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

Question

Larry Dalton · Accepted Answer

Medicare does not provide annual physicals; these are called wellness exams.  If the doctor bills it as a physical, you will most likely pay 100%.  However, if you have a Medicare Advantage plan, it may be covered as an annual physical under your policy coverage.  All Medicare Advantage plans are different, and their coverage for these items varies; check your policy.

Under traditional Medicare Part A and B, you can receive a yearly wellness exam.  Talk to your doctor about the upcoming exam and what it entails.

William Lawler · Answer

Annual physicals are always free with Medicare. Perhaps your doctor is not in network? Your agent should always check and ascertain that your primary care physician is in network.

Steven Bleicher · Answer

Find out the difference in the coverages between you and your friend and you will have your answer. Doctors actually could not care any less about Medicare costs. So, since true physicals are covered, it comes down to how the visit was “coded” by the doctor's billing department. If they mis-code the visit, they are no longer permitted to fix their error.

Answered by Steven Bleicher on May 8, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Tasha Riggs · Answer

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.

John L Herman Jr · Answer

The first thing that comes to mind is that your Doctor isn't in the network of your Plan. This is a common mistake that people make when letting a caller sign them into a Plan or when they go on-line and enroll themselves. MEDICARE is confusing...and people should always trust an Independent Broker to help them...and remember...a Broker never charges the client a fee for their help.

Answered by John L Herman Jr on April 21, 2025

Broker Licensed in MD, DE & PA

Answered by John L Herman Jr Medicare Insurance Agent

Steve Brauer · Answer

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

Gary Henderson · Answer

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

Jerry Cohen · Answer

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.

Andre Cabral · Answer

If your doctor billed you, he/she probably does not take Original Medicare; or he/she takes Medicare, but is out of your plan's network; or his/her rate is above (up to 15%) of Medicare allowed rate.

Scott Klag · Answer

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

Kevin Chaikin · Answer

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

Casey Peterson · Answer

There could be many reasons that one person is billed for a service and another is not. Medicare covers something called an Annual Wellness exam. This is not the same thing as a traditional annual physical. It normally consists of the provider asking a series of questions, but it does not include a hands-on physical or lab work. If your provider did a hands-on physical and ordered labs, that may be why you saw a charge and your friend did not. Another reason may be that your provider billed you, and your friends did not. It is up to the provider to correctly bill Medicare or insurance for services performed.

Answered by Casey Peterson on May 6, 2025

Broker Licensed in ID, AZ, CO & 6 other states

Answered by Casey Peterson Medicare Insurance Agent

Payal Acharya · Answer

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.

Debra Hartman · Answer

You may have had additional tests or an exam that was different from the Medicare wellness exam. Please call your clinic billing department to ask for a detailed explanation.

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

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

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