Medicare’s yearly wellness visit is prevention planning, not a routine physical. Eligible patients pay nothing for the covered wellness visit if the provider accepts assignment, but separately billed medical services can have cost-sharing. Original Medicare does not cover routine physical exams; Medicare Advantage members should check their plan’s specific benefits.
Booking an “annual checkup” can mean different things to you and the billing office. Before making the appointment, name the service you want: Medicare’s yearly wellness visit, its one-time introductory preventive visit, or a physical exam. The distinction can change what you owe.
Match the appointment to the benefit
Medicare’s yearly wellness visit focuses on a personalized prevention plan. It includes a health-risk questionnaire, routine measurements and a review of your history and prescriptions; it is not a comprehensive physical. Eligible patients pay nothing for this benefit when the provider accepts assignment, and the Part B deductible does not apply.
| Visit | When it applies | Key distinction |
|---|---|---|
| Welcome to Medicare | Once, during your first 12 months of Part B | Introductory prevention review, not a comprehensive physical |
| Yearly wellness | Once every 12 months, subject to first-visit eligibility | Prevention planning, not a routine physical |
| Routine physical | Separate from these preventive benefits | Not covered by Original Medicare |
Your first wellness visit cannot be within 12 months of starting Part B or receiving a Welcome to Medicare visit. You do not have to use the Welcome visit first. Ask the office to confirm your eligibility date rather than assuming January starts a new allowance.
The Welcome to Medicare visit has its own first-year window. It reviews medical and social history, includes a simple vision test and provides a prevention plan. With assignment accepted, this visit also has no patient charge or Part B deductible. Bring your medical and vaccination records, family history, and a list of medicines and supplements.
Why a covered wellness visit can still produce a bill
A separate medical service may be billed at the same appointment. CMS’s billing guidance allows an additional evaluation-and-management service when it is significant, separately identifiable and medically necessary. Merely mentioning a symptom does not, by itself, establish that those billing conditions were met.
For example, suppose an eligible patient has a covered wellness visit and also receives a separately billable evaluation of a knee problem. The prevention visit can remain free while the problem-focused service has cost-sharing. This is a hypothetical billing scenario, not a diagnosis or a prediction about any particular appointment.
Assume Original Medicare, an assignment-accepting provider, a Part B deductible already met, no supplemental coverage or cost-sharing assistance, and a $150 Medicare-approved amount for that separate covered office service. Using the usual 20% Part B coinsurance, the example patient owes $30: $150 × 0.20. This excludes tests and other charges; $150 is an invented amount, not a Medicare price quote.
A routine physical is a different issue: Original Medicare does not cover it, so the patient may owe its full price. Do not use the $30 example to estimate the bill for a noncovered physical.
What to ask before the appointment
Ask the office: “Which preventive visit are you booking, am I eligible now, and do you accept assignment? If you also evaluate a health problem or perform tests, which services could be billed separately?” Tell the office about health concerns when scheduling so it can arrange appropriate care; cost clarification should not mean concealing symptoms.
If you have Medicare Advantage, check your plan’s network and coverage details before booking. Plans cover Original Medicare services and may offer extra benefits, but a plan’s advertised physical or additional service needs its own coverage check. The Original Medicare calculation above is not an Advantage copayment quote.
For a broader coverage decision, see our Medicare plan total-cost comparison. For this appointment, request the expected charges for each planned service, not simply confirmation that the office “takes Medicare.”
Prepared with AI assistance using Medicare and CMS sources checked November 11, 2026. The billing example is hypothetical; the featured image is an original editorial illustration.
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