Does Medigap cover preventive testing and all preventive out-of-pocket charges? That is the $100,000 question. Since we know how important preventive care is to your health, we have created this quick rundown of how it works.

Medicare Annual Wellness Exam

The first thing everyone needs to know is that Original Medicare DOES NOT cover “Physicals.” Medicare offers a free “Welcome to Medicare Screening” and an Annual Wellness Exam, but not Physicals. Usually 100% of Medicare’s Annual Wellness Exam is usually covered by Original Medicare Part B. These are the main services offered during your annual exam:

1) An Office visit where your doctor will:

  • Take height, weight, blood pressure, and other routine measurements
  • Detect any cognitive impairment
  • Offer personalized health advice
  • Review of your medical and family history
  • Provide a list of risk factors and treatment options for you

2) Certain screenings and test based on frequency or your age:

  • Lipid blood panel to check cholesterol every 5 years
  • Colorectal cancer screenings every 12 to 120 months (depending on the test)
  • Mammogram screenings once a year
  • See a list of other Medicare preventive screenings

Medicare Annual Exam’s Costs

For most of the above, you won’t need to worry about out-of-pocket costs, because Original Medicare’s Part B has you covered. However, if you happen to need more frequent testing than outlined above, it is consider a diagnostic exam, and you could be charged the Part B deductible, copays, excess charges and coinsurance.

This happens more often than you think. For example, if your doctor wants you to have your cholesterol checked every year, then you would have to pay those fees 4 out of 5 years.

The good news: the majority of Medigap plans pay all of your Part B coinsurance and copays*. However, only Medigap Plan F will cover your Part B excess charges and your part B deductible. So, if you end up need diagnostic testing, with Plan F you should have no out of pocket expenses.

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*Plans K and L make you pay 50% and 75% of these costs, respectively. Plan N requires you to pay a $20 copay per doctor’s office visit.

Next Steps

If you have Medicare and Medigap, call your doctor and set up your annual exam. If you don’t have Medigap yet, call one of our licensed agents at 800-930-7956.