Medicare 2026

Medicare Wellness Visits vs. a Physical: Why a 'Free' Checkup Can Still Bring a Bill

If you've just enrolled in Medicare and booked what you thought was a "free annual physical," you may be surprised when a bill arrives weeks later. The confusion is understandable: Medicare does cover certain preventive visits at no cost, but those visits are not the head-to-toe physical many people picture. Knowing the difference ahead of time can save you money and spare you a frustrating phone call to the billing office.

The "Welcome to Medicare" visit

Part B covers a one-time "Welcome to Medicare" preventive visit during your first 12 months of Part B coverage. If your provider accepts assignment, you pay nothing for the visit, and the Part B deductible does not apply.

During the appointment, the provider reviews your medical and social history, calculates your body mass index, gives you a simple vision test, reviews your risk for depression, and gives you a written checklist of the screenings, vaccines, and other preventive services you should consider. Medicare is clear that this is not a comprehensive physical exam — no stethoscope-to-toes workup, no lab panel ordered as a matter of routine.

The yearly Wellness visit

After you've had Part B for more than 12 months, you become eligible for a yearly Wellness visit, which Medicare covers once every 12 months. The first Wellness visit cannot occur within 12 months of your Part B enrollment or within 12 months of your Welcome to Medicare visit. You do not need to have had a Welcome visit to qualify for the yearly Wellness visit later.

Think of the Wellness visit as a prevention planning session. You'll fill out a short Health Risk Assessment. Your provider will take routine measurements like height, weight, and blood pressure; review your current prescriptions; and perform a cognitive assessment to look for early signs of dementia. Together, you'll build or update a personalized prevention plan.

Medicare again notes that this is not a routine physical exam, and specifically advises booking a separate appointment to discuss specific health concerns.

Why a "free" visit can still produce a bill

Here's where the surprise bills come from. Both the Welcome and the Wellness visits are free only for the preventive service itself. If, during the same visit, your provider performs additional tests or services that fall outside the preventive benefit, the standard Medicare rules kick in: you may owe the Part B deductible, which is $283 in 2026, plus 20% of the Medicare-approved amount after that, as long as your provider accepts assignment.

And if the extra service isn't covered at all — a true comprehensive physical exam, for instance — you could be responsible for the full charge.

A few common examples:

• You mention a nagging knee pain, and the visit turns into an evaluation and treatment plan. The problem-focused portion is billable.
• The provider orders blood work that isn't part of a Medicare-covered preventive screening. That lab work may be subject to cost-sharing or not covered at all.
• You ask for a thorough "annual physical" like you had before Medicare. Medicare does not pay for routine physicals, so you may owe the full amount.

The lesson isn't to avoid raising concerns — it's to know what's preventive and what isn't, and to ask the office how a service will be billed before it's done.

Two useful add-ons

Part B also covers an optional physical activity and nutrition risk assessment. It costs nothing when it's done during your yearly Wellness visit. If you have it as part of another office or behavioral health appointment, you'll pay 20% of the Medicare-approved amount after the Part B deductible. It's available once every 6 months (or more often if more than one provider is involved).

Voluntary advance care planning — a conversation about the care you'd want if you became seriously ill — is also free when it's part of your Welcome to Medicare or yearly Wellness visit and your provider accepts assignment. Done at other times as part of medical treatment, the Part B deductible and coinsurance apply.

How your coverage choice affects what you pay

In Original Medicare, after you meet the Part B deductible, you typically pay 20% of the Medicare-approved amount for covered services when the provider accepts assignment. Some people add a Medigap policy to help with those out-of-pocket costs; others choose a Medicare Advantage plan, which bundles coverage and sets its own cost-sharing and network rules. Each path has trade-offs around flexibility, provider access, and predictability of costs. Neither is the "right" answer for everyone — it depends on your health, budget, and preferences.

A quick note on upcoming dates and changes

The Part D out-of-pocket cap is $2,100 in 2026 and rises to $2,400 in 2027. Annual Enrollment for 2027 coverage runs October 15 – December 7, 2026, with changes taking effect January 1, 2027. The 2027 Part B standard premium, deductible, and IRMAA income brackets have not yet been announced; CMS typically releases those figures in the fall.

If you receive Medicaid or Extra Help, you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone plans. Full-benefit dual-eligible individuals can also join an integrated D-SNP in any month.

Where to get official answers

Before your next appointment, it's worth asking the office two simple questions: "Is this being billed as a preventive Wellness visit?" and "If you address other concerns today, will there be additional charges?" A clear answer up front beats a confusing bill later.

For official information on what Medicare covers, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).