Medicare Annual Wellness Visit vs. a Physical: What’s Free, What Isn’t, and How to Avoid the Surprise Bill
Medicare Part B covers one yearly “Wellness” visit every 12 months, and you pay nothing if your doctor accepts assignment. The Part B deductible doesn’t apply. But it is not a physical exam. It’s a conversation to build or update your prevention plan. If the doctor also examines a new problem or orders tests that aren’t part of the wellness benefit, those can be billed with your usual deductible and 20% coinsurance, and Medicare doesn’t pay for a routine physical at all.
That gap between “wellness visit” and “physical” is where most surprise bills come from. Here’s how the three Medicare check-ups differ and how to keep yours at $0. All coverage details are from Medicare.gov’s yearly Wellness visit page and its “Welcome to Medicare” visit page, checked October 13, 2026.
Three different visits, three different rules
| “Welcome to Medicare” visit | Yearly “Wellness” visit | Routine physical exam | |
|---|---|---|---|
| When | Once, within your first 12 months of Part B | Once every 12 months after that | Whenever you schedule one |
| Your cost | $0 with an assigned provider | $0 with an assigned provider | Not covered by Original Medicare; you may pay the full amount |
| Part B deductible | Doesn’t apply | Doesn’t apply | Not applicable (not covered) |
| Hands-on, head-to-toe exam | No | No | Yes |
| Main purpose | Review history, set up screenings and vaccines | Health Risk Assessment and a written prevention plan | Full exam, often with routine labs |
Medicare’s rule on timing: your first yearly Wellness visit can’t happen within 12 months of when your Part B started or of your “Welcome to Medicare” visit. You don’t need to have had the Welcome visit to qualify. To avoid a denied claim, book each Wellness visit at least a year after the last one.
What actually happens at the yearly Wellness visit
You’ll fill out a questionnaire called a Health Risk Assessment (many offices send it ahead of time, so you can do it at home). Then, according to Medicare, your provider will:
- Take routine measurements like height, weight and blood pressure
- Review your medical and family history
- Review your current prescriptions
- Do a cognitive assessment to look for signs of dementia. If they see possible problems, Medicare covers a separate, more thorough visit
- Review risk factors for substance use disorder, and, if you take opioids, your pain treatment and non-opioid options
- Offer to talk about advance directives
- Give you a written prevention plan, like a checklist of the screenings and vaccines you’re due for
- Offer an optional physical activity and nutrition risk assessment
- Order other tests if needed (these may be billed separately)
The visit can be done by a doctor or another health care provider, such as a nurse practitioner or physician assistant, as long as they take Medicare.
Why people get a bill after a “free” visit
Medicare.gov is blunt about it: you may owe coinsurance, and the Part B deductible may apply, if your provider does additional tests or services during the same visit that the wellness benefit doesn’t cover. If Medicare doesn’t cover the extra service at all, like a routine physical, you may pay the full amount.
The usual triggers:
- Bringing up a new problem. “My knee’s been hurting” turns part of the appointment into a problem-focused visit, billed separately with your deductible and 20%.
- Routine blood work. Labs ordered “just to check” usually aren’t part of the wellness visit. Some screening tests are free under their own benefit if you qualify. My Medicare blood test guide shows which ones and how often.
- The office scheduled a “physical.” If the visit is booked or coded as a routine physical, Original Medicare won’t pay it.
- Your provider doesn’t accept assignment. The $0 promise depends on it.
For 2026, the Part B deductible is $283 and coinsurance is usually 20% of the Medicare-approved amount (Medicare.gov costs).
How to keep the visit at $0
- Use the exact words when booking: “I’d like my Medicare yearly Wellness visit.” Ask whether anything else will be billed.
- Book problems separately. If you have a specific concern, Medicare itself suggests scheduling a separate appointment so the Wellness visit stays focused on prevention. Or ask the doctor up front if they’ll bill that part separately so you can decide.
- Ask before any lab draw: “Is this covered as a screening test, or will it go toward my deductible?”
- Check your Medicare Summary Notice afterward. If a wellness visit shows cost sharing you didn’t expect, call the office and ask them to recheck the billing.
If you’re in a Medicare Advantage plan, it must cover the Wellness visit too, and many plans also cover a routine physical as an extra benefit. Check your plan’s Evidence of Coverage, and use an in-network provider.
What to bring
- A list of every medicine you take, including over-the-counter drugs, vitamins and supplements, and why you take them (or bring the bottles)
- Your family health history
- Names of your other doctors and specialists
- Dates of recent screenings and vaccines, if you have them
- Your questions, written down
Getting the most out of the visit
The wellness visit is a good time to raise things that rarely come up in a rushed problem visit:
- Falls and balance. If you’ve fallen, nearly fallen, or feel unsteady, say so. My balance exercise guide has moves you can start at home.
- Medication load. If you take five or more medicines, ask whether any can be stopped or reduced. Here’s why polypharmacy matters after 65.
- Mood and memory. Be honest on the questionnaire. Depression and early memory changes are easier to address when caught early.
- Screenings you’re due for. Your written plan should list them. Many are free. See my list of free Medicare preventive screenings.
- Activity and diet. Use the optional physical activity and nutrition assessment to talk about strength training, protein and any weight you’ve lost without trying.
Common questions
Is the Medicare Annual Wellness Visit free?
Yes, if your provider accepts assignment. You pay nothing and the Part B deductible doesn’t apply. Extra tests or services during the same visit can be billed separately.
Is the Annual Wellness Visit the same as a physical?
No. It’s a planning visit built around a Health Risk Assessment and routine measurements. Original Medicare doesn’t cover routine physical exams.
How often does Medicare cover the wellness visit?
Once every 12 months. Your first one can’t be within 12 months of starting Part B or of your “Welcome to Medicare” visit.
Does the wellness visit include blood work?
Not routinely. Your provider can order tests if needed, but they may be billed separately unless they’re covered screening tests you qualify for.
Do I need the Welcome to Medicare visit first?
No. You can get yearly Wellness visits without ever having had the “Welcome to Medicare” visit.
Written by Khasim Basha Shaik. I research Medicare rules and compare official sources for readers. I’m not a licensed insurance agent or medical professional. This article summarizes Medicare.gov materials and isn’t medical or legal advice. Last reviewed October 13, 2026.
