This confusion generates more surprise medical bills for Medicare beneficiaries than almost any other coverage misunderstanding. A patient schedules their “free annual physical.” The doctor takes blood pressure, reviews medications, discusses health goals. A few weeks later, a bill arrives for $150–$350. What happened? The visit was coded as an office visit, not an Annual Wellness Visit — or extra services were added that triggered diagnostic billing. Here’s how to navigate this correctly.
The Three Preventive Visit Types Medicare Covers
| Visit Type | When Available | Your Cost | Key Features |
|---|---|---|---|
| Welcome to Medicare Visit (IPPE) | One time only, within first 12 months of Part B enrollment | $0 | One-time baseline assessment; vision test; EKG referral; referrals for preventive screenings |
| Annual Wellness Visit (AWV) | Once per year (at least 12 months after your first AWV or Welcome Visit) | $0 | Health risk assessment; cognitive screening; depression screening; prevention plan; medication review |
| Traditional physical exam | Any time medically needed | 20% coinsurance after Part B deductible | Head-to-toe physical examination; diagnostic workup; billed as a standard office visit |
What the Annual Wellness Visit Includes (and Doesn’t)
- Review and update of your medical and family history
- A list of your current providers and prescriptions
- Height, weight, BMI, blood pressure, and other routine measurements
- Cognitive impairment detection (brief screening)
- Depression screening
- Review of functional ability and safety (fall risk, hearing, vision)
- Written schedule of preventive services you should receive based on your age and risk factors
- Advance care planning discussion (if you choose to have it)
- Referrals for other covered preventive services
Not included in the AWV — and not covered at $0:
- Physical examination of the heart, lungs, abdomen, joints, or reflexes
- Routine blood work ordered to check your cholesterol, blood sugar, kidney function, etc.
- Urinalysis or other diagnostic tests
- Any evaluation or treatment of a new or existing health problem
- Discussion of or treatment for symptoms or conditions you bring up during the visit
How to Have a $0 Annual Wellness Visit
To keep your AWV at $0, follow these steps:
- Schedule the visit specifically as an “Annual Wellness Visit.” Use those exact words when scheduling. Some offices call it an AWV, some call it a Medicare Wellness Exam. Confirm before you arrive that the visit is coded as an AWV, not a general physical or office visit.
- Save new medical concerns for a separate appointment. If you have symptoms, new pain, or medical questions beyond the AWV’s preventive scope, schedule a separate follow-up appointment. Don’t bring up medical problems during your AWV if you want to avoid additional billing.
- Decline optional add-ons unless you understand the billing. If your doctor wants to draw blood during the AWV, ask how it will be billed. Preventive screening labs (once-every-5-year lipid panel, diabetes screening, etc.) are still $0. Diagnostic lab work ordered because of findings is not.
- Ask at checkout what codes were used. Request a copy of the visit’s billing codes. The AWV should be billed under HCPCS code G0438 (first AWV) or G0439 (subsequent AWV). If you see a standard evaluation and management (E&M) code instead, your visit was not billed as an AWV.
The Welcome to Medicare Visit—Your One-Time First-Year Benefit
When you first enroll in Medicare Part B, you are entitled to a one-time “Welcome to Medicare” preventive visit (also called the Initial Preventive Physical Examination, or IPPE). This must be used within your first 12 months of Part B enrollment and is covered at $0.
The Welcome to Medicare visit includes:
- A comprehensive review of your medical and social history
- Height, weight, BMI, blood pressure measurement
- A vision test
- An EKG (electrocardiogram)—though only the electrocardiogram tracing itself, not interpretation and report, which may cost more
- Referrals for other covered preventive services you are due for
- Education and counseling about preventive services and health risks
Many newly enrolled Medicare beneficiaries miss this one-time visit — it’s valuable for establishing a baseline and getting all your preventive service referrals organized at the start of Medicare coverage. Schedule it within your first 12 months.
Medicare Preventive Services Covered at 100%
Beyond the AWV itself, Medicare covers a wide range of preventive services at $0 — no deductible, no coinsurance. Your Annual Wellness Visit is a good time to receive referrals for these services if you haven’t completed them on schedule:
| Preventive Service | Frequency | Your Cost |
|---|---|---|
| Mammogram (breast cancer screening) | Once per year | $0 |
| Colonoscopy (average risk) | Every 10 years | $0 (screening rate) |
| Cardiovascular disease risk screening (cholesterol) | Every 5 years | $0 |
| Diabetes screening | Up to twice per year if at risk | $0 |
| Flu vaccine | Annually | $0 |
| Pneumococcal vaccines (PCV15, PPSV23) | Per schedule | $0 |
| Shingles vaccine (Shingrix) | 2-dose series | $0 under Part D on most plans |
| Depression screening | Annually | $0 |
| Lung cancer screening (CT) | Annually (qualifying smokers) | $0 |
| Bone density measurement (osteoporosis) | Every 24 months for high-risk women | $0 |
| Abdominal aortic aneurysm ultrasound | One time (qualifying male smokers) | $0 |
Frequently Asked Questions
If Medicare doesn’t cover a traditional physical, how do I get one?
You can ask your doctor for a standard physical examination at any time. It will be billed as a diagnostic office visit under Part B — you pay 20% coinsurance after your $283 annual deductible. A comprehensive physical exam typically costs $150–$400 before Medicare’s share; your 20% would be $30–$80. Alternatively, a Medigap plan covers this coinsurance.
Can my doctor do both an Annual Wellness Visit and a problem visit on the same day?
Yes — but they must be billed separately, and you will receive two separate charges. The AWV portion is $0; the problem visit (for a symptom or condition) is billed as a standard office visit with 20% coinsurance. This is legitimate and allows you to handle both preventive and medical needs in one trip. Just know in advance that you’ll receive a bill for the problem portion.
Does my Annual Wellness Visit reset every calendar year or every 12 months?
Every 12 months from your previous AWV — not necessarily on a calendar year basis. If you had your last AWV in September 2026, you are eligible for your next one in September 2027, not January 2027. Medicare requires at least 12 months between AWV visits.
Does Medicare Advantage cover a physical exam differently?
Many Medicare Advantage plans include benefits beyond the standard AWV. Some plans cover an annual physical examination (with hands-on exam) at $0 or a low copay as an added supplemental benefit. Check your plan’s Summary of Benefits—if a physical exam is listed as a covered benefit, the cost-sharing your plan specifies applies.
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This article is for informational purposes only. Medicare billing codes and covered services are updated periodically by CMS. The best way to avoid billing surprises is to confirm how your visit will be coded before you arrive — ask your provider’s office directly. For questions about specific claims, contact Medicare at 1-800-MEDICARE or visit Medicare.gov.
