Recently it was discussed on social networks that Medicare does or does not cover annual physical examinations, those that you routinely do to monitor your overall health status. Some people said that the Social Security act clearly prohibited Medicare from paying for such tests, to the dismay of many users.
However, other netizens commented that on the official website of the HHS.gov (Health and Human Services) says, quite transparently, that physical exams are covered. It’s explained in the part where it says Medicare Part B. And the debate intensified because there are people who claim that they have not been covered for the payment of physical examinations. So, what is the truth?
Medicare does not cover a physical exam, and here’s why
The Affordable Care Act incorporated a certain type of preventive health screening at the beginning. This preventive checkup for people with Medicare is not like a typical physical examination, and here’s where people are confused.
Techniques such as touching or listening to the body, which are important parts of a physical examination, are not performed. Also, unlike annual physical exams, this exam is only done once, within the first 12 months after enrolling in Medicare Part B.
The confusion arose because the term “physical examination” appears in the official title, which led to a great confusion that persists to this day. Now, Medicare refers to this service as a “Welcome to Medicare preventive visit.”
This means that, although the official name may be misleading, it is actually a preventive visit that welcomes those who enroll in Medicare.
What’s that medical exam that is actually covered by Medicare?
Well, the medical exam that is covered by Medicare is the welcome exam, a process that focuses on giving doctors as much input as possible, while taking advantage of it to give the patient advice on treatments or preventive services that he should address.
The information that doctors obtain in this initial examination includes (but is not limited to):
- Height, weight, and blood pressure measurement to assess your fitness.
- Body mass index calculation to determine if you are in a healthy weight range.
- Performing a basic vision test to check your visual acuity.
- Review of depression-related risk factors, functional capacity and safety level, as well as review of current opioid prescriptions to ensure appropriate use.
- Detection of possible substance use disorders and evaluation of visual acuity.
- Education, counseling and referral to additional services based on the results of the above assessments.
- End-of-life planning, in case the patient gives consent to address this issue.
As you can see, that’s where the confusion was, it’s the name that has confused people on social networks like Facebook, X (formerly Twitter) or Instagram, where they have debated about this confusion.
What Medicare does offer is a second preventive visit, every 12 months. It may be annual, but this view is also not a physical examination as such. The objective of this is to update the information to follow the patient’s preventive plan. Your medical and family history, height, weight, blood pressure, and other routine measurements will be checked. Signs of any cognitive impairment and basic mental health will also be looked for. But no, it’s not a physical exam per se.