Medicare Coverage: Wellness Visit vs. Physical

For those on Medicare, the system can sometimes get confusing. What is covered? What isn't covered?

There are several types of Medicare now that patients can have, and different forms of Medicare differ in what they pay for.. One of the more confusing areas for both patients and physicians alike center around the relatively new visit called the annual wellness visit, and the physical.

It is important to know that type of Medicare you have and what it will cover. Traditional Medicare does not cover annual physicals but does cover the annual wellness exam. Most Medicare advantage plans, like Priority Health, will cover both.

But what's the difference between an annual wellness visit and an annual physical? Here's a rundown so patients can break down what their Medicare covers:

  • Annual Wellness Visit
    • Routine measurements, like height, weight, blood pressure
    • Review of family history
    • Assessment of risk factors
    • Updating lists of your providers and medications
    • Scheduling of appropriate preventive services
    • It was really designed to update a patient’s current medical record and screen for certain high risk conditions and it does not include any examination.
  • Annual Physical
    • Measurement of height, weight, BMI, blood pressure
    • Check your vital signs
    • Review of family history
    • Assessment of current medical problems
    • Perform an appropriate exam
    • Possible submission of blood and/or urine samples for labs
    • It does not include addressing new medical problems.

Doctors prefer if patients come in to do both in the same visit.

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