Medicare "Physicals"
Preventive care evaluations are an important part of your health care but not all preventive services are covered by Medicare. The following is content from the Medicare website posted here to help our patients understand their Medicare benefits. We have highlighted in yellow the information pertaining to routine and preventive “physical exams”. Further information is available in your benefit booklet or at the Medicare website http://www.medicare.gov/mbp/default.asp. - FMPA
Medicare Part B Helps Cover Your:
Medical and Other Services: Doctors' services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, outpatient physical and occupational therapy, including speech-language therapy. Read Medicare and Your Mental Health Benefits and Getting a Second Opinion Before Surgery for more information.
Clinical Laboratory Services: Blood tests, urinalysis, and more.
Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services. Please visit the Home Health Compare section of our website for more information.
Outpatient Hospital Services: Hospital services and supplies received as an outpatient as part of a doctor's care. Read Your Guide to the Outpatient Prospective Payment System for more information.
Blood: Pints of blood you get as an outpatient or as part of a Part B covered service.
Medicare Also Helps Cover:
- Ambulance services (when other transportation would endanger your health).
- Artificial eyes.
- Artificial limbs that are prosthetic devices, and their replacement parts.
- Braces - arm, leg, back, and neck.
- Chiropractic services (limited), for manipulation of the spine to correct a subluxation.
- Emergency care.
- Eyeglasses - one pair of standard frames after cataract surgery with an intraocular lens.
- Immunosuppressive drug therapy for transplant patients as long as you are covered by Medicare (transplant must have been paid for by Medicare).
- Kidney dialysis. Read Medicare Coverage of Kidney Dialysis and Kidney Transplant Services for more information.
- Macular degeneration of the eye ("wet" age-related) treatment, using ocular photodynamic therapy with verteporfin.
- Medical nutrition therapy services for people with diabetes or kidney disease with a doctor's referral.
- Medical supplies - items such as ostomy bags, surgical dressings, splints, casts, and some diabetic supplies.
- Outpatient prescription drugs (very limited). For example, some oral drugs for cancer.
- Preventive services. Read Medicare Preventive Services to Keep You Healthy or Women with Medicare - Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam for more information.
- Prosthetic devices, including breast prosthesis after mastectomy.
- Second opinion by a doctor (in some cases). Read Getting a Second Opinion Before Surgery for more information.
- Services of practitioners such as clinical social workers, physician assistants, and nurse practitioners.
- Telemedicine services in some rural areas.
- Therapeutic shoes for people with diabetes (in some cases).
- Transplants - heart, lung, kidney, pancreas, intestine, bone marrow, cornea, and liver (under certain conditions and when performed at approved facilities).
- X-rays, MRIs, CAT scans, EKGs, and some other diagnostic tests.
What is not paid for by Medicare Part A and Part B:
The Original Medicare Plan does not cover everything. Health care costs not covered by Medicare will include, but are not limited to:
- Acupuncture.
- Deductibles, coinsurance, or copayments when you get health care services.
- Dental care and dentures (in most cases).
- Cosmetic surgery.
- Custodial care (help with bathing, dressing, using the bathroom,and eating) at home or in a nursing home.
- Health care you get while traveling outside of the United States (except in limited cases).
- Hearing aids and hearing exams.
- Orthopedic shoes.
- Outpatient prescription drugs (with only a few exceptions).
- Routine foot care (with only a few exceptions).
- Routine eye care and most eyeglasses (see exception above for one pair of standard frames after cataract surgery with an introcular lens).
- Routine or yearly physical exams.
- Screening tests except those listed in Medicare Preventive Services to Keep You Healthy.
- Shots (vaccinations) except those listed in Medicare Preventive Services to Keep You Healthy.
If your Medicare Part B coverage begins on or after January 1st, 2005, Medicare will cover a one-time preventive physical exam within the first six months that you have Part B. The exam will include a thorough review of your health, education and counseling about the preventive services you need like certain screenings and shots, and referrals for other care if you need it. The "Welcome to Medicare" physical exam is a greaty way to get up-to-date on important screenings and shots and to talk with your doctor about your family history and how to stay healthy.
How often is it covered? One time only within the first six months that you have Part B.
For Whom? All people whose Medicare Part B begin on or after January 1st, 2005.
Your costs in the Original Medicare Plan? You pay 20% of the Medicare-approved amount after the yearly Part B Deductible.
