Posted on July 6, 2026 by Steve Shorr — No Comments ↓

Medicare Preventive Services & Annual Wellness Visit

Medicare does cover many preventive services. That can include screenings, vaccines, lab tests, counseling, health risk assessments, the one-time “Welcome to Medicare” visit, and the yearly “Wellness” visit. The catch is that Medicare preventive care is not the same thing as a full annual physical exam, and billing can change if extra medical problems, tests, or non-covered services are handled during the same appointment.

What Medicare Covers
Why You May Be Billed
Ask Steve

What preventive care does Medicare cover?

Medicare Part B covers many preventive services when you meet Medicare’s eligibility rules and use a provider who accepts Medicare assignment. Medicare lists preventive and screening services such as cardiovascular screenings, colorectal cancer screenings, diabetes screenings, depression screenings, mammograms, prostate cancer screenings, obesity counseling, tobacco-use counseling, vaccines, and the yearly Wellness Visit. Medicare.gov preventive and screening services

Common Medicare preventive services people ask about

“Welcome to Medicare” visit: one time during the first 12 months you have Part B. Medicare.gov
Yearly “Wellness” visit: once every 12 months after you qualify. Medicare.gov
Flu, COVID-19, pneumococcal, and hepatitis B vaccines: generally handled under Part B when Medicare rules are met. Medicare.gov
Shingles, RSV, Tdap, and many other adult vaccines: generally handled under Part D drug coverage when ACIP recommends them. Medicare.gov shingles vaccine
Cardiovascular screenings: cholesterol, lipid, and triglyceride tests when Medicare’s rules are met. Medicare.gov
Depression screening: covered when done in a primary care setting that can provide follow-up treatment or referrals. Medicare.gov
Glaucoma screening: covered for people at high risk. Medicare.gov

The important phrase: “Annual Wellness Visit”

When you call the doctor’s office, use Medicare’s words: “I want to schedule my Medicare Annual Wellness Visit.” Do not simply ask for a “physical,” because Medicare generally does not treat a routine physical exam the same way it treats the Annual Wellness Visit.

The yearly Wellness Visit is mainly a prevention-planning visit. Medicare says it can include routine measurements, medical and family history, prescription review, health advice, a Health Risk Assessment, cognitive screening, and a written plan for screenings, vaccines, and other preventive services. Medicare.gov Yearly Wellness Visit

Why was I billed if Medicare preventive care is covered?

A bill does not automatically mean Medicare denied your preventive benefits. Common reasons include:

The appointment was billed as a routine physical exam instead of a Medicare Wellness Visit.
You discussed a new or ongoing medical problem, so part of the visit was billed as a diagnostic office visit.
The doctor ordered tests that are not covered under that preventive benefit.
The service was done more often than Medicare allows.
The provider does not accept Medicare assignment.
You are in a Medicare Advantage plan and used the wrong network, referral process, or plan procedure.
The vaccine belongs under Part D prescription drug coverage, not Part B.

Original Medicare, Medigap, and Medicare Advantage

With Original Medicare, many preventive services are covered under Part B, and you generally pay nothing for most covered preventive services when the provider accepts assignment. If you have a Medigap / Medicare Supplement plan, it may help with Part B cost-sharing when cost-sharing applies, but Medigap does not turn a non-covered service into a covered preventive benefit.

If you have a Medicare Advantage plan, the plan must cover at least the same Medicare-covered services as Original Medicare, but the plan can have its own network and administrative rules. That means a service may be covered, but you may still need to use the correct doctor, facility, pharmacy, referral process, or plan procedure.

What to ask before your appointment

“Is this being scheduled as my Medicare Annual Wellness Visit?”
“Do you accept Medicare assignment?”
“Will anything today be billed separately as a diagnostic visit, office visit, or physical exam under Medicare Part B?”
“Is this screening allowed now, or is Medicare saying it is too soon?”
“If I have a Medicare Advantage plan, is this provider in-network for my plan?”
“Is this vaccine billed under Medicare Part B or Medicare Part D Rx?”

What to do if you were charged

Ask for the bill, the Medicare Summary Notice, or the Medicare Advantage Explanation of Benefits. Look for the procedure code, the provider name, the date of service, and whether the service was billed as preventive, diagnostic, office visit, physical exam, or vaccine. If it looks wrong, you can ask the provider’s billing office to review the coding. You can also contact Medicare, your Medicare Advantage plan, or your Part D plan.

Not sure whether your Medicare preventive care was billed correctly?

Send me the bill, Medicare Summary Notice, or Explanation of Benefits. I can help you understand whether this looks like a Medicare coverage issue, a provider billing issue, a Medicare Advantage network issue, or a Part D vaccine issue.

Steve Shorr Insurance is an independent California insurance agency. This page is for general information and is not medical, tax, or legal advice.

Related Medicare pages

Official Medicare resources

Optional Deeper Details Below

The practical explanation is above. The section below includes supporting documents, background material, citations, examples, and technical details for readers who want more.