Medicare Preventive Services: Free Screenings and Wellness Visits You Should Use

What Medicare Counts as a Preventive Service

Medicare defines preventive services as the screenings, counseling, vaccines, and wellness visits designed to catch problems early or stop them from starting. When you see a provider who accepts Medicare assignment and you meet the eligibility rules for a given service, you typically pay nothing. No deductible, no coinsurance, no copay, even though the 2026 Part B deductible has risen to $283 and the standard Part B premium is now $202.90 per month.

Medicare covers a broad set of preventive services at no cost when you get them from a provider that accepts Medicare and when you meet the eligibility and frequency rules for each service. The full 2026 menu is longer than most people realize and includes cancer screenings, cardiovascular tests, diabetes screening, bone mass measurements, depression and alcohol misuse screening, obesity counseling, tobacco cessation counseling, HIV and hepatitis screening, pre-exposure prophylaxis (PrEP) for HIV prevention, and every recommended adult vaccine. Learn more about what Medicare covers and does not cover for a bigger picture of where the gaps still lie.

The Welcome to Medicare Visit vs. the Annual Wellness Visit

Two of the most valuable free benefits are also the two most commonly confused: the Welcome to Medicare visit (officially the Initial Preventive Physical Exam, or IPPE) and the Annual Wellness Visit (AWV). Neither one is a traditional head-to-toe physical.

The Welcome to Medicare visit is a one-time preventive visit available only during the first 12 months after you enroll in Medicare Part B. It includes a review of your medical and social history, a review of risk factors for depression, an assessment of functional ability and safety, basic measurements (height, weight, BMI, blood pressure, vision), a review of current opioid prescriptions, end-of-life planning if you agree, and a written preventive screening schedule with referrals. It is not a full physical exam.

After that first year, you become eligible for the AWV. The Annual Wellness Visit is a preventive visit available once every 12 months after you've had Part B long enough to qualify. Its main purpose is to develop or update a personalized prevention plan and health risk assessment, review medications, screen for cognitive impairment, and update your list of providers. It is also not a full physical exam.

How the wellness visit differs from a physical exam

This is where beneficiaries get tripped up. A routine physical is usually more hands-on and may include listening to the heart and lungs, checking reflexes, examining the abdomen, head/neck, and skin, and ordering blood or urine tests. Medicare says routine physical exams are not covered as a standard benefit under Original Medicare.

If your doctor addresses a new symptom or medical problem during a wellness visit, that part may be billed separately. So if you go in for your AWV and mention a new knee pain, be prepared for a small charge on the diagnostic portion of that visit, subject to the $283 Part B deductible and 20% coinsurance.

How to schedule your AWV each year

Call your primary care office and specifically ask for the "Medicare Annual Wellness Visit." Do not just ask for an "annual physical," because that scheduling shortcut is the single most common reason people get billed. Most offices book AWVs 60-90 days out, so put a recurring reminder on your calendar for the same month each year. Medicare counts eligibility in full months, not the exact date, so you can generally schedule as soon as 11 full months have passed since your last AWV.

The Full Menu of Free Medicare Screenings in 2026

Once you have your AWV on the books, use it to check off the screenings you are due for. Here is how often Medicare pays for each of the major screenings in 2026, including the newly covered CT colonography benefit.

New for 2026, Medicare now covers CT colonography (virtual colonoscopy) as a screening option for colorectal cancer, giving beneficiaries another non-invasive alternative alongside stool tests and traditional colonoscopy.

Counseling services that are also free

Beyond blood draws and imaging, Medicare also pays 100% for several behavioral counseling services when delivered in a primary care setting:

• Alcohol misuse screening and counseling (up to 4 brief counseling sessions per year for those who screen positive)
• Obesity behavioral therapy (weekly, then tapering, for beneficiaries with a BMI of 30 or higher)
• Tobacco cessation counseling (up to 8 face-to-face visits per year)
• Cardiovascular behavioral therapy (one visit per year in primary care)
• Medical nutrition therapy (for diabetes and kidney disease)
• Medicare Diabetes Prevention Program (for eligible beneficiaries with prediabetes)

Vaccines: Part B vs. Part D Coverage

Medicare splits vaccines between two parts of the program, and knowing which is which prevents a lot of billing headaches at the pharmacy.

Part B vaccines (covered under medical benefits)

Part B vaccines include flu, pneumococcal, COVID-19, and hepatitis B for people at medium or high risk. Part B also covers vaccines needed to treat an injury or exposure such as tetanus, rabies, and hepatitis A. These are billed through your doctor's office or clinic and cost $0 when the provider accepts assignment.

Part D vaccines (covered under your drug plan)

Part D vaccines include shingles (Shingrix), RSV, Tdap boosters, MMR, meningococcal, hepatitis A, hepatitis B for low-risk adults, HPV, varicella, mpox, and every other ACIP-recommended adult vaccine not covered by Part B. These are typically administered at a pharmacy and billed through your standalone Part D plan or the drug portion of your Medicare Advantage plan. For a deeper look at how these plans work, see our guide to Part D prescription drug plans in 2026.

How the Inflation Reduction Act made adult vaccines free

Before 2023, the shingles vaccine could cost Medicare beneficiaries $150-$200 out of pocket. That changed with the Inflation Reduction Act. Since January 1, 2023, all ACIP-recommended adult vaccines covered under Part D are available at zero cost sharing, with no deductible, no copay, and no coinsurance. The 2026 Part D final rule codifies this benefit, and it remains fully in force this year. Data from HHS shows more than 10 million Medicare beneficiaries used this free vaccine benefit in the first year alone, driving a 42% increase in shingles vaccine uptake.

When a Free Preventive Service Becomes a Bill

Here is the trap that catches thousands of Medicare beneficiaries every year: a service can start as a free screening and end as a billable diagnostic procedure. The colonoscopy is the most famous example.

Medicare preventive services can still incur costs when the service is no longer treated as pure screening and instead becomes diagnostic or therapeutic because of symptoms, abnormal findings, or extra procedures such as polyp removal. Specifically for colonoscopies, Medicare says a screening colonoscopy is free if your provider accepts assignment, but if a polyp or other tissue is removed, you pay 15% coinsurance for the provider's services in 2026. If the procedure is done in a hospital outpatient setting or ambulatory surgical center, you also pay a 15% facility coinsurance. The Part B deductible does not apply to this converted-screening scenario.

The same principle applies elsewhere. A screening mammogram is free, but a diagnostic mammogram ordered because of a lump or abnormal finding is subject to the 20% coinsurance after the $283 Part B deductible. A screening EKG done as part of your Welcome to Medicare visit is free, but a follow-up EKG to investigate chest pain is diagnostic. If you have signs or symptoms already, the encounter is diagnostic from the start. This is where a Medigap plan like Plan G or Plan N can dramatically reduce your exposure to unexpected coinsurance charges.

Frequently Asked Questions

Does Medicare cover a yearly physical exam in 2026?

No. Original Medicare does not cover a traditional annual physical exam. It covers a one-time Welcome to Medicare preventive visit within your first 12 months of Part B, and then an Annual Wellness Visit every 12 months after that. Some Medicare Advantage plans add a routine physical as an extra benefit, but under Original Medicare a full physical is not a covered service.

Is the shingles vaccine really free under Medicare now?

Yes, for people with Part D coverage. Since the Inflation Reduction Act took effect in 2023, ACIP-recommended adult vaccines, including shingles (Shingrix), RSV, and Tdap boosters, are covered at $0 through your Part D plan. This benefit is codified in the 2026 Part D final rule and remains fully in effect. If your pharmacy tries to charge you a copay, ask them to reprocess the claim through your Part D vaccine benefit.

How often can I get a colonoscopy through Medicare in 2026?

For most people at average risk, Medicare covers a screening colonoscopy once every 10 years. If you are at high risk for colorectal cancer, Medicare covers a screening colonoscopy every 2 years. Stool-based tests like FIT and Cologuard are covered more frequently, and starting in 2026 CT colonography (virtual colonoscopy) is also a covered screening option every 5 years for average-risk patients.

What is the difference between a screening and a diagnostic test?

A screening test is done when you have no symptoms and no known abnormality, purely to look for hidden disease. A diagnostic test is done to investigate a specific symptom, follow up an abnormal finding, or monitor a known condition. Medicare pays 100% for most screening services, but diagnostic services are subject to the 2026 Part B deductible of $283 and 20% coinsurance, which is where Medigap coverage becomes valuable.

Can I schedule my Annual Wellness Visit and a problem visit on the same day?

Yes, but expect two separate charges. The AWV portion will be $0, and the problem-focused portion (for a new symptom, medication adjustment, or chronic condition management) will be billed as a regular office visit subject to your Part B deductible and 20% coinsurance. Many doctors will let you know upfront if a same-day discussion will trigger a separate bill, so it's worth asking at check-in.