Medicare doesn’t cover routine annual physicals because the law that created the program specifically excludes them. Section 1862 of the Social Security Act lists “routine physical checkups” among the services for which no payment may be made under Part A or Part B. When Medicare was established in 1965, Congress designed it to cover treatment for illness and injury, not general preventive care for people who felt fine. That exclusion has never been removed from the statute, even as Congress has added dozens of individual preventive services over the decades.
The good news: Medicare does cover something very similar called the Annual Wellness Visit, plus a long list of preventive screenings, all at no cost to you. The distinction between what’s covered and what isn’t can feel arbitrary, but understanding it can save you hundreds of dollars in surprise bills.
The Law Behind the Exclusion
The Social Security Act explicitly bars Medicare from paying for routine physical checkups, eyeglasses, eye exams for prescribing glasses, hearing aids, and most immunizations (with specific exceptions added later). This language has been in the law since Medicare’s creation. The reasoning was financial: Medicare was built as insurance against the high cost of getting sick, not a wellness program. At the time, preventive medicine wasn’t emphasized the way it is today, and covering checkups for every enrollee was seen as too expensive for a program already taking on enormous costs.
Over the years, Congress recognized that preventing disease is cheaper than treating it, so lawmakers added coverage for specific screenings and preventive services one by one. But rather than strike the blanket exclusion on physicals, they carved out individual exceptions. The result is a patchwork system where Medicare covers a mammogram, a colonoscopy, and a diabetes screening, but not the traditional head-to-toe physical exam your doctor might have done when you had private insurance.
What Medicare Covers Instead
Medicare offers two preventive visits that serve much of the same purpose as an annual physical, just structured differently.
The “Welcome to Medicare” Visit
This is a one-time preventive exam available during your first 12 months of Part B coverage. It includes a review of your medical, surgical, and family history, along with measurements of height, weight, BMI, blood pressure, balance, and gait. Your provider will screen for depression, check your vision, assess your fall risk and ability to handle daily activities, and discuss end-of-life planning if you’re open to it. You’ll also get a written checklist of recommended preventive screenings, including a once-in-a-lifetime screening electrocardiogram if appropriate. There’s no cost to you for this visit.
The Annual Wellness Visit
After your first 12 months on Part B, you’re eligible for an Annual Wellness Visit every year at no cost. This is not a physical exam in the traditional sense. Your provider won’t typically listen to your heart and lungs, press on your abdomen, or do the hands-on exam you might expect. Instead, the visit focuses on planning and risk assessment. You’ll fill out a Health Risk Assessment questionnaire, and your provider will review your medications, update your medical and family history, check your height, weight, and blood pressure, and perform a cognitive assessment to screen for signs of dementia.
The visit also includes a review of risk factors for substance use disorders, including opioid use if you have a current prescription. Your provider will create or update a personalized prevention plan and give you a screening schedule for the preventive services you’re due for. Some visits also include an optional Social Determinants of Health assessment that looks at factors like housing, food access, and transportation that may affect your care.
Preventive Screenings That Are Fully Covered
Even without covering a traditional physical, Medicare Part B pays 100% for a substantial list of preventive screenings when you see a provider who accepts Medicare assignment. These include:
- Cancer screenings: mammograms, colonoscopies, flexible sigmoidoscopies, fecal occult blood tests, multi-target stool DNA tests, CT colonography, lung cancer screenings (for qualifying smokers), prostate cancer screenings, and cervical and vaginal cancer screenings
- Cardiovascular screenings: cholesterol and lipid panels, behavioral therapy for cardiovascular disease, and abdominal aortic aneurysm screening (one-time, for qualifying patients)
- Metabolic and infectious disease screenings: diabetes screenings, hepatitis B and C screenings, HIV screenings, and sexually transmitted infection screenings
- Mental health and behavioral screenings: depression screenings, alcohol misuse screenings and counseling, tobacco cessation counseling, and obesity behavioral therapy
- Vaccines: flu shots, pneumococcal shots, COVID-19 vaccines, and hepatitis B shots
- Other services: bone mass measurements, glaucoma screenings, medical nutrition therapy, and diabetes self-management training
Many of these screenings can be ordered during your Annual Wellness Visit, which is one reason Medicare structures preventive care this way. The wellness visit acts as the gateway to identifying which of these covered screenings you need.
How This Catches People Off Guard
The most common problem is that people schedule what they think is a free Annual Wellness Visit, but the appointment turns into something that gets billed as a traditional office visit or physical exam. This happens when you bring up a new symptom, ask your doctor to investigate a concern, or when the provider performs a hands-on examination that goes beyond what the wellness visit covers. Your provider may bill the wellness visit portion to Medicare at no charge, then bill an additional evaluation-and-management code for the extra work, leaving you with a share of that second charge.
To avoid unexpected costs, it helps to be clear when scheduling that you want the Annual Wellness Visit specifically. If you have health concerns you want addressed, consider making a separate appointment for those. Some providers handle both in one visit and bill them separately, which is legal, but the diagnostic portion will involve your usual Part B cost-sharing.
Medicare Advantage May Offer More
If you’re enrolled in a Medicare Advantage plan (Part C), your plan is required to cover everything Original Medicare covers, including the Annual Wellness Visit and all the preventive screenings listed above. Many Advantage plans go further and offer supplemental benefits that can include routine physical exams, vision exams, hearing exams, and dental care. These extras vary by plan, so it’s worth checking your specific plan’s evidence of coverage document to see whether a traditional physical is included.
Original Medicare with a Medigap supplement does not add routine physical coverage. Medigap policies only help pay your share of services that Medicare already covers. Since Medicare excludes routine physicals by statute, Medigap won’t pick up that cost either.
The Practical Difference
For most people, the Annual Wellness Visit combined with Medicare’s covered screenings provides the same health monitoring that a traditional annual physical would. The key differences are structural: the wellness visit is more focused on questionnaires, risk assessment, and care planning than on a hands-on exam. If you want a provider to physically examine you (listen to your lungs, check your reflexes, palpate your thyroid), that falls outside what the wellness visit covers, and you’d pay out of pocket or through Part B cost-sharing if it’s tied to a specific medical concern.
If you haven’t had your Annual Wellness Visit this year, scheduling one is the single best way to make sure you’re getting the preventive care Medicare does pay for. It costs you nothing, and it ensures your provider has an up-to-date picture of your health risks and can order the screenings you’re eligible for.