Let’s Get Physical? The Differences Between Physical Exams and Annual Wellness Visits

From changing guidelines about when to start getting mammograms to understanding the different types of annual visits to schedule with your primary care doctor, navigating medical care can be complicated.

If you are on Medicare, it's important to understand these nuances, especially the difference between a physical exam and an annual wellness visit. Your insurance defines these two appointments differently, which could affect your out-of-pocket costs. Here’s what you need to know about these two types of visits. 

Annual physical exam

During a physical exam, your doctor will discuss basic recommended health screenings with you and provide physical examinations. For women or people assigned female at birth, a yearly checkup may include a pelvic exam and recommended screenings such as mammograms or Pap smears. For men or people assigned male at birth, this appointment might include a testicular exam and a prostate-specific antigen (PSA) blood test to screen for prostate cancer. 

Your doctor may recommend other screenings, such as:

• Colonoscopy
• Behavioral health screenings
• Cholesterol level
• Blood sugar level

These appointments are beneficial in a variety of ways, including an in-depth look into the status of your current conditions and providing you with updated insights through tests and screenings. Physicals give you a better understanding of your health, increase your ability to assess your risk for future complications and offer a professional guide to help navigate diagnoses and treatment. 

“The costs of these appointments can change based on the types of testing performed, and Medicare generally does not cover lab work like cholesterol screenings unless it is tied to a specific medical condition,” said Jillian Gansert, MD, Primary Care Physician at Inspira Medical Group. “While Medicare does not cover annual physical exams, it does cover a single ‘initial preventive physical examination’ visit offered to newly-enrolled Medicare beneficiaries. Those are followed by exams called annual wellness visits.”

Medicare annual wellness visit

An annual wellness visit is an appointment covered by Medicare Part B focused on health promotion and preventive care. During a visit, your health care provider can give you personalized health advice, and together you will develop action plans based on your risk factors, lifestyle, existing medical conditions, and individual needs. 

This type of visit also includes: 

• A routine check of your height, weight, blood pressure, and body mass index (BMI) 
• A review of the medications, supplements, and vitamins you are currently taking 
• An overview of your personal and family medical history
• Screenings for issues with your mood or memory that can affect your health and well-being 
• Routine vaccinations, including annual flu and pneumonia vaccines

“Because Medicare covers annual wellness visits 100 percent, these appointments can give you insight into your health without increasing your healthcare costs,” said Dr. Gansert. “Patients get the opportunity to review existing medical conditions and current list of medications with their care team, receive preventive care, and plan small life changes.”

Which type of appointment should you make?

While these two annual visits may sound the same on the surface, different care is associated with each. Additional costs are associated with an annual physical exam, but they can give you more in-depth information through testing and screenings related to your health in specific areas. If you are looking to get a routine check of your vitals, updates on vaccinations, and an overview of your current health, schedule an annual wellness visit. Both appointments are important and should be part of your yearly health plan. 

Inspira offers comprehensive primary care throughout the South Jersey region. Click here to schedule an annual wellness visit at Inspira Health.