2026 Medicare Annual Wellness Visit vs Physical: What Medigap Covers for Preventive Screenings

If you’re on Medicare and your doctor says it’s time for your “annual physical,” you might assume it’s fully covered. But Medicare doesn’t cover traditional physical exams — it covers an Annual Wellness Visit (AWV), which is a very different thing. Confusing the two can lead to surprise bills, missed preventive screenings, and gaps in your healthcare. This guide explains exactly what Medicare’s Annual Wellness Visit includes, how it differs from a physical, which preventive screenings are covered under Part B in 2026, and how your Medigap policy helps with cost-sharing.

What Is the Medicare Annual Wellness Visit (AWV)?

The Medicare Annual Wellness Visit is a preventive benefit available to all Medicare Part B enrollees. Introduced under the Affordable Care Act, it’s designed to create or update a personalized prevention plan based on your current health and risk factors.

What the AWV Includes

The AWV is not an examination — it’s a health planning conversation. Here’s what happens during a typical AWV:

• Health Risk Assessment (HRA) — A questionnaire covering your medical history, family history, lifestyle, and mental health
• Review of medical and family history — Your doctor updates your records with any new diagnoses or family health changes
• Current medications and supplements review — All prescriptions, OTC medications, and supplements are documented
• Detection of any cognitive impairment — Basic screening for memory issues or cognitive decline
• Depression screening — Standardized questionnaire (such as PHQ-9) for mental health assessment
• Review of functional ability and safety — Assessment of your ability to perform daily activities, fall risk, and home safety
• Height, weight, and blood pressure measurement — Basic vitals are recorded
• Personalized prevention plan — Your doctor creates a schedule of recommended screenings, vaccines, and follow-ups
• Advance care planning (optional) — Discussion of your preferences for future medical care

What the AWV Does NOT Include

This is where confusion causes surprise bills. The AWV does not include:

• A comprehensive physical examination (listening to heart/lungs, full body check)
• Blood panels or lab work (CMP, CBC, lipid panel, etc.) — these are separate services
• Diagnostic testing of any kind
• Treatment for any condition found during the visit
• Referrals to specialists (these require a separate office visit)

The AWV typically takes 20-30 minutes and is primarily a conversation and documentation visit. If you expect your doctor to perform a thorough physical, you’ll be disappointed — or you’ll get an unexpected bill.

AWV Coverage Details

Detail	Coverage
Frequency	Once every 12 months (after your first year on Part B)
Cost to you	$0 (no Part B deductible, no coinsurance)
Provider requirement	Must accept Medicare assignment
Billing codes	G0438 (Initial AWV) or G0439 (Subsequent AWV)
Eligibility	Enrolled in Medicare Part B for more than 12 months

What Is a “Physical Exam” and Why Medicare Does Not Cover It

A traditional annual physical exam — the kind most people had with their doctor before turning 65 — is a comprehensive head-to-toe examination. It typically includes:

• Complete physical examination (heart, lungs, abdomen, neurological, skin, etc.)
• Extensive blood work (CBC, CMP, lipid panel, thyroid, etc.)
• Urinalysis
• EKG or other baseline cardiac screening
• Cancer screening discussions and physical checks
• Detailed review of each body system

Medicare does not cover routine physical exams. This is one of the most common sources of confusion and surprise billing for new Medicare beneficiaries. Under Medicare’s rules, a physical exam is considered a “routine” service that isn’t medically necessary unless you have specific symptoms.

Why Medicare Makes This Distinction

Medicare’s coverage philosophy centers on medically necessary services and Medicare-approved preventive benefits. A routine physical falls into neither category. Medicare has specifically defined which preventive services it covers (like the AWV, mammograms, and colonoscopies) and a general physical isn’t one of them.

What Happens If Your Doctor Performs a Physical

If your doctor performs a comprehensive physical exam and bills it as such, here’s the financial impact:

• You pay 100% of the cost for the physical exam portion
• A typical physical exam can cost $200-$500+ depending on what’s included
• If blood work is ordered, those labs are billed separately and may or may not be covered
• Your Medigap policy will not cover a service that Medicare doesn’t cover in the first place

This is why it’s critical to clarify with your doctor’s office before your appointment exactly what type of visit they’re scheduling.

”Welcome to Medicare” Preventive Visit vs Annual Wellness Visit

Medicare actually offers two different preventive visits, and the distinction matters:

The “Welcome to Medicare” Preventive Visit

This is a one-time visit available during your first 12 months on Medicare Part B. It’s similar to the AWV but has a specific time window.

Feature	”Welcome to Medicare” Visit	Annual Wellness Visit
When available	First 12 months on Part B only	Every 12 months (after first year on Part B)
Billing code	G0402	G0438 (initial) / G0439 (subsequent)
Cost to you	$0	$0
What’s included	Health risk assessment, medical history review, vitals, depression screening, written prevention plan	Same as Welcome visit plus update of existing prevention plan
Can include EKG	Yes, one-time screening EKG included	No EKG included
Purpose	Establish baseline health and prevention plan	Update and maintain prevention plan annually

Important: If you miss the “Welcome to Medicare” visit window (your first 12 months on Part B), you cannot get it later. However, you can still get the Annual Wellness Visit once you’ve been on Part B for 12+ months.

Can You Get Both?

Yes, but not in the same 12-month period. If you get the “Welcome to Medicare” visit in your first year, you can get your first Annual Wellness Visit 12 months after that Welcome visit date. They are separate benefits with separate billing codes.

Medicare Part B Preventive Screenings Covered in 2026

While the AWV itself doesn’t include screenings, Medicare Part B covers a wide range of preventive screenings separately. These screenings are the real value of your Annual Wellness Visit — your doctor uses the AWV to identify which screenings you need and orders them.

Here are the key preventive screenings covered under Medicare Part B in 2026:

Screening Service	Frequency	Your Cost (2026)
Screening mammogram	Once per year (women 40+)	$0 (100% covered)
Screening colonoscopy	Every 10 years (45+), or 2 years if high risk	$0 screening; 20% coinsurance if polyp removed*
Cologuard (stool DNA test)	Every 3 years (45-85)	$0 (100% covered)
Bone density test (DEXA)	Every 2 years (qualifying women; men at risk)	$0 (100% covered)
Cardiovascular disease screening	Once every 5 years	$0 (cholesterol, lipid, triglyceride levels)
Diabetes screening (FPG/GTT)	Up to 2 times per year (if at risk)	$0 (100% covered)
Lung cancer screening (LDCT)	Once per year (50-77, with smoking history)	$0 (if criteria met; 20% coinsurance if not)
Cervical cancer screening (Pap/HPV)	Every 3 years (Pap); every 5 years (Pap + HPV)	$0 screening; Part B deductible may apply to Pap collection visit
Prostate cancer screening (PSA)	Once per year (men 50+)	$0 for PSA test; 20% coinsurance for digital exam
Depression screening	Once per year (in primary care)	$0 (100% covered)
Alcohol misuse screening	Once per year	$0 (100% covered)
Hepatitis C screening	One-time (all adults 18-79); annual if high risk	$0 (100% covered)
HIV screening	Once per year (15-65); more often if high risk	$0 (100% covered)
Glaucoma screening	Once per year (high risk only)	20% coinsurance after Part B deductible
Abdominal aortic aneurysm screening	One-time (men 65-75 with smoking history)	$0 (100% covered)

*The colonoscopy polyp-removal billing change is one of the most common causes of surprise bills. If your screening colonoscopy finds and removes a polyp, Medicare reclassifies it from a "screening" to a "diagnostic" procedure, and the Part B deductible ($240) plus 20% coinsurance apply.

How Medigap Covers Preventive Care Cost-Sharing

Most preventive screenings are covered at 100% under Medicare Part B when you meet the criteria. But when a screening becomes diagnostic, or when a service falls outside the preventive benefit, your cost-sharing kicks in. That’s where Medigap helps.

When Preventive Screenings Become Diagnostic (and Cost Money)

This is a critical concept that catches many Medicare beneficiaries off guard:

• Screening colonoscopy → Diagnostic colonoscopy: If a polyp is found and removed, your “free” screening becomes a diagnostic procedure. You owe the Part B deductible ($240) plus 20% of the Medicare-approved amount. For a colonoscopy, that 20% can be $200-$400+.
• Screening mammogram → Diagnostic mammogram: If your screening mammogram finds something suspicious, the follow-up diagnostic mammogram is subject to the Part B deductible and 20% coinsurance.
• Routine Pap test → Diagnostic follow-up: If abnormal cells are found, the colposcopy or biopsy that follows is diagnostic and subject to cost-sharing.

Medigap Plan Coverage for Diagnostic Follow-Ups

Cost-Sharing Scenario	Plan G Coverage	Plan N Coverage	No Medigap
Part B deductible ($240)	Not covered (you pay)	Not covered (you pay)	You pay $240
20% coinsurance on diagnostic services	100% covered	100% covered (no copay for specialist)	You pay 20%
Part B excess charges (up to 15%)	100% covered	You pay	You pay
Lab work billed as diagnostic (not preventive)	100% covered after deductible	100% covered after deductible	You pay 20%
Glaucoma screening (always has coinsurance)	100% covered after deductible	100% covered after deductible	You pay deductible + 20%

Plans C and F: The Exception for Part B Deductible

If you have Plan C or Plan F (available only if you were first eligible for Medicare before January 1, 2020), these plans cover the Part B deductible of $240. This means even the deductible on a diagnostic follow-up is covered. For everyone else — including those with Plan G — you pay the first $240 of diagnostic services out of pocket each year.

To understand how different Medigap plans affect your overall costs, use our Medicare Supplement Plan Cost Estimator to compare plans side by side.

When Your Doctor Bills a Physical Instead of an AWV

This is the single most common billing issue related to the Annual Wellness Visit. Here’s how it happens and how to avoid it:

The Scenario

You schedule your “annual checkup.” The doctor’s office schedules it generically. During the visit, your doctor performs a comprehensive physical examination — checks your heart, lungs, abdomen, does a neurological screening, orders extensive blood work — and bills it as a comprehensive office visit (CPT 99213 or 99214) rather than an AWV (G0438/G0439).

The Bill You Receive

• Office visit copay/coinsurance: 20% of the Medicare-approved amount (typically $30-$60 for a standard visit, $100+ for a comprehensive visit)
• Part B deductible applies: The $240 deductible applies to office visits
• Blood work: Lab costs are billed separately — some may be covered as preventive, others may not
• Total surprise bill: $150-$500+ depending on what was performed

How to Prevent Surprise Bills

Before your appointment:

1. Tell the scheduler you want a “Medicare Annual Wellness Visit” specifically — not a physical
2. Confirm the billing code when you check in — ask if they’re billing G0438 (initial) or G0439 (subsequent)
3. Bring your previous AWV date — Medicare requires 12 months between AWVs; scheduling too early will cause a denial

During your appointment:

4. Remind your doctor you’re here for the AWV, not a comprehensive physical
5. Understand that if your doctor needs to examine something, they may bill a separate office visit alongside the AWV — ask them to explain the billing
6. If additional issues come up, your doctor can bill both an AWV and a regular office visit in the same appointment, but you’ll owe cost-sharing on the office visit portion

After your appointment:

7. Check your Medicare Summary Notice (MSN) — make sure the AWV was billed correctly
8. If you receive an unexpected bill, call your doctor’s billing office and ask them to review the coding — sometimes a simple coding correction resolves the issue
9. If the bill is legitimate (because actual diagnostic work was done), your Medigap plan will cover the coinsurance portion

For more tips on avoiding costly Medicare mistakes, read our guide to the most common Medicare Supplement Enrollment Mistakes to Avoid in 2026.

How to Prepare for Your Annual Wellness Visit

Preparation makes the AWV more valuable and reduces the risk of billing surprises. Here’s a checklist:

Documents to Bring

• Complete medication list — All prescriptions, OTC drugs, vitamins, and supplements with dosages
• Medical history updates — Any new diagnoses, surgeries, or hospitalizations since your last visit
• Family history changes — Any new diagnoses in immediate family members (especially cancer, heart disease, diabetes)
• List of all healthcare providers — Names and contact info for every doctor, specialist, and therapist you see
• Previous screening results — Dates of your last mammogram, colonoscopy, bone density test, etc.
• Immunization records — Flu shots, pneumonia vaccine, shingles vaccine, COVID-19 boosters, Tdap
• Advance directive — If you have a living will or healthcare power of attorney, bring a copy

Information Your Doctor Needs

• Any new symptoms or health concerns (these may require a separate visit)
• Your exercise habits and physical activity level
• Your diet and nutrition patterns
• Alcohol and tobacco use
• Sleep quality and any sleep disorders
• Mental health concerns — anxiety, depression, grief, loneliness
• Fall history or balance problems
• Home safety concerns
• Sexual health concerns
• Vision and hearing changes

Questions to Ask During Your AWV

• “Which preventive screenings am I due for this year?”
• “Am I up to date on all recommended vaccinations?”
• “Based on my health risk assessment, what should I be watching for?”
• “Do I need a referral for any specialist screenings?”
• “When should I schedule my next screening mammogram/colonoscopy/bone density test?”

Cost Comparison: With and Without Medigap

Here’s a realistic scenario showing how Medigap affects your costs for the AWV and common preventive screenings in 2026:

Scenario: 68-year-old woman on Medicare Part B

During her AWV, her doctor orders a screening mammogram (abnormal result → diagnostic mammogram), a screening colonoscopy (polyp removed), and a bone density test (follow-up needed).

Service	Medicare-Approved Amount	No Medigap (You Pay)	With Plan G (You Pay)
Annual Wellness Visit	$180	$0 (preventive)	$0 (preventive)
Screening mammogram	$150	$0 (preventive)	$0 (preventive)
Diagnostic mammogram (follow-up)	$280	$56 (20% coinsurance)	$0 (Plan G pays 20%)
Screening colonoscopy (polyp removed → diagnostic)	$1,800	$240 deductible + $312 (20%) = $552	$240 (deductible only; Plan G pays 20%)
Bone density test (DEXA) — screening	$250	$0 (preventive)	$0 (preventive)
Diagnostic lab work (follow-up to DEXA)	$200	$40 (20% coinsurance)	$0 (Plan G pays 20%)
Office visit to discuss results	$120	$24 (20% coinsurance)	$0 (Plan G pays 20%)
Total Annual Cost		$672	$240

Plan G saves $432 in this scenario — and that's just from one year of preventive screenings that turned diagnostic. Over multiple years, the savings compound significantly, especially for beneficiaries who regularly need follow-up diagnostics.

For help estimating your own costs based on your health profile and expected medical needs, use our free Medicare Supplement Penalty Calculator.

Understanding the Part B Deductible Impact on Preventive Screenings

The 2026 Medicare Part B deductible is $240 per year. Here’s how it interacts with preventive care:

Services Where the Deductible Does NOT Apply

Medicare waives the Part B deductible for services it classifies as preventive benefits:

• Annual Wellness Visit
• Screening mammograms
• Screening colonoscopies (when no polyps are found)
• Bone density tests
• Cardiovascular disease screenings
• Diabetes screenings
• Depression and alcohol misuse screenings
• Hepatitis C and HIV screenings
• Lung cancer screenings (for qualifying individuals)
• Most immunizations (flu, pneumonia, shingles, COVID-19, Hepatitis B)

Services Where the Deductible DOES Apply

The Part B deductible applies when a preventive screening turns diagnostic or for services Medicare doesn’t classify as preventive:

• Diagnostic mammograms (follow-up to abnormal screening)
• Colonoscopy with polyp removal (reclassified as diagnostic)
• Diagnostic lab work
• Glaucoma screenings
• Any office visit billed separately from the AWV
• Specialist consultations for abnormal screening results

This is where having the right Medigap plan for your health profile makes a real financial difference. If you’re someone who tends to need follow-up diagnostics, Plan G’s coverage of the 20% coinsurance can save you hundreds per year.

Preventive Care and Medigap: A Strategic View

Choosing the right Medigap plan for preventive care cost-sharing depends on your likelihood of needing diagnostic follow-ups:

Low-Risk Strategy (Healthy, Minimal Follow-Ups Expected)

If you’re generally healthy, rarely have abnormal screening results, and see few specialists:

• Plan N provides adequate coverage at lower premiums
• The $240 Part B deductible is a one-time annual cost you can absorb
• Your preventive screenings are mostly free
• Copays ($20 office visit, $50 ER) are manageable for your low utilization

Moderate-Risk Strategy (Some Chronic Conditions, Occasional Follow-Ups)

If you have 1-2 well-managed conditions and occasionally need diagnostic follow-ups:

• Plan G provides the best balance of premium cost and coverage
• You pay the $240 deductible but nothing beyond that for Part B services
• No excess charge risk if your specialist doesn’t accept assignment
• Predictable costs year over year

High-Risk Strategy (Multiple Conditions, Frequent Screenings and Follow-Ups)

If you manage multiple chronic conditions, have a history of abnormal screenings, or see specialists regularly:

• Plan G is strongly recommended
• The 20% coinsurance savings alone justify the higher premium
• Excess charge protection is critical for frequent specialist visits
• Consider Plan F if you’re eligible (covers the $240 deductible too)

Frequently Asked Questions

Can I get both an Annual Wellness Visit and a physical exam on the same day?

Technically yes, but they will be billed as two separate services. The AWV portion is free (billed as G0438/G0439), while the physical exam portion will be billed as a regular office visit subject to the Part B deductible and 20% coinsurance. Many doctors bundle these together — if yours does, make sure you understand what you’ll owe before the appointment. With Plan G, the coinsurance on the physical portion would be covered, but the $240 deductible would still apply.

If my screening colonoscopy finds a polyp, how much will I owe with Medigap Plan G?

With Plan G, you’ll owe the $240 Part B deductible (which Plan G does not cover) but nothing beyond that. Medicare’s approved amount for a colonoscopy with polyp removal is typically $1,500-$2,000, so the 20% coinsurance ($300-$400) is fully covered by Plan G. Without Medigap, you’d owe the $240 deductible plus $300-$400 in coinsurance — a total of $540-$640.

Does the Annual Wellness Visit include blood work or lab tests?

No. The AWV itself does not include any lab work or blood tests. However, during the AWV, your doctor may order separate blood work as a cardiovascular disease screening (cholesterol/lipid panel, covered once every 5 years at 100%) or a diabetes screening (covered at 100% if you’re at risk). Any lab work ordered outside these specific preventive benefits will be subject to the Part B deductible and 20% coinsurance.

How is the “Welcome to Medicare” visit different from the first Annual Wellness Visit?

The “Welcome to Medicare” preventive visit (G0402) is available only during your first 12 months on Part B and includes a one-time screening EKG. The Annual Wellness Visit (G0438 for initial, G0439 for subsequent) is available every 12 months after your first year on Part B and does not include an EKG. Both are free when provided by a Medicare-participating doctor. If you get the Welcome visit in year one, your first AWV can be scheduled 12 months after that visit.

What if my doctor finds something concerning during the Annual Wellness Visit?

If your doctor identifies a health concern during the AWV (e.g., elevated blood pressure, signs of cognitive decline, depression), they can address it in one of two ways: (1) Schedule a separate follow-up appointment to evaluate and treat the concern (this follow-up is billed as a regular office visit with cost-sharing), or (2) Address it during the same visit by billing both the AWV and a separate office visit (you’ll owe cost-sharing on the office visit portion). With Medigap Plan G, the 20% coinsurance on the office visit portion is covered; you’d only owe the $240 Part B deductible if you haven’t already met it.

Do Medigap Plans cover the cost of preventive screenings that Medicare doesn’t cover?

No. Medigap only supplements what Medicare already covers. If Medicare doesn’t cover a service (like a routine physical exam or a screening that doesn’t meet Medicare’s criteria), your Medigap plan won’t cover it either. For example, if you want a whole-body skin exam by a dermatologist and Medicare denies it as not medically necessary, your Medigap plan won’t pay. Medigap only covers cost-sharing (deductibles, coinsurance, copays) for services that Medicare has approved.

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