Does Medicare cover routine checkups? A guide to physicals, wellness visits, and preventive care in 2026

Short answer

No — Original Medicare doesn’t cover a traditional annual physical. It does cover three related visits: a one-time Welcome to Medicare preventive visit (within your first 12 months of Part B), an Annual Wellness Visit every 12 months, and a broad list of preventive screenings under Part B. These are health-planning visits, not head-to-toe exams. Many Medicare Advantage plans add a traditional annual physical on top.

What “routine checkup” means to Medicare

The phrase “routine checkup” trips a lot of new Medicare beneficiaries because Medicare uses it differently than private insurance does.

Under most employer plans, an annual physical is expected: a scheduled visit where the doctor examines you head to toe, orders standard blood work, and updates your health history. Original Medicare does not cover that. There’s no billing code in Medicare for a general adult physical.

What Medicare covers instead is a set of three specific preventive touchpoints:

1. The Welcome to Medicare visit, one time only, in your first 12 months of Part B.
2. The Annual Wellness Visit (AWV), once every 12 months after that.
3. Preventive and screening services under Part B — over 20 individual screenings, vaccines, and counseling visits that Medicare pays for at no cost to you.

These are not the same as a physical. They’re planning conversations plus targeted screenings — designed to catch problems early rather than to examine you comprehensively.

The Welcome to Medicare visit (IPPE)

The Welcome to Medicare visit is Medicare’s introduction. Its technical name is the Initial Preventive Physical Examination (IPPE). You can have it only once, and only within your first 12 months of Part B coverage. Miss the window and it’s gone — the AWV takes over.

What happens during the IPPE:

• Review of your medical and social history, family history, and medications.
• Height, weight, blood pressure, body mass index, and vision test.
• Screening for depression and functional ability (safety, hearing, fall risk).
• Discussion of end-of-life planning if you want to have it.
• A written plan and a checklist of preventive services Medicare will pay for going forward.

What it costs: $0 if your provider accepts Medicare assignment and codes the visit correctly (billing code G0402). No deductible, no coinsurance.

What it doesn’t include: hands-on physical examination beyond the checks listed above, blood work, or diagnostic tests. If your doctor orders those the same day, they may be billed separately under standard Part B rules.

The Annual Wellness Visit (AWV)

The Annual Wellness Visit picks up after your IPPE window closes. You can have your first AWV 12 months after your IPPE (or 12 months after your Part B start date if you skipped the IPPE). After that, you can have one every 12 months for the rest of your life on Medicare.

What happens during the AWV:

• A Health Risk Assessment (a questionnaire about your health, habits, and risk factors).
• Update of your medical history and family history.
• Measurement of blood pressure, weight, height, and body mass index.
• Cognitive screening (a check for memory issues that may signal early dementia).
• Review of your medications and preventive-services schedule.
• A personalized prevention plan — the doctor’s recommendations for the next 12 months.

What it costs: $0 with Medicare assignment. Billed as G0438 for the first AWV and G0439 for every subsequent one.

What it doesn’t include: a hands-on physical exam, routine blood work, or evaluation of a specific health complaint. If you bring up a new symptom during the visit and the doctor addresses it, that portion may be billed separately (often called a “significant separately identifiable evaluation” — billing modifier -25).

What Medicare doesn’t cover: the traditional annual physical

If you request a traditional annual physical — the kind private insurance covers — Original Medicare will not pay for it. There are two ways this can play out in practice:

Path 1 — The office bills the visit as a physical. Medicare denies the claim. You are billed the full charge (often several hundred dollars).

Path 2 — The office converts the visit to an AWV. Coverage kicks in, but the visit becomes a wellness assessment, not a physical exam. The doctor may not examine you the way you were expecting.

Path 3 — The office bills part as an AWV and part as a diagnostic visit. If you brought up a specific complaint (chest discomfort, joint pain, a new medication issue), the diagnostic portion can be billed under standard Part B. You may owe your Part B deductible plus 20 percent coinsurance on that portion.

The safest way to avoid a surprise bill is to say “Annual Wellness Visit” (not “physical”) when you schedule, and to check with the office in advance whether they bill any additional exam separately.

The preventive services Medicare covers at no cost

Beyond the IPPE and AWV, Medicare Part B covers a long list of preventive services with $0 cost-share when your provider accepts Medicare assignment. Highlights:

• Cardiovascular screening: cholesterol, lipid, and triglyceride tests every 5 years; abdominal aortic aneurysm ultrasound one-time for at-risk beneficiaries.
• Cancer screening: colorectal (colonoscopy every 10 years or FIT test yearly), breast (mammogram yearly ages 40+), cervical (Pap and pelvic exam every 24 months, more often for higher risk), prostate (PSA test yearly for men 50+), lung cancer (annual low-dose CT for eligible smokers).
• Diabetes: screening for at-risk patients, self-management training, glaucoma test.
• Bone density: every 24 months for at-risk beneficiaries.
• Hepatitis B, hepatitis C, HIV, and STI screening for those at risk.
• Vaccines: flu, pneumococcal, hepatitis B, COVID-19, and — since 2023 — most ACIP-recommended adult vaccines including shingles at $0 under Part D per the Inflation Reduction Act.
• Alcohol misuse, obesity, and tobacco cessation counseling.
• Depression screening and cognitive-impairment care planning.

The full list is published on medicare.gov. Your Welcome to Medicare visit or AWV is a good time to walk through which screenings you’re due for.

What Medicare Advantage plans add

Medicare Advantage (Part C) plans must cover everything Original Medicare covers — including the IPPE, AWV, and Part B preventive services. But most MA plans go further and include a traditional annual physical exam as an extra benefit at no cost to the member.

Every MA plan is different. Check your plan’s Evidence of Coverage or annual notice of change to see whether a routine physical is included. Some plans also add extras like hearing exams, dental cleanings, or vision refractions that Original Medicare doesn’t cover.

If having a comprehensive annual physical matters to you, this is one of the reasons people choose an MA plan during Open Enrollment (October 15 – December 7) or the Medicare Advantage Open Enrollment period (January 1 – March 31).

How to make sure your visit is billed correctly

Small language changes make a big difference in whether Medicare pays.

• When you schedule, say “I’d like to schedule my Annual Wellness Visit” or “my Welcome to Medicare visit.” Do not say “I need my annual physical” unless you have an MA plan that covers it.
• When you arrive, confirm at the front desk that the visit is being billed as G0402 (IPPE), G0438 (initial AWV), or G0439 (subsequent AWV). Note the code — you’ll see it later on your Medicare Summary Notice.
• If the doctor brings up a new problem during the visit — a new symptom, a follow-up on a diagnosed condition — ask whether that portion will be billed separately. If yes, you may owe your Part B deductible and 20 percent coinsurance for that piece.
• After the visit, check your Medicare Summary Notice (MSN) or the mymedicare.gov claims page. If you’re billed for something you weren’t expecting, contact the provider’s billing office before you pay — the fix is often as simple as re-coding the claim.

How Baba helps

• Explains the difference between an AWV and a physical before you schedule, so you know what to expect in the room.
• Reviews the covered preventive-screening list against your medical history so you don’t miss free screenings you qualify for.
• Checks your MA plan’s Evidence of Coverage if you’re enrolled in Part C, and confirms whether an annual physical is included.
• Helps you script the scheduling call with practice language: “I’d like to schedule my Annual Wellness Visit” — so the office bills the correct code.
• Reviews your Medicare Summary Notice after the visit if something looks off — an unexpected charge, a denied claim, or a code you didn’t expect.
• Escalates billing disputes if a wellness visit is billed as a physical or vice versa. Most billing mistakes are fixable with a single call to the practice.

Call (855) 765-9011 or schedule a call to have a Baba advocate walk you through your Medicare preventive-care schedule and MA-plan benefits.

Frequently asked questions

Do I have to have a Welcome to Medicare visit?

No — it’s optional. If you miss the 12-month window, you can’t have one later, but you can still start the AWV cycle 12 months after your Part B coverage begins. Many people skip the IPPE and go straight to their first AWV.

Can I get a full head-to-toe physical if I ask for one?

Original Medicare will not pay for it. Your doctor can perform the exam, but you’ll be billed for the visit yourself (or you can pay out-of-pocket). If you’re on Medicare Advantage, check your plan — many MA plans include a routine physical.

Is a blood test covered at the AWV?

Not as part of the AWV itself. If your doctor orders blood work based on the risk assessment, that lab work is billed separately under Part B. Some tests are $0 (screening labs on Medicare’s preventive list); others carry a 20 percent coinsurance after your Part B deductible.

How often can I have an Annual Wellness Visit?

Once every 12 months. Medicare counts the months exactly — if your last AWV was in June, the next one has to be at least the following June or later. Some offices book the AWV month by month; others let you schedule 11 months out. If you have two AWVs less than 12 months apart, Medicare will deny the second one.

What’s the difference between an AWV and an annual physical?

An AWV is a wellness-planning conversation: risk assessment, cognitive check, medication review, personalized prevention plan. A physical is a hands-on exam: heart, lungs, abdomen, reflexes, and often lab work. The AWV asks about your health; the physical looks at your body. Medicare pays for the first, not the second.

Do I need to fast before an Annual Wellness Visit?

Usually not — the AWV itself doesn’t include blood work. But if your doctor plans to order labs the same day (a common practice), the office may ask you to fast. Confirm when you schedule.

This information is for educational purposes and should not substitute for professional guidance. Healthcare coverage details vary by individual plan. Consult with Baba’s support team or your insurance provider for information specific to your situation.