For Professionals: Medicare Basics

New Medicare Beneficiaries Have More Time to Get the “Welcome to Medicare” Physical Exam

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Updated: March 2, 2009

Medicare does not cover routine physical exams, but it does cover the one-time “Welcome to Medicare” physical exam, also known as the initial preventive physical exam or IPPE. The latest Medicare law (Medicare Improvement for Patients and Providers Act – MIPPA) expanded this benefit to allow new Medicare beneficiaries one year, versus 6 months, to get the IPPE, and beneficiaries do not have to meet the deductible before Medicare covers this preventive service.

The “Welcome to Medicare” physical exam was first available to people whose Medicare Part B became effective on January 1, 2005 or later. The IPPE includes a review of a beneficiary’s medical and social history, measurement of beneficiary’s height, weight, and blood pressure, and performance and interpretation of an electrocardiogram. Previously, Medicare covered the service (80% of the Medicare-approved amount) only if a beneficiary took advantage of it within 6 months of becoming eligible for Medicare Part B and met the Part B annual deductible. Thus, if a beneficiary had not yet met the deductible, he/she would pay full cost for the IPPE; or if the beneficiary missed the 6-month window, the IPPE would not be available to him/her as a covered benefit.

Now under the new law, Medicare beneficiaries who take advantage of the IPPE on or after January 1, 2009, do not have to meet the annual deductible ($135 in 2009) before Medicare covers this service. In addition, people who become eligible for Medicare on or after January 1, 2009, have one year, instead of 6 months, to take advantage of the service.

Note that some people who became eligible for Medicare prior to January 1, 2009, can also take advantage of the deductible waiver. Specifically, people who became eligible for Medicare between October and December 2008 are still in their 6-month window to take advantage of the IPPE. If they delay the IPPE until April or June 2009 (which still falls within their 6-month window for the physical exam benefit), they will not have to meet the deductible before Medicare covers the IPPE. For example, a beneficiary who became eligible for Medicare Part B on October 1, 2008, has until April 30, 2009 to go for the IPPE. If s/he had the IPPE before January 1, 2009, Medicare would have covered it only if s/he met the deductible. If he/she goes for the IPPE now in 2009 (within her 6-month timeframe), Medicare covers it even if s/he has not met the deductible.

Medicare beneficiaries are encouraged to go for the “Welcome to Medicare” physical exam because it is a preventive service, and because other services (such as counseling to stop smoking, screenings for diabetes, cancer and cardiovascular disease) that are referred by the doctor performing the IPPE may also be covered by Medicare.

See Medicare Basics for more information on Medicare-covered benefits and services.

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