Does Medicare Cover Annual Wellness Visits and Preventive Care?

Medicare Part B covers many preventive services, screenings, vaccines, and an annual wellness visit. Most cost nothing out of pocket if your provider accepts assignment. The wellness visit itself is not a full physical exam. That difference surprises plenty of people and can affect what you actually pay.

Retirees in Cary, Wake County, and the Triangle often want clear answers on these benefits to manage fixed-income healthcare costs. This guide covers the services, how the visits work, cost rules, Medicare Advantage differences, local provider access, and free NC SHIIP counseling. Rules depend on your specific plan, eligibility, and provider, so verification matters.

What preventive services does Original Medicare cover?

Medicare Part B covers dozens of preventive and screening services. Not every service applies to every person. Eligibility depends on age, sex, risk factors, and timing since your last test. Frequency also varies.

Services generally fall into these categories. Medicare.gov publishes a detailed guide called Your Guide to Medicare Preventive Services with eligibility and frequency for each. The version updated in May 2026 remains current.

Cancer screenings

• Colorectal cancer screenings, including colonoscopy, fecal occult blood tests, and other approved methods
• Cervical and vaginal cancer screenings (Pap tests and HPV tests)
• Mammograms for breast cancer screening
• Prostate cancer screenings (PSA blood test and digital rectal exam)
• Lung cancer screening with low-dose CT (LDCT) if you meet specific age and smoking history criteria

Vaccines

• Annual flu shots
• Pneumococcal vaccines
• Hepatitis B vaccines if you are at medium or high risk

Flu and pneumococcal vaccines carry no deductible or coinsurance, even if you have not met your Part B deductible.

Heart and metabolic health

• Cardiovascular disease screenings, including blood tests for cholesterol, lipid, and triglyceride levels (covered once every five years)
• Cardiovascular behavioral therapy focused on aspirin use, diet, and other steps
• Diabetes screenings for those with risk factors such as high blood pressure or obesity
• Bone mass measurements for people at risk for osteoporosis
• Abdominal aortic aneurysm (AAA) screening ultrasound for those with family history or smoking background

Mental health and behavioral screenings

• Depression screenings once per year
• Alcohol misuse screening and counseling
• Tobacco use cessation counseling

Other covered preventive services

• Hepatitis C screening for those born between 1945 and 1965 or with risk factors
• HIV screening
• Obesity screening and counseling
• Sexually transmitted infection (STI) screening and counseling

You can log into your Medicare.gov account to see what applies to you. The full guide is available at Medicare.gov.

How the annual wellness visit works

The annual wellness visit and a physical exam are not the same. Mixing them up is common. The visit focuses on prevention.

Your provider has you complete a Health Risk Assessment questionnaire. It asks about medical history, medications, daily activities, mood, and concerns. From that discussion they create or update a personalized prevention plan. The plan may schedule future screenings, suggest vaccines, recommend lifestyle changes, or make referrals.

The visit usually checks cognitive function and can cover advance directives if you choose. It does not include a head-to-toe physical exam. If those elements occur, they may bill separately under standard Part B rules and trigger cost-sharing.

You qualify for the yearly visit once every 12 months after your first 12 months of Part B or after your Welcome to Medicare visit.

Your one-time Welcome to Medicare visit

Medicare also covers a one-time Welcome to Medicare visit, sometimes called the Initial Preventive Physical Examination or IPPE. Schedule it within the first 12 months of Part B coverage.

This visit is prevention-focused, not a full physical. It includes a review of medical and social history, height, weight, blood pressure, a basic vision screen, a written schedule of recommended preventive services, and referrals as needed. You can discuss advance directives here too.

If you miss the first-year window you cannot claim it later. Scheduling early creates a useful baseline for ongoing preventive care.

What you pay for preventive services

Most covered preventive services under Original Medicare cost $0 when the provider accepts assignment. No deductible or coinsurance applies to the preventive portion.

Accepting assignment means the provider takes the Medicare-approved amount as payment in full. Most Medicare-participating providers do, but confirm ahead of time.

A few practical points:

• If the provider does not accept assignment you could face up to 15% higher charges in many cases.
• Any non-preventive tests or services ordered during the visit follow normal Part B cost-sharing after the deductible.
• The Part B deductible does not apply to wellness visits or most preventive services themselves.

Preventive versus diagnostic billing causes the most surprise bills. A screening colonoscopy that finds and removes a polyp may shift to diagnostic coding. Ask the office how they plan to code the service beforehand.

How Medicare Advantage plans handle preventive care

Medicare Advantage plans must cover the same preventive services as Original Medicare. They cannot charge more than Original Medicare for those services when you stay in-network.

Practical differences still exist. Networks limit which providers give $0 preventive care. Some plans add extra benefits such as dental, vision, hearing, or fitness programs. These vary by plan year and ZIP code. Certain plans require referrals even for preventive visits. Network doctors can change annually.

Check your plan's Summary of Benefits and confirm the provider is in-network. The Medicare Plan Finder at Medicare.gov helps compare plans by your ZIP code.

Finding a provider in Cary and Wake County

Many providers in the Triangle accept Medicare. Local health systems including WakeMed, Duke Health, and UNC Health participate. WakeMed Cary Hospital is one option among several.

Practical ways to locate a provider:

• Use Medicare.gov Care Compare. Search by ZIP code and specialty to see who accepts assignment and view quality ratings. Start at Medicare.gov/care-compare.
• Call the office. Ask if they accept new Medicare patients and assignment. For Medicare Advantage plans, confirm network status.
• Review your plan's provider directory if you have Medicare Advantage.

Acceptance policies and networks change. Confirm details right before booking.

What to verify before your next appointment

Run through this checklist:

• Confirm eligibility and frequency for the specific service using your Medicare.gov account or 1-800-MEDICARE.
• Verify the provider accepts assignment or is in your Medicare Advantage network.
• Clarify whether the appointment is coded as preventive or diagnostic.
• Ask how any additional tests will be billed.
• Review your plan's Summary of Benefits for network or referral rules.

Free help from NC SHIIP

North Carolina's Seniors' Health Insurance Information Program (NC SHIIP) provides free, unbiased Medicare counseling. Counselors serve every county, including Wake, and are not tied to insurance sales.

They can walk through preventive coverage, help decode bills, review plans during open enrollment, and explain cost-help programs. Call 1-855-408-1212 or use the locator at the NC Department of Insurance website. Sessions sometimes appear at Cary libraries and other local spots.

CaryFixedIncome.com is an educational resource, not a Medicare plan provider, insurance agency, or financial planning firm. The information here explains how Medicare preventive coverage works and what to check in your own situation. For your specific needs speak with a licensed professional, contact NC SHIIP, or ask a question through our site. You can also browse our Medicare and Social Security guides for related topics.