Moving from employer insurance to Medicare may change what the phrase annual checkup means. A preventive appointment, a physical exam and a visit to diagnose symptoms are not interchangeable billing categories. Knowing which service you are scheduling helps you ask useful coverage questions.
The Welcome to Medicare visit
During your first 12 months with Part B, you can receive a one-time Welcome to Medicare preventive visit. It reviews your health history and prevention needs and is not a comprehensive physical examination. Under Original Medicare, you pay nothing for this benefit when the provider accepts assignment. Additional services can have separate costs.
The yearly wellness visit
After the first year of Part B, the yearly wellness visit focuses on developing or updating a personalized prevention plan. It is available once every 12 months, subject to the timing rules, and is not a routine physical exam. Your first wellness visit cannot be within 12 months of your Part B enrollment or Welcome visit. You do not have to receive a Welcome visit first.
With Original Medicare, the wellness benefit has no charge when the provider accepts assignment. That does not make everything performed on the same day part of that benefit. Evaluation of symptoms or other added services may create cost sharing; a service Medicare does not cover may be your full responsibility.
Screenings have their own rules
Medicare covers a range of preventive services, but age, risk factors, frequency and other conditions can determine eligibility. Not every screening is due every year. Ask your clinician which services are medically appropriate and ask the office to check the applicable coverage criteria and last service date.
If you have Medicare Advantage, confirm network and scheduling requirements with your plan. An additional routine-physical benefit, when offered, is governed by that plan’s terms. Do not assume that a benefit your previous employer plan offered continues in the same form.
Four questions when you schedule
- Are we scheduling the Welcome visit, yearly wellness visit, a physical or a problem-focused appointment?
- Am I eligible for this preventive benefit on the proposed date?
- Does this provider accept assignment, or participate in my Advantage plan’s network?
- Are any planned tests or services outside the preventive benefit, and what might I owe?
For example, you might schedule a wellness visit and also want to discuss a new knee problem. Tell the office about both needs. Ask how the additional evaluation will be scheduled and billed. Do not delay necessary medical attention to keep an appointment in a particular billing category.
Bring information that makes the visit useful
- Your current coverage cards and the date of the last preventive visit.
- A list of medicines, supplements and treating providers.
- Available vaccination and screening records.
- Questions about recommended screenings and follow-up appointments.
- A way to keep the written prevention plan and next due dates.
Afterward, compare any bill with the Medicare Summary Notice or your plan’s Explanation of Benefits. These statements are not themselves bills. If a charge is unexpected, ask the billing office which service was billed and then ask the plan how it processed that service. Keep dates and reference numbers with your records.
Make coverage questions part of your transition
Our agents can help you understand how provider access and coverage arrangements fit your needs. Your clinician determines which screening or treatment is appropriate. Bring insurance questions to a consultation and medical questions to your care team.
Sources and update notes
Published by MyCoverageRelay. Updated September 24, 2026. General education; coverage, eligibility and state protections require an individual review.