My friend said she got a free annual physical with Medicare, but my doctor billed me. What's going on?

Answered by 7 licensed agents

Per Law all preventative is free. I am not sure why your doctor would bill you. My guess is they did not code it as preventative but as diagnostic.

Answered by Tasha Riggs on April 10, 2025

Broker Licensed in CO, AZ, HI & 10 other states

Answered by Tasha Riggs Medicare Insurance Agent
Medicare does not have free annual physical exams but DOES have a yearly wellness visit. It's possible that your friend has a Medicare Advantage Plan and most of those have a $0 copay for visits to your primary care physician.

Answered by Steve Brauer on April 13, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent
If a doctor builds you always question it. Check your explanation of benefits before you pay any bill. Often doctors will bill you because they haven't been paid yet and it's lagging or something like that by the insurance company or Medicare. And also depends on whether you have a Medicare advantage plan or a Medicare supplement plan. If it's a supplement plan, Medicare pays first and then your plan pay-c remaining 20%. You do have an annual deductible for doctor visits of $257 this year. Once that's been met you would not have any further charges for the rest of the year. If you'd like to go over this in more detail, give me a call at 737-530-4626 pick option 2. That's my direct line. If it's busy, just leave a message and I'll call you back

Answered by Gary Henderson on April 10, 2025

Agent Licensed in TX, AK, AL & 46 other states

Answered by Gary Henderson Medicare Insurance Agent
Original Medicare only provides a "Welcome to Medicare" physical the first year. After that you will have to pay if you stay on Original Medicare. If you have a Medicare Advantage or Medicare Supplement the Annual physical is at a $0 cost.

Answered by Scott Klag on April 9, 2025

Agent Licensed in OH

Answered by Scott Klag Medicare Insurance Agent
There is a lot of confusion about what Medicare will and will not cover under the " free " status so far as it pertains to an annual physical.

What Medicare will pay for isa a visit that only addresses health maintenance and preventive care. Included in the Medicare annual wellness visit there is no requirement for an actual hands-on physical exam such as listening to your heart and lungs.

It is really just to check on stuff that is not actively going on that you might not have symptoms of—and that’s what makes it different from other types of visits where you usually go in because either you’re sick, you’re not feeling well, there’s something wrong or you already have a disease that you’re managing and want to make sure that it hasn’t gotten worse or ... what to do next for it. Medicare calls the visit to the doctor an Annual Wellness visit. There is also a one time Welcome to Medicare visit which is covered by Medicare at 100% but it is not the same as a comprehensive Physical Exam.

Answered by Jerry Cohen on April 10, 2025

Broker Licensed in NY

Answered by Jerry Cohen Medicare Insurance Agent
Medicare does not provide an annual physical but rather a wellness exam. If the doctor billed it as a physical then you will pay 100%. If you have a Medicare advantage plan the plan MAY cover an annual physical.

Answered by Kevin Chaikin on April 14, 2025

Broker Licensed in VA, AL, AZ & 31 other states

Answered by Kevin Chaikin Medicare Insurance Agent
In order to answer you properly, If you are also on Medicare, I do need some more information about your visit.

But just check the following things to start with.

- Is your doctor accepts Medicare?

- what Medicare plan do you have. HMO or PPO?

- Is the doctor in your plan network?

Feel free to reach out to me if you want 1-1 conversation.

Answered by Payal Acharya on April 18, 2025

Broker Licensed in MA & NH

Answered by Payal Acharya Medicare Insurance Agent

Tags: Coverage Medicare Part B The Medicare System

Agents: Share Your Expertise

Have insights or experiences related to this topic? Help others by sharing your knowledge and answering this question.

Add Your Answer