Medigap does not generally pay for a routine annual physical that Original Medicare excludes. Medicare’s covered preventive visits are different services. Knowing which appointment you book helps avoid treating a “yearly checkup” as a promise that every examination and test is covered.
Compare the appointment types
| Visit | Key Medicare rule |
|---|---|
| Welcome to Medicare preventive visit | Available once within the first 12 months of Part B. |
| Yearly Wellness visit | Available once every 12 months when eligible; it develops or updates a prevention plan. |
| Routine physical examination | Not the same benefit and generally not covered by Original Medicare. |
| Visit to evaluate symptoms or a medical condition | May be covered separately, with applicable cost sharing. |
The first Wellness visit cannot occur within 12 months of enrolling in Part B or receiving the Welcome visit. You do not have to have used the Welcome visit to qualify later.
What the Wellness visit is for
It includes a health-risk assessment, review of medical and family history, routine measurements and a personalized prevention plan. It is not a comprehensive physical examination or an automatic entitlement to every screening test.
For the covered Wellness service, you pay nothing when the provider accepts assignment, and the Part B deductible does not apply. Additional services can create charges. For a covered problem-focused service, cost sharing may apply; for an excluded routine physical, you may owe the full amount.
Where Medigap fits
Medigap may pay eligible cost sharing on Medicare-covered services according to your policy. That is different from covering an excluded physical. If you have Medicare Advantage instead, check the plan’s own preventive and additional examination benefits.
Before scheduling
- Ask the office to book the exact Medicare visit you need.
- Confirm your last preventive-visit date and current eligibility.
- Ask whether additional services will be billed separately.
- Discuss health concerns with the clinician and clarify any separate appointment.
- Review the claim notice against the services actually received.
Related coverage questions
- What the Welcome to Medicare Preventive Visit Is and When It Happens
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