| Tue, Feb 12, 2019 @ 08:00 AM

What’s the Difference Between a Physical Exam and a Medicare Wellness Visit?

Posted by Medicare Made Clear

The difference between a physical exam and a Medicare Wellness Visit is basically the difference between your doctor focusing on what’s wrong versus on what’s right. Each is important, depending on the situation.

  • When you’re sick or in pain, you want to get better. A physical exam helps your doctor figure out what the problem is and what needs to be done.
  • When you’re healthy and feeling good, you want to stay that way. A wellness exam helps your doctor understand what’s working for you and how to best support your continued health and well-being.

Your doctor performs specific tasks in each of these two exams in order to achieve its purpose.


What’s Included in a Physical Exam?

A physical exam is an assessment of your body’s health. The primary purpose is to look for health problems.

During the exam, your doctor uses his or her senses – mainly sight, touch and hearing – to gauge how your body is performing. Based on what’s learned, your doctor may ask you to have tests to discover or rule out possible health problems.

The list below shows some of the things your doctor may do during a physical exam.

  • Visually check your body overall for signs of existing health issues
  • Look into your eyes, ears, nose and throat for potential problems
  • Listen to your heart and lungs to detect irregular sounds
  • Touch parts of your body to feel for abnormalities
  • Test your motor function and reflexes
  • Perform pelvic and rectal exams
  • Measure your height, weight and blood pressure

As a rule, Medicare does not cover an annual physical. The exam and any tests your doctor orders are separate services, and you may have costs related to each depending on your Medicare plan.


What’s Included in a Medicare Wellness Visit?

A Medicare Wellness Visit, also called a wellness exam, is an assessment of your overall health and well-being. The primary purpose is prevention.

During the exam, your doctor combines information from the visit with your medical record to gauge your risk for common preventable health problems such as heart disease, cancer and type 2 diabetes. Based on what’s learned, your doctor creates your personal prevention plan with a checklist of screenings you need to have.

The list below shows some of the things your doctor may do during a wellness exam.

  • Review your health risk assessment (questions you answer about your health)
  • Confirm your medical and family history
  • Record your current prescriptions and providers
  • Measure and document your height, weight, and blood pressure
  • Look for signs of memory loss, dementia, or frailty
  • Document your health risk factors and treatment options
  • Provide personalized health advice

Medicare Part B covers an annual wellness exam and many preventive screenings with no copay or deductible. And while it’s not mandatory, there are very good reasons to have a wellness exam every year.


Do You Need a Physical Every Year?

The medical community has questioned the value of physical exams in recent years, due in part to the potential for over-testing, false positive results and unnecessary costs. You need to decide if you want to get annual physical exams based on your health needs, coverage, and budget. However, it’s important to take advantage of your Medicare benefits and schedule a Medicare Wellness Visit every year.


For more information, explore Medicare Made Clear or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.