Medicare Pays for One Wellness Visit Every Year

Every year each Medicare beneficiary is eligible for one wellness visit. Any further appointments will be to address issues discussed during the wellness visit.

The whole cost of the annual wellness visit is covered by Medicare Part B as long as the provider accepts Medicare as the primary insurance. Some physicians will not accept Medicare as a primary insurance.  Therefore, if Original Medicare is the only insurance plan in place, providers may charge an additional fee, called an excess charge, or may not be willing to accept it.

If the doctor diagnoses or treats something new or treats an existing condition during the wellness visit, it becomes part of diagnostic care. Medicare can bill separately for that. Medicare Part B will pay for 80% of the cost of the care, but only after your Part B deductible has been paid.

Most, but not all, Medigap plans will help cover this diagnostic care bill and it depends on which Medigap plan you're enrolled in. Medigap plans F and G will both cover the 20% coinsurance leftover.

A Wellness Visit Versus a Physical

A physical is generally more involved than a wellness visit. Physicals may involve lab test for blood and urine. A doctor may examine the head, neck, lungs, and abdomen during a physical, and may also perform a reflex or neurological test.

The Annual Wellness Visit generally doesn't include such extensive types of testing. If it does, the bill may fall under Part B for diagnostic tests.

That being said, the wellness visit has a great deal of value. It offers an opportunity to have some direct dialogue about your health with a primary health care provider and get ahead of any health care concerns before they become anything more serious.