Does Medicare Pay for Routine Physicals?

Medicare does not cover routine physical exams. You pay 100 percent for annual physical exams. However, effective January 1, 2009, Medicare will pay 80 percent of the Medicare-approved amount of a one-time routine physical examination during the first 12 months after you enroll in Medicare Part B regardless of your age. The Part B deductible does not apply to this benefit.
Note: If you enrolled in Medicare in 2008 and did not have a "welcome to Medicare" physical, you will still be able to have it in 2009 as long as it is done within 12 months of your initial enrollment. The “welcome to Medicare” physical exam benefit does not include payment for clinical laboratory tests.
Some Medicare private health plans (HMO, PPO, PFFS) may cover routine physicals.
The initial preventive physical exam, referred to as the "welcome-to-Medicare" exam, includes:
· An electrocardiogram (EKG)
· Measurement of height, weight and blood pressure
· Education, counseling and referral related to other preventive services covered by Medicare
· Ultrasound screening for abdominal aortic aneurysms (AAA) if you are at risk
An electrocardiogram (EKG) is a test that measures the electrical signals that control your heartbeat. An EKG may show:
· Signs of heart enlargement
· Signs that not enough blood is flowing to the heart
· Signs of a new or old injury to the heart (heart attack)
· Heart rhythm problems (arrhythmias)
· Changes in the electrical activity of the heart
· Signs of inflammation of the sac surrounding the heart (pericarditis)
An EKG cannot predict whether you will have a heart attack.
The AAA screening will be available to men aged 65-75 if you have smoked at least 100 cigarettes in your lifetime and if you have a family history of AAAs.

Medicare now covers blood tests every five years to screen for cholesterol, for lipid and triglyceride levels, and for other signs of cardiovascular disease (or indications that you are at high risk for it). Medicare will pay 100% of its approved amount for these tests, even before you have met the Part B deductible.
The American Heart Association estimates that over 80 million Americans have one or more forms of heart disease, including high blood pressure, coronary heart disease and stroke. Heart disease and stroke are the first and third leading causes of death in the US. Heart screening can save your life and improve your quality of life by treating the condition before it results in more severe health problems.



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