Getting a Free Wellness Exam Under Medicare

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Medicare has started offering what looks like a free physical. This is good news for Medicare beneficiaries, as under the old rules, the program didn’t cover any routine exams except for the first introductory physical. But watch out—you might still get a bill in the mail.

Under President Obama’s new health care law, Medicare covers annual physicals—but the wording in the Medicare booklet for 2011 on the new free exam has been confusing. People have been setting appointments for the wrong type of exam with their doctors, only to get billed later. And many aren’t aware that the free wellness program exists or is offered by their doctor—only about 1.2 million of over 31 million eligible Medicare beneficiaries have used the wellness exam so far.

Here are a few important things to know about Medicare’s new wellness exam program.

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A wellness exam is a valuable opportunity to talk to your doctor about health issues and concerns you may have, get your cognitive performance assessed.




The wellness exam is not a physical

It’s more of an opportunity for you and the doctor to talk about any possible health issues. The doctor will measure your height, weight, blood pressure, and body mass. You’ll also get a quick test of your cognitive abilities, and the doctor may listen to your heart through your clothes. You won’t usually have to take your clothes off. The rest of the visit consists of discussing your family and medical history, any areas of concern, and possible risk factors for disease. Your doctor may also set a schedule for future appointments, and may refer you to a specialist or recommend certain tests and screenings.

It’s a valuable time to get to have a lengthy conversation with your doctor—and in a time when doctors are often very pressed for time, this is rare. But it isn’t a full physical that involves lots of poking and prodding in a hospital gown.

Not all doctors offer it

Medicare does not require any doctor to offer the wellness exam, and your doctor may not. If that’s the case, and you call up and request a physical, you will definitely be billed for it. If your doctor doesn’t offer the free wellness exam, you are free to visit a doctor who does.

Be specific

When you call the doctor’s office, ask for “the free Medicare wellness visit.” Don’t use the word “physical”—as you might confuse the office, leading them to schedule you for a real physical, which is not covered. You could also use the medical billing code, which is G0438 for the first wellness visit and G0439 for any subsequent annual visit.

Your doctor may offer it, but may not be telling you

Many doctors throughout the country have been offering the visit to those who ask for it, but not going out of their way to inform other patients that it’s available. While some see the wellness visits as a valuable opportunity to have conversations with patients, others see it as a strain on an already busy practice—if more doctors had time to have a 45-minute conversation with patients about their health, they would have worked it in already. Don’t wait for your doctor to inform you about the wellness visit.

A wellness exam is a valuable opportunity to talk to your doctor about health issues and concerns you may have, get your cognitive performance assessed, and set a schedule for future tests and visits. It’s not a full physical, however, and while doctors are still getting used to offering it, you may have to be quite specific when you call and set an appointment. If you are, you won’t be billed later—and you’ll get important time to talk to the doctor and catch any upcoming health issues before they become serious.