What’s the Difference Between a Physical Exam and a Medicare Wellness Visit?
June 04, 2025 | Tags:
Regularly checking on your health is important, especially as you age. This can be done through a physical exam or a wellness visit. But when it comes to scheduling time with your primary care provider (PCP), do you know which appointment you need?
While both types of visits aim to maintain or improve your health and should be done annually, only a Medicare wellness visit is covered by Medicare. Understanding the differences between these appointments can help you know what to expect so you can make the most of your visit.
What is a physical exam and what does it include?
A physical examination, sometimes called a physical for short, is an evaluation of your general health done by your PCP. The focus is to look for potential health problems, and most healthcare providers recommend getting a physical every year, according to Cleveland Clinic.
However, a routine physical exam is not covered by Medicare. While some Medicare benefits may cover elements of a routine physical, patients might pay a copay or out of pocket for the exam and any tests ordered as separate services.
At most physical exams, your PCP will do the following:
- Perform a full-body exam, like listening to your heart and lungs, examining your ears, nose, mouth and throat and checking your skin for changes.
- Review your medical and family history.
- Measure your height and weight.
- Check your reflexes and vital signs, like blood pressure, pulse and respiratory rate.
- Assess how your social environment impacts your health, like smoking and substance abuse.
- Review any personal health concerns or symptoms.
Your PCP may order additional testing following a physical exam, like X-rays or blood tests. Always check with your PCP beforehand to see what is and isn’t covered with your health insurance plan.
What is a Medicare wellness visit and what does it include?
A Medicare wellness visit, also called an annual wellness visit (AWV), is an assessment of your overall health and wellbeing. It’s designed to be more of a discussion with your PCP, focusing on preventive health.
Medicare covers one AWV for patients within the first 12 months of their Part B enrollment or 12 months after their last AWV. A Medicare wellness visit will require a health risk assessment (HRA) to be completed. This will help your provider better understand your social needs and potentially refer you to appropriate services and support by providing:
- Demographic data
- A self-assessment of health
- Psychological and behavioral risks
- Activities of daily living (ADL)
- Instrumental activities of daily living (IADL)
While a Medicare wellness visit shares some similarities with a physical exam, it focuses more on preventive care. Your PCP will do the following:
- Review your medical and family history.
- Measure blood pressure, height, weight and body mass index (BMI).
- Perform a cognitive assessment to check for cognitive impairment.
- Review current prescriptions, medications and medical providers.
- Update your list of risk factors and conditions, like depression, home safety, fall risk and hearing impairment.
- Evaluate current opioid prescriptions to assess pain severity and provide non-opioid treatment options.
- Create a personalized preventive care plan.
- Offer personalized health advice.
Schedule your annual wellness visit today
Being proactive with your health can help you plan for other preventive care you may need.
If you’re unsure what to discuss with your PCP during your visit, Medical Mutual offers a provider checklist with common questions that cover both physical and emotional health.
If you don’t have a PCP, Medical Mutual can help. Use the Find a Provider tool to find an in-network provider or call the Customer Care number on your member ID card.