You book your annual checkup, chat with your doctor, and leave feeling good about your health. A few weeks later, a bill arrives for $200 or more. You didn’t have any new symptoms, and you thought Medicare covered preventive care 100%.
What happened? You fell into the terminology trap between a “wellness visit” and a “physical.”
Medicare Part B, which covers outpatient care like doctor visits, includes an annual wellness visit completely free of charge. However, it does not cover a routine annual physical exam.
If your doctor crosses the invisible line between these two services during your appointment, the insurance coding changes, and you get stuck with a bill you likely didn’t expect.
The difference between talking and touching
To avoid this cost, you must understand how Medicare defines these visits. They sound identical, but in the eyes of medical coders, they are completely different products.
The annual wellness visit: Think of this as a planning session, not an exam.
- What happens: You and your doctor discuss your medical history, review medications, update your list of providers and check for cognitive impairment. The doctor measures your height, weight and blood pressure.
- The goal: To create a prevention plan for the coming year.
- The cost: $0 (100% covered, no deductible).
The annual physical exam: This is the hands-on checkup most people expect once a year.
- What happens: The doctor listens to your heart and lungs, palpates your abdomen, checks your reflexes and physically examines your body.
- The goal: To find new health problems.
- The cost: You pay 100% of the cost unless you have a secondary insurance plan that explicitly covers it.
How the surprise bill happens
The trouble starts when these two worlds collide. You schedule your free annual wellness visit, but during the appointment, you ask the doctor to look at a sore shoulder, or the doctor decides to listen to your heart just to be safe.
The moment the doctor performs a physical exam or addresses a specific new problem, they must add a separate billing code to your visit.
- Code G0438/G0439: The annual wellness visit (Medicare pays).
- Code 99202–99215: A problem-focused visit (triggers deductible and coinsurance).
- Code 99381–99397: A routine physical exam (not covered).
This second code triggers your Part B deductible and coinsurance. In 2026, the Part B deductible is $283. If you haven’t met this deductible yet, you’ll owe the full amount plus 20% of the remaining cost.
However, if the doctor codes the visit as a routine physical exam, Medicare covers nothing. You will be responsible for 100% of the bill because Medicare does not cover routine physicals.
How to protect your wallet
You can still get your free care without the surprise bill, but you have to manage the appointment wisely.
- Use the exact terminology: When scheduling, say you want to schedule your Medicare annual wellness visit. Do not ask for a checkup or a physical.
- Clarify at the start: When the doctor walks in, remind them you are there for your wellness visit only and do not want a physical exam.
- Hold your questions: If you bring up a new ailment — like a new rash or knee pain — the doctor is legally required to treat and code it as a diagnostic visit. If you want to avoid a bill, save those specific health concerns for a separate appointment where you expect to pay your share.
Under Original Medicare, the annual wellness visit is covered at 100% with no deductible if you see a participating provider. Medicare Advantage plans are also required to cover the full cost without copays, provided you stick to an in-network doctor.
Learn more about what you can get with your Medicare coverage in “13 Things That Are Free With Medicare.”
Add a Comment