requirements. A Wellness visit is considered preventative treatment.
Medigap Coverage
Medicare offers more coverage through its Medigap plans that will cover some of the services and expenses that traditional Medicare does not cover. Most states offer 10 different Medigap plans that are standardized by the government but offered through private insurance companies. Each plan will vary in cost, coverage, and the cost-sharing requirements.The various plans cover different needs, but people can choose which ones they need, but it may also depend on your budget. Medicare.gov says they offer extra coverage to help pay for the costs that Medicare does not cover, including copayments, coinsurance, deductibles, and any out-of-pocket costs.
These extra policies do not cover costs related to other forms of health care, such as Medicare Advantage plans, Medicaid, TRICARE, stand-alone drug plans from Medicare, or plans offered by employers or union groups. Most often, you cannot buy a Medigap plan if you have a Medicare Advantage plan or Medicaid.
Medicare Advantage Plans
If you want more coverage than what standard Medicare offers apart from the various Medigap plans, you can buy a Medicare Advantage plan in its place. Private insurers offer these plans and must contain all the Medicare benefits—and more.
An Advantage Plan will offer an annual wellness visit—and some plans will cover complete physical exams. NerdWallet says there may be copays with some plans, but some companies will have $0 copays. Other plans may not offer them at all.
A Medicare Advantage plan is Part C of Medicare. It combines parts A and B and will often include Part D—the drug plan. They may also include vision, hearing, and dental—which Medicare does not cover. The cost varies between companies but will usually cost a minimum equal to the cost of Part B and may include extra charges.
Long-Term Care Coverage
Another thing that standard Medicare does not cover is long-term care. If you want this coverage, you must buy a long-term care policy from a private insurance company.Forbes lists several other things that Medicare does not cover, including:
- some services given by a chiropractor or acupuncturist not considered medically necessary
- routine foot care
- cosmetic surgery
- alternative or experimental medicine
- most over-the-counter drugs
- medical services needed outside the United States
Medicare requires that Wellness visits be 365 days apart. If you have an opportunity to get a Wellness visit, see if you can schedule a physical appointment at the same time, but be prepared to pay for it—or at least part of it.
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