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Does Medicare Cover Doctor Visits?

Having access to a physician who can address your concerns, diagnosis medical issues, and treat you is absolutely essential, especially as we age. When you first become eligible for Medicare when you turn 65, you have the option of enrolling in Medicare Part B (Medical Insurance.) Most people choose to enroll in Part B as soon as they are eligible to avoid late enrollment penalties when they join after their initial enrollment period has ended, but enrolling in Part B isn’t just a financial decision. Part B coverage can make a big difference in your overall health, now and in the future.

Seeing a Physician – Medicare Part B Benefits

Medicare Part B helps cover the cost of medically necessary services and supplies that meet accepted standards of medical practice in a physician’s office or outpatient setting in order to diagnose and treat a medical condition. Part B includes coverage for ambulance services, clinical research, inpatient and outpatient mental health care, a second opinion before surgery, and durable medical equipment (DME). DME includes medically necessary equipment you need to use in your home and that is prescribed by a physician.

Part B also covers a wide range of preventive services, including a Welcome to Medicare visit when you are first enrolled, and annual Wellness visits after you have had Part B for 12 months. These annual exams can serve as great opportunities to build a rapport with your doctor, discuss your family medical history, and keep track of any changes in your physical or mental health.

  Do You Have to See Specific Doctors?

When you become eligible for Medicare, you have the choice to get your Part A and/or Part B benefits through Original Medicare, the federal program that administers your coverage, or through a Medicare Advantage plan, offered by private insurance companies that contract with Medicare to provide your Part A and Part B benefits. If you have Original Medicare Part B, you may visit any doctor who is participating in Medicare and accepts assignment. You do not need referrals from a primary doctor in order to see a specialist. You can visit any specialist that accepts assignment, as well. You will likely pay 20% of the Medicare approved amount and the Part B deductible may apply.

If you choose to enroll in a Medicare Advantage plan, you will have at least the same Part A and Part B benefits as Original Medicare, but many MA plans provide additional coverage, including prescription drug coverage, vision and dental care, and annual out-of-pocket maximums. If you are enrolled in a Medicare Advantage plan, you will likely have to visit doctors and specialists that belong to your plan’s network. If you go outside of the plan’s network, you may be responsible for the full amount of any medical care you receive.

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Doctor Visits

Get Your Medicare Wellness Visit Every Year

Take Action

If you have Medicare, be sure to schedule a yearly wellness visit with your doctor or nurse. A yearly wellness visit is a great way to help you stay healthy.

What happens during a yearly wellness visit?

First, the doctor or nurse will ask you to fill out a questionnaire called a health risk assessment. Answering these questions will help you get the most from your yearly wellness visit.

During your visit, the doctor or nurse will:

• Go over your health risk assessment with you
• Measure your height and weight and check your blood pressure
• Ask about your health history and conditions that run in your family 
• Ask about other doctors you see and any medicines you take
• Give advice to help you prevent disease, improve your health, and stay well
• Look for any changes in your ability to think, learn, or remember
• Ask about any risk factors for substance use disorder and talk with you about treatment options, if needed

If you take opioids to treat pain, the doctor or nurse may talk with you about your risk factors for opioid use disorder, review your treatment plan, and tell you about non-opioid treatment options. They may also refer you to a specialist. 

Finally, the doctor or nurse may give you a short, written plan to take home. This plan will include any screening tests and other preventive services that you’ll need in the next several years. Preventive services are health care services that keep you from getting sick. 

Learn more about yearly wellness visits .

Plan Your Visit

When can i go for a yearly wellness visit.

You can start getting Medicare wellness visits after you’ve had Medicare Part B for at least 12 months. Keep in mind you’ll need to wait 12 months in between Medicare wellness visits.

Do I need to have a “Welcome to Medicare” visit first?

You don’t need to have a “Welcome to Medicare” preventive visit before getting a yearly wellness visit.

If you choose to get the “Welcome to Medicare” visit during the first 12 months you have Medicare Part B, you’ll have to wait 12 months before you can get your first yearly wellness visit. 

Learn more about the “Welcome to Medicare” visit .

What about cost?

With Medicare Part B, you can get a wellness visit once a year at no cost to you. Check to make sure the doctor or nurse accepts Medicare when you schedule your appointment.

If you get any tests or services that aren’t included in the yearly wellness visit (like an extra blood test), you may have to pay some of those costs.

Who Can Get Medicare?

Medicare is a federal health insurance program. You may be able to get Medicare if you:

• Are age 65 or older
• Are under age 65 and have a disability
• Have amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease
• Have permanent kidney failure (called end-stage renal disease)

You must be living in the United States legally for at least 5 years to qualify for Medicare.  Answer these questions to find out when you can sign up for Medicare .

Make an Appointment

Take these steps to help you get the most out of your Medicare yearly wellness visit.

Schedule your Medicare yearly wellness visit.

Call your doctor’s office and ask to schedule your Medicare yearly wellness visit. Make sure it’s been at least 12 months since your last wellness visit.

If you're looking for a new doctor,  check out these tips on choosing a doctor you can trust .  

To find a doctor who accepts Medicare:

• Search for a doctor on the Medicare website
• Call 1-800-MEDICARE (1-800-633-4227)
• If you use a TTY, call Medicare at 1-877-486-2048

Gather important information.

Take any medical records or information you have to the appointment. Make sure you have important information like:

• The name and phone number of a friend or relative to call if there’s an emergency
• Dates and results of checkups and screening tests
• A list of vaccines (shots) you’ve gotten and the dates you got them
• Medicines you take (including over-the-counter medicines and vitamins), how much you take, and why you take them
• Phone numbers and addresses of other places you go to for health care, including your pharmacy

Make a list of any important changes in your life or health.

Your doctor or nurse will want to know about any big changes since your last visit. For example, write down things like:

• Losing your job
• A death in the family
• A serious illness or injury
• A change in your living situation

Know your family health history.

Your family's health history is an important part of your personal health record.  Use this family health history tool  to keep track of conditions that run in your family. Take this information to your yearly wellness visit.

Ask Questions

Make a list of questions you want to ask the doctor..

This visit is a great time to ask the doctor or nurse any questions about:

• A health condition
• Changes in sleeping or eating habits
• Pain or discomfort
• Prescription medicines, over-the-counter medicines, or supplements

Some important questions include:

• Do I need to get any vaccines to protect my health?
• How can I get more physical activity?
• Am I at a healthy weight?
• Do I need to make any changes to my eating habits?

Use this question builder tool  to make a list of things to ask your doctor or nurse.

It can be helpful to write down the answers so you remember them later. You may also want to take a friend or relative with you for support — they can take notes, too.

What to Expect

Know what to expect at your visit..

The doctor or nurse will ask you questions about your health and safety, like:

• Do you have stairs in your home?
• What do you do to stay active?
• Have you lost interest in doing things you usually enjoy?
• Do you have a hard time hearing people on the phone?
• What medicines, vitamins, or supplements do you take regularly?

The doctor or nurse will also do things like:

• Measure your height and weight
• Check your blood pressure
• Ask about your medical and family history

Make a wellness plan with your doctor.

During the yearly wellness visit, the doctor or nurse may give you a short, written plan — like a checklist — to take home with you. This written plan will include a list of preventive services that you’ll need over the next 5 to 10 years.

Your plan may include:

• Getting important screenings for cancer or other diseases
• Making healthy changes, like getting more physical activity

Follow up after your visit.

During your yearly wellness visit, the doctor or nurse may recommend that you see a specialist or get certain tests. Try to schedule these follow-up appointments before you leave your wellness visit.

If that’s not possible, put a reminder note on your calendar to schedule your follow-up appointments.

Add any new health information to your personal health documents.

Make your next wellness visit easier by updating your medical information in the personal health documents you keep at home. Write down any vaccines you got and the results of any screening tests.

Medicare offers an online tool called  MyMedicare  to help you track your personal health information and Medicare claims. If you have your Medicare number, you can  sign up for your MyMedicare account now .

Healthy Habits

Take care of yourself all year long..

After your visit, follow the plan you made with your doctor or nurse to stay healthy. Your plan may include:

• Getting important screenings
• Getting vaccines for older adults
• Keeping your heart healthy
• Preventing type 2 diabetes
• Lowering your risk of falling

Your plan could also include:

• Getting active
• Eating healthy
• Quitting smoking
• Watching your weight

Content last updated February 9, 2023

Reviewer Information

This information on Medicare wellness visits was adapted from materials from the Centers for Medicare and Medicaid Services

Reviewed by: Rachel Katonak Centers for Medicare and Medicaid Services Division of Policy and Evidence Review Coverage and Analysis Group

November 2022

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Health & Wellness

What to Expect From Your ‘Welcome to Medicare’ Visit

Preventive care is a key factor in staying healthy. Medicare Advantage plans cover many preventive services, one of which is a Welcome to Medicare visit.

After you enroll in Medicare for the first time, your Welcome to Medicare visit should take place as soon as possible within the first 12 months of coverage. Your primary care doctor will assess the medical and social factors most likely to impact your health, then create a plan for preventive care that is tailored to your specific needs.

What Does a Welcome to Medicare Visit Include?

The Welcome to Medicare visit is a review of your health, followed by counseling on preventive care services you need. This visit is designed to improve your quality of life and catch health issues before they can become severe illnesses or disabilities.

During the visit, your doctor may assess the following, in addition to other care-related concerns:

• Overview of health screenings you need
• Vaccination history and schedule
• Vision test
• Measuring your height, weight and blood pressure
• Screening for depression and other mental health issues
• Counseling about your alcohol and tobacco intake
• Your home life, family and social and community relationships
• Optional discussion of advance directives
• Referrals for other preventive care as needed

After the assessment, your doctor will create a personalized preventive care plan for you with recommended health screenings, shots, exams and additional counseling and therapies as needed.

What Preventive Care Does Medicare Cover?

Original Medicare covers a variety of preventive care and screenings such as: 

• Vaccinations for the flu, COVID-19, hepatitis B and pneumococcal diseases
• Diabetes screening and management
• Lung cancer screening
• Cardiovascular disease screening and behavioral therapy
• Smoking cessation counseling

Our Medicare Advantage plans include the same preventive visits covered under Original Medicare in addition to services that are not covered. 

Preventive care covered by many Medicare Advantage plans—like Baylor Scott & White Health Plan’s Medicare Advantage HMO-POS—but not covered under Original Medicare includes fitness programs and gym memberships, annual physicals, cognitive health assessments, diabetes education and more. 

What Does a Welcome to Medicare Visit Cost?

Your Welcome to Medicare visit is covered under Original Medicare and most Medicare Advantage   plans . There is zero out-of-pocket cost for this visit. However, if you opt to have additional services or tests on the day of your visit, they may or may not have additional costs depending on your coverage level. 

When to Schedule Your Welcome to Medicare Visit

Your Welcome to Medicare visit must be scheduled within the first 12 months of your coverage.

You can schedule this visit whenever you want during this period, with any doctor that accepts Medicare. IMPORTANT: When making the appointment, you need to specify that it is your Welcome to Medicare visit and not a routine physical exam.

It’s best to arrange your Welcome to Medicare preventive visit as early as possible once your coverage starts. This way, you can fully benefit from the preventive healthcare services that your doctor recommends.

How to Prepare For Your Welcome to Medicare Visit

After scheduling your Welcome to Medicare visit, you should prepare the following information:

• A list of all medical procedures and your known health issues
• Family medical history that you have knowledge of
• List of medications, vitamins, supplements and over-the-counter drugs you regularly take, along with the amount, how often you take them and the purpose

To get the most out of your visit, you should also prepare a list of questions for your doctor regarding health concerns you have. If you need referrals for specialists or want additional information on managing existing conditions or conditions you are at risk for, you should also discuss them with your doctor.

If you are interested in setting up an advance directive, which is when you name another person to make healthcare decisions for you if you cannot, your doctor can also discuss this with you during your Welcome to Medicare visit and refer you to resources for navigating this process.

What’s the Difference Between the Welcome to Medicare Visit and the Annual Wellness Visit?

The Welcome to Medicare visit often gets confused with the Medicare Annual Wellness visit. 

Welcome to Medicare is strictly a one-time appointment during the first year you are covered by Medicare, while the Medicare Annual Wellness visit takes place every year, as the name implies. Like Welcome to Medicare, the Annual Wellness Visit includes an assessment by your primary care doctor followed by a preventive care plan tailored to your needs. 

Your Welcome to Medicare visit creates the roadmap for your future Annual Wellness Visits, so it’s crucial to schedule Welcome to Medicare as early as possible to get the benefits of your personalized preventive care plan.

For more information on what to expect from your Welcome to Medicare visit, or to learn more about Baylor Scott & White Health Plan’s Medicare Advantage coverage, call 1.800.782.5068 (TTY: 711). 

What is the difference between a physical exam and a Medicare Wellness Visit?

Published by Medicare Made Clear®

The difference between a physical exam and a Medicare Wellness Visit is basically the difference between your doctor focusing on what’s wrong versus on what’s right. Each is important, depending on the situation.

When you’re sick or in pain, you want to get better. A physical exam helps your doctor figure out what the problem is and what needs to be done.

When you’re healthy and feeling good, you want to stay that way. A wellness exam helps your doctor understand what’s working for you and how to best support your continued health and well-being.

Your doctor performs specific tasks in each of these two exams in order to achieve its purpose. See below for a chart that lists some of the services that may be covered in a physical exam versus a Medicare wellness visit, or that may be covered in both.

NOTE: this chart is not complete and you should ask your physician what is covered and your Medicare plan provider to understand how different health services may or may not be covered.

What’s included in a physical exam?

An annual physical exam is an assessment of your body’s health. The primary purpose is to look for health problems.

During the exam, your doctor uses his or her senses – mainly sight, touch and hearing – to gauge how your body is performing. Based on what’s learned, your doctor may ask you to have tests to discover or rule out possible health problems.

The list below shows some of the things your doctor may do during a physical exam.

Visually check your body overall for signs of existing health issues

Look into your eyes, ears, nose and throat for potential problems

Listen to your heart and lungs to detect irregular sounds

Touch parts of your body to feel for abnormalities

Test your motor function and reflexes

Perform pelvic and rectal exams

Measure your height, weight and blood pressure

As a rule, Medicare does not cover an annual physical. The exam and any tests your doctor orders are separate services, and you may have costs related to each depending on your Medicare plan.

What’s included in a Medicare Wellness Visit?

A Medicare Wellness Visit, also called a wellness exam, is an assessment of your overall health and well-being. The primary purpose is prevention – either to develop or update your personalized prevention plan. Medicare covers a wellness visit once every 12 months (11 full months must have passed since your last visit), and you are eligible for this benefit after you have had Part B for at least 12 months.

During the exam, your primary care provider combines information from the visit with your medical record to gauge your risk for common preventable health problems such as heart disease, cancer and type 2 diabetes. Based on what’s learned, your doctor creates your personal prevention plan with a checklist of screenings you need to have.

The list below shows some of the things your doctor may do during a wellness exam.

Review your health risk assessment (questions you answer about your health)

Confirm your medical and family history

Record your current prescriptions and providers

Measure and document your height, weight, and blood pressure

Look for signs of memory loss, dementia, or frailty

Document your health risk factors and treatment options

Provide personalized health advice

Develop a screening schedule (like a checklist) for the preventive services recommended for you

Medicare Part B covers an annual wellness exam and many preventive screenings with no copay or deductible. However, you may have to pay a share of the cost for certain recommended tests or services. And while it’s not mandatory, there are very good  reasons to have a wellness exam  every year.

What is a "Welcome to Medicare" visit?

Medicare Part B covers a "Welcome to Medicare" visit. This visit is also called an Initial Preventive Physical Exam (IPPE). You are eligible for this benefit once within the first 12 months you are enrolled in Part B

What to expect at your "Welcome to Medicare" visit

During the visit your provider will:

Record and evaluate your medical and family history, current health conditions and prescriptions.

Check your blood pressure, vision, weight and height to get a baseline for your care.

Make sure you are up-to-date with preventive screenings and services, such as cancer screenings and shots.

Order further tests, depending on your general health and medical history.

You do not pay a copayment for your "Welcome to Medicare" visit. The Part B deductible does not apply to the cost of the visit either.

After the visit, your provider will give you a personalized prevention plan or checklist with the screenings and preventive services recommended for you. These services are not part of the "Welcome to Medicare" visit. You may have to pay a co-payment for the recommended services when you get them. Your Part B deductible may also apply.

Learn more about what to expect at your Medicare wellness visit.

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The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical. Also, this service is similar to but separate from the one-time Welcome to Medicare preventive visit .

Eligibility

Medicare Part B covers the Annual Wellness Visit if:

• You have had Part B for over 12 months
• And, you have not received an AWV in the past 12 months

Additionally, you cannot receive your AWV within the same year as your Welcome to Medicare preventive visit.

Covered services

During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:

• Check your height, weight, blood pressure, and other routine measurements
• This may include a questionnaire that you complete before or during the visit. The questionnaire asks about your health status, injury risks, behavioral risks, and urgent health needs.
• This includes screening for hearing impairments and your risk of falling.
• Your doctor must also assess your ability to perform activities of daily living (such as bathing and dressing), and your level of safety at home.
• Learn about your medical and family history
• Medications include prescription medications, as well as vitamins and supplements you may take
• Your PCP should keep in mind your health status, screening history, and eligibility for age-appropriate, Medicare-covered preventive services
• Medicare does not require that doctors use a test to screen you. Instead, doctors are asked to rely on their observations and/or on reports by you and others.
• Screen for depression
• Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.

AWVs after your first visit may be different. At subsequent AWVs, your doctor should:

• Check your weight and blood pressure
• Update the health risk assessment you completed
• Update your medical and family history
• Update your list of current medical providers and suppliers
• Update your written screening schedule
• Screen for cognitive issues
• Provide health advice and referrals to health education and/or preventive counseling services

If you qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider . This means you pay nothing (no deductible or coinsurance ). Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.

During the course of your AWV, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.

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