Free Medicare Preventive Services: What Is Covered Without Cost-Sharing

One of Medicare's most underutilized benefits is its preventive care coverage. Dozens of screenings, vaccinations, and counseling services are covered at zero cost to you under Part B, no deductible, no 20% coinsurance. But two things confuse many beneficiaries: the difference between the free Annual Wellness Visit and a regular physical, and a common billing scenario where a preventive visit generates an unexpected charge. Understanding both before you schedule a preventive appointment avoids surprises.

Bryce's Take

The billing situation I describe here has happened to virtually every client I have worked with at some point. They go in for their Annual Wellness Visit, mention a symptom, and receive a bill for an office visit they did not expect. It is technically correct billing. It is also preventable if you schedule the symptom visit on a different day from your wellness visit.

The Annual Wellness Visit

Medicare covers one Annual Wellness Visit per year after your first 12 months on Part B. This is not a physical examination in the traditional sense. The AWV reviews your health history, medications, and functional ability, measures height, weight, and blood pressure, establishes a list of risk factors, creates or updates a personalized prevention plan, and may include cognitive assessments. There is no copay and it does not apply toward your Part B deductible. Schedule it annually with your primary care physician.

The Welcome to Medicare Preventive Visit

In your first 12 months on Medicare Part B, you are eligible for a one-time Welcome to Medicare visit. This initial exam establishes baseline health measurements, reviews your health history, identifies risk factors, and creates a prevention plan. It also covers a review of potential depression, functional ability, and safety risks. Like the AWV, it has no cost-sharing. After this first year, transition to the Annual Wellness Visit annually.

Covered screenings with no cost-sharing

Medicare covers a substantial list of preventive screenings at zero out-of-pocket cost, including annual mammograms for women 40 and older, colorectal cancer screenings (colonoscopy, stool tests), cardiovascular disease risk screenings and counseling, diabetes screenings for at-risk individuals, bone density scans (DEXA) for qualifying women, lung cancer screenings (low-dose CT) for current or recent smokers aged 50 to 77, prostate cancer PSA tests, sexually transmitted infection screenings and counseling, and depression screenings. Vaccines covered at no cost include flu, COVID-19, pneumococcal, and hepatitis B for at-risk individuals.

The billing trap: preventive visits that become office visits

Here is the scenario that generates unexpected bills. You go in for your Annual Wellness Visit, which is free. While there, you mention a new symptom, a sore knee, high blood pressure readings at home, or a concerning mole. Your physician evaluates the symptom. That evaluation is a separate service from the preventive visit, and it may be billed as a regular office visit under Part B with standard cost-sharing. Medicare allows both a preventive service and an office visit to be billed on the same day if documented separately. The result: you expected a free visit and received a bill. The billing is technically correct, but you should be aware before the visit.

How to avoid the billing surprise

Before your Annual Wellness Visit, understand that it is not a comprehensive physical and is not designed to address specific health problems. If you have acute concerns or symptoms to discuss, schedule a separate office visit. If something comes up during the AWV, ask the physician whether it will be billed as a separate office visit and whether you can address it at a future appointment instead. This gives you control over when cost-sharing applies.

Preventive services under Medicare Advantage

Medicare Advantage plans must cover all Medicare-required preventive services at zero cost-sharing. Many plans go further and add additional preventive screenings, wellness programs, or gym memberships. The Annual Wellness Visit is covered at $0 under all Advantage plans. Some plans offer transportation to preventive appointments or additional health coaching as part of their preventive benefits.

Bryce Casson

Licensed Independent Medicare Broker

Bryce Casson is an independent Medicare insurance broker who works with every major carrier. He does not represent any single insurer, which means his recommendations are based on what actually fits each client's situation, not on commissions or quotas.