As you get older, annual physicals can be vital to help detect health issues early, as well as maintaining overall wellness. If you are enrolled in a Medicare Supplement Insurance plan (Also known as Medigap), you should be aware on if your plan offers coverage for your annual physical.
Are Annual Physicals Covered by Medicare Supplement Plans?
Technically, No, Medicare Supplement plans do not cover annual physicals, but you will still receive coverage for your annual physical. Annual physicals are covered by Original Medicare (Part A and Part B) rather than Medicare Supplement Plans.
Although your Medigap plan won't be offering the coverage, you will still be covered for your annual physicals because you are required to have Original Medicare to have a Medicare Supplement plan.
However, Medicare Supplement plans can help with costs related to your annual physical if additional services are performed during your visit that aren't fully covered by Original Medicare.
What Original Medicare Covers
Original Medicare Part B covers several types of preventive visits and screenings without requiring you to pay deductibles, copayments, or coinsurance:
Welcome to Medicare Preventive Visit
This one-time visit is available within the first 12 months of enrolling in Medicare Part B. During this comprehensive exam, your doctor will review your medical history, provide preventive care recommendations, and discuss screenings and vaccinations you may need.
Annual Wellness Visits
After your first year on Medicare, you're eligible for an Annual Wellness Visit once every 12 months. This visit focuses on developing or updating a personalized prevention plan based on your current health and risk factors. The wellness visit includes health risk assessments, reviewing your medical history, and creating a screening schedule for the coming year.
Preventive Screenings and Services
Medicare Part B also covers numerous preventive screenings and services at 100%, including mammograms, colonoscopies, cardiovascular screenings, diabetes screenings, and various vaccinations.
How Medicare Supplement Plans Can Help With Annual Physicals
While Medicare Supplement plans don't cover the annual physical itself, they can provide valuable coverage in several scenarios:
Additional Services During Your Visit
If your doctor performs additional diagnostic tests, procedures, or treatments during your annual physical that aren't considered preventive care, these services may be subject to Medicare's standard deductibles and coinsurance. Medicare Supplement plans can help cover these out-of-pocket costs.
Follow-Up Care
If your annual physical reveals health concerns that require follow-up appointments, diagnostic tests, or treatments, your Medicare Supplement plan will help cover the costs that Original Medicare doesn't pay in full.
Specialist Referrals
Should your annual physical result in referrals to specialists, Medicare Supplement plans can help reduce your out-of-pocket costs for these visits and any associated procedures.
Preventive Care vs Diagnostic Care
When you are getting tests done, you'll need to understand the difference between preventive care and diagnostic care.
Preventive Care
Preventive care includes routine screenings and services to prevent illness or early detection of health problems. Medicare generally covers these services 100%.
Diagnostic Care
Diagnostic care involves tests and procedures performed when you are having symptoms or when your preventive care reveals a potential issue. Diagnostic care is generally subject to Medicare's deductibles and coinsurance. Depending on the situation, your Medicare Supplement plan may help cover some of these costs.