You book your free Medicare checkup. While you’re there, you mention that your knee has been acting up. A few weeks later, a bill arrives for a visit you were told would cost nothing.
That isn’t a scam, exactly. It’s how the billing works, and almost nobody explains it before you’re sitting on the exam table.
Medicare pays for a yearly wellness visit, and it can cost you $0. Yet a 2025 research letter in the Journal of the American Board of Family Medicine says the visits reached fewer than 1 in 4 people in Original Medicare, aka traditional Medicare, during the 2020-2022 period it studied.
So most people skip a free benefit, and some who use it get surprised by a bill. Here’s what the visit really is, what it isn’t, and how to keep it free.
1. What the visit is — and isn’t
The yearly wellness visit is a planning session, not a head-to-toe exam. According to Medicare.gov, Medicare covers one every 12 months.
It’s $0 to you as long as your provider accepts assignment, meaning the office takes Medicare’s approved amount as full payment. And you don’t have to meet your Part B deductible first.
Here’s the part most people miss: Medicare says flat out that this visit isn’t a routine physical. Your provider takes basic measurements such as blood pressure, height and weight, goes over your medical and family history, and gives you health advice.
That’s not the annual physical you may remember from your working years. The gap between what people expect and what Medicare covers is where the trouble starts.
What to do: Think of it as a strategy meeting about your health. Go in expecting a conversation, not an exam.
2. What’s included that most people skip
According to Medicare.gov, your provider will also:
- Go over the prescriptions you’re taking now.
- Do a cognitive assessment, looking for signs of dementia such as Alzheimer’s.
- Screen for substance use risks and point you to treatment if it’s warranted.
- Offer a conversation about advance directives, the documents that spell out your wishes if you can’t speak for yourself.
- Give you a written checklist of the screenings and shots you’re due for.
That medication review can be worth the trip on its own if you’re juggling prescriptions from several doctors. If a family member is already living with dementia, read about how 1 in 4 Medicare patients with dementia get risky drugs.
There’s money hiding in the advance-directive conversation, too. The Centers for Medicare & Medicaid Services says it waives your deductible and coinsurance for advance care planning once a year when it’s done with the wellness visit. Have that talk at a separate appointment, and you’ll owe your deductible and coinsurance.
3. How a second bill happens the same day
This is where a free visit turns into a bill.
Say you’re in for your wellness visit and you bring up a sore shoulder or a new rash. If the doctor examines and treats that problem, that part of the appointment is no longer preventive care. It’s a regular office visit.
CMS’ billing guidance lets doctors bill that separately on the same day when the problem is significant, distinct from the wellness visit and medically necessary. They flag it with a billing add-on called modifier 25. In plain English: one appointment, two charges.
That’s a legitimate rule, not a trick, and not every doctor handles it the same way. But when it happens, the second visit isn’t free.
Medicare.gov says that when extra services happen during the same visit, you could owe coinsurance, and your Part B deductible could come into play. In 2026, that annual deductible is $283. After you’ve met it, you usually pay 20% of the cost.
So if it’s early in the year and you haven’t met your deductible, you could pay the full Medicare-approved price of that office visit yourself. Nobody hands you this rulebook at the front desk.
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4. Tests that can cost extra
Medicare.gov says your provider may order other tests during the wellness visit if your health and history call for them. That’s fine. Just don’t assume everything ordered that day rides on the $0 price tag.
The rule: If a test or service falls outside the preventive benefit, you may owe coinsurance and the deductible. And if Medicare doesn’t cover it at all — a routine physical is the example Medicare gives — the whole bill may be yours.
That’s why walking in and asking for “my annual physical” can backfire. You may be asking for something Medicare won’t pay for.
What to do: When something gets ordered, ask two questions. Is this part of my wellness visit? And if not, what will I owe? Some services really are free, and we rounded them up in “13 Things That Are Free With Medicare.”
Women can also bring “The Essential Health Screening Checklist for Women Over 50” to know what to ask about.
5. Welcome to Medicare vs. the yearly visit, and Medicare Advantage
If you’re new to Part B, your first stop is different. The Welcome to Medicare preventive visit is a one-time checkup you can get during your first year on Part B.
It reviews your medical history and gets you current on screenings and shots. It’s also $0 when your provider accepts assignment. It isn’t a full physical either, and the same warning about extra tests applies.
Timing matters. The first yearly visit can’t come within 12 months of signing up for Part B or of your Welcome visit. You don’t need the Welcome visit to qualify, though. So count the months before you call.
On Medicare Advantage? Medicare.gov says those plans must cover everything Original Medicare covers. But check whether your doctor is in your plan’s network. Going out of network usually means paying a bigger share, if your plan allows it at all.
6. What to say when you book, and what to do if you’re billed
Plenty of surprise bills start with a misunderstanding at scheduling. Use the right words:
- Say “Medicare annual wellness visit” when you call — not “physical.”
- Ask whether the office accepts assignment.
- If you have a problem you want looked at, ask whether it’ll be billed as a separate visit. Then decide whether to deal with it at the wellness visit or book a separate appointment.
If a bill shows up anyway, don’t just pay it. With Original Medicare coverage, start with your Medicare Summary Notice, the statement listing what was billed to Medicare, and compare it with the bill. Ask the office whether the charge is for the wellness visit or a separate service.
If you still think it’s wrong and you have Original Medicare, Medicare.gov says to appeal by the date printed on your notice. Circle the disputed charge on a copy, explain in writing why you disagree, and mail it to the address listed.
Ask your doctor’s office for anything that strengthens your case. On Medicare Advantage, call your plan and ask how its appeals work.
Stuck? Call 1-800-MEDICARE (1-800-633-4227), or get free, one-on-one help from your State Health Insurance Assistance Program.
The bottom line
Medicare’s yearly wellness visit is one of the better deals in the program: a free sit-down to review your meds, check your memory and map out your screenings. Most people in traditional Medicare don’t use it.
Use it. Just know what you’re booking. Call it by its name, keep new problems separate unless you’re willing to pay, and read every statement that follows. The visit is free. The misunderstanding isn’t.
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