Medicare Free Preventive Care: What's Covered and How to Avoid Surprise Bills

Welcome to Medicare Visit

In your first 12 months of Medicare Part B enrollment, you are entitled to a one-time Welcome to Medicare Preventive Visit (also called the "Initial Preventive Physical Examination" or IPPE). This is a free visit that covers:

• A review of your medical and social history
• A physical examination and measurement of height, weight, BMI, and blood pressure
• Detection of cognitive impairment
• Review and update of your written preventive care plan
• Referrals for other preventive services you may need

The Welcome to Medicare visit is free only when it is billed as a preventive service (HCPCS code G0402). If your doctor bills it as a regular evaluation and management (E&M) office visit instead, you'll be charged the 20% Part B coinsurance. Confirm before or after the visit that the billing code was preventive.

Annual Wellness Visit vs. Regular Physical

This is the most important distinction in Medicare preventive care—and the source of more surprise bills than any other preventive service.

Annual Wellness Visit (AWV): Free

Starting in your second year of Medicare Part B (after the Welcome to Medicare visit), you can have an Annual Wellness Visit once per calendar year at no cost. The AWV covers:

• Health risk assessment questionnaire
• Review of your health and family history
• Blood pressure, height, weight, BMI measurements
• Cognitive function assessment
• Personalized prevention plan with a 5-10 year screening schedule
• Depression screening

Regular Physical Examination: Not Covered

A comprehensive physical examination—where the doctor examines your whole body, listens to your lungs, checks your reflexes, etc.—is not a covered Medicare service. This is one of the most common Medicare myths. If you go to your doctor requesting a "full physical," Medicare will not pay for it and you'll be billed as a regular office visit.

Cancer Screenings

Medicare covers the following cancer screenings at no cost to you:

The Colonoscopy Billing Trap

If your doctor finds and removes polyps during a screening colonoscopy, the procedure may be reclassified as a diagnostic or therapeutic colonoscopy, triggering 20% coinsurance on the total procedure cost. The colonoscopy itself can cost $1,500–$3,000, meaning your share could be $300–$600.

Federal law (the ACA) established protections against this for private insurance, but Medicare billing rules differ. Many Medicare patients are surprised by a coinsurance bill after a colonoscopy. Ask your gastroenterologist: "If you find and remove a polyp, will you bill this as a screening or therapeutic colonoscopy?"

Cardiovascular Screenings

Medicare covers the following cardiovascular screenings at no cost once every 5 years:

• Cholesterol (total, HDL, LDL) test
• Lipid panel (triglycerides)
• Lipoprotein test

Medicare also covers:

• Abdominal aortic aneurysm (AAA) ultrasound: One-time screening for men who have ever smoked (at least 100 cigarettes in their lifetime), in the first 12 months of Medicare enrollment
• Cardiovascular behavioral counseling: 15-minute intensive counseling sessions for people with cardiovascular disease risk factors, covered in primary care settings

Diabetes Screening and Education

Medicare covers:

• Diabetes screening tests: Up to two fasting blood glucose tests per year if you have risk factors (obesity, hypertension, family history of diabetes)
• Diabetes self-management training: Up to 10 hours of initial training and 2 hours annually for follow-up, at no cost after you meet your Part B deductible. Must be referred by your doctor and provided by an accredited program.
• Diabetes prevention program: Two years of intensive behavioral counseling and lifestyle coaching for people with prediabetes, at no cost through Medicare-recognized suppliers
• Diabetes supplies: Blood glucose monitors, test strips, and lancets covered under Medicare Part B DME benefit (with 20% coinsurance)

Depression and Mental Health Screening

Medicare covers annual depression screening at no cost when done in a primary care setting. This includes:

• One annual depression screening per year (PHQ-2 or PHQ-9 questionnaire)
• Alcohol misuse screening and counseling (four sessions per year)
• Opioid use disorder screening and referral
• Tobacco cessation counseling (up to 8 sessions per year)
• Obesity screening and intensive behavioral counseling (weekly for first month, then as appropriate)

Vaccines

Medicare Part B covers these vaccines at no cost (no deductible, no coinsurance):

• Flu vaccine: One per season, from any provider that accepts Medicare
• COVID-19 vaccine and boosters: Current authorized vaccines at no cost
• Pneumococcal vaccines: PCV15 and/or PPSV23 (two vaccines in a series)
• Hepatitis B vaccine: For at-risk beneficiaries (includes people with diabetes, kidney disease, occupational exposure)

Note: The shingles (Shingrix) vaccine and Tdap vaccine are covered under Medicare Part D, not Part B. Your cost depends on your Part D plan formulary.

How to Avoid Preventive Care Surprise Bills

Follow these steps to protect yourself from unexpected bills when receiving Medicare-covered preventive services:

1. Before the visit: Tell your doctor's office you are scheduling your Annual Wellness Visit specifically and ask them to bill it as a preventive service (CPT codes G0438 or G0439, not 99213 or similar E&M codes).
2. During the visit: At the start, tell your doctor you want to keep the visit to AWV/preventive topics only. If you have new complaints, offer to schedule a separate appointment for those. This prevents accidental "dual billing."
3. During a colonoscopy consultation: Ask how the procedure will be billed if polyps are found. Get the answer in writing or note who said what.
4. After the visit: Check your Medicare Summary Notice within 1–2 months. Confirm the billing code shown is a preventive code. If it shows an E&M code (99202–99215) and you only had a preventive visit, dispute the billing.
5. For any free service you were charged for: Ask the provider's billing department to review the coding. Many preventive billing errors are corrected with a simple call. If not, file a Medicare redetermination request.

• Medicare.gov — Preventive & Screening Services
• CMS — Medicare Prevention
• Medicare.gov — Annual Wellness Visits
• KFF — Preventive Services Coverage