Does Medicare cover an annual physical in Peoria, AZ?

No. Original Medicare does not pay for a routine annual physical, and it never has. What it pays for, at $0 when the provider accepts assignment, is a one-time Welcome to Medicare visit in your first 12 months of Part B and a yearly wellness visit once every 12 months after that. Neither one is a physical. Both are a sit-down about your history, your medications and your risks, with a few measurements and a written plan at the end, and the difference between that and the head-to-toe exam you had every year on your employer plan is where the confusion and the surprise bills come from.

I get this question most often from two kinds of Peoria households. The first has just turned 65 in Vistancia or Trilogy and wants to know whether “the free physical” is real. The second moved into the 85383 corridor from another state in the last couple of years, is finally establishing with a new primary care doctor near Lake Pleasant Parkway or over at Arrowhead, and got a bill for a visit they were told was covered. Here is what each visit includes, why the bill happens, what a Medicare Advantage plan changes, and how to book the first appointment so it goes the way you expect.

Two covered visits, and neither is a physical

Medicare’s preventive benefit is built around two appointments. Both are covered by Part B, both cost nothing when the provider accepts assignment, and the Part B deductible does not apply to either.

Source: Medicare.gov, "Yearly Wellness visits," "Welcome to Medicare preventive visit" and "Preventive and screening services," 2026. Medicare Advantage plans must cover both preventive visits at $0 and may add a routine physical on their own terms.

The thing to hold onto is that a wellness visit is a conversation with measurements, not an examination. Medicare.gov’s own page says it plainly: it “isn’t a routine physical exam.” Nobody listens to your chest. Nobody draws blood as part of the benefit. You leave with a list of what you are due for, which is genuinely useful, and if you were expecting the exam you had at 62, it feels like a visit that did not happen.

Why a covered visit still produces a bill

This is the part that generates the phone calls. The wellness visit itself is $0. But Medicare.gov adds a sentence people skip: “you may have to pay coinsurance, and the Part B deductible may apply if your provider performs additional tests or services during the same visit that Medicare doesn’t cover under this preventive benefit.” And if the extra service is something Medicare does not cover at all, such as a routine physical, “you may have to pay the full amount.”

In practice the same appointment can carry two or three separately billed pieces:

1. The wellness visit. Covered in full.
2. A problem visit. You mention that your knee has been aching since spring, the doctor examines it and adjusts your plan. That is a diagnostic visit, and the practice can bill it alongside the wellness visit. On Original Medicare it goes against the $283 Part B deductible, then 20% coinsurance. A Medicare Supplement Plan G picks up the coinsurance; on a Medicare Advantage plan it is the plan’s primary care copay.
3. A routine physical. The doctor does the head-to-toe exam because that is how the practice has always run its annual visits. Medicare does not cover it, and the practice may hand you the whole charge.

None of that is improper billing. The practice performed the services. The problem is that nobody explained beforehand that “your annual visit” was going to be three things with three different price tags, and the fix is to ask at the front desk, before you sit down: “Is this being scheduled as a Medicare wellness visit, and is anything else being done today?” Practices that see a lot of Medicare patients, and most of the primary care groups around Arrowhead and in Sun City do, will know exactly what you are asking.

What blood work Medicare does cover

The wellness visit has no lab work in it, but that does not mean Medicare will not pay for screening tests. It pays for a long list of them, each on its own schedule, and the wellness visit is where the doctor works out which ones you are due for. Two examples with real rules behind them:

• Cardiovascular screening. A blood test for cholesterol, lipid and triglyceride levels is covered once every five years, at $0 when the provider accepts assignment.
• Diabetes screening. Covered up to twice in a 12-month period, at $0, if you have a risk factor such as high blood pressure, a history of abnormal cholesterol, obesity or a history of high blood sugar, or two or more secondary factors including simply being 65 or older.

The full list on Medicare.gov runs to mammograms, colorectal screening, bone density, prostate screening, lung cancer screening for long-term smokers, and the flu, pneumococcal, hepatitis B and COVID-19 vaccines, among others. What it does not include is the shingles vaccine, which is a Part D benefit rather than a Part B one, and I have written about how that one is paid.

The line to understand is preventive versus diagnostic. The same cholesterol test is $0 as a five-year screening and subject to the deductible and coinsurance if it is ordered because you already have a diagnosis being managed. A general chemistry panel run “because it’s your annual” with no screening rule and no diagnosis behind it may not be covered at all. Ask which bucket a test falls in before the needle goes in.

What a Medicare Advantage plan does differently

A Medicare Advantage plan has to cover the Welcome to Medicare visit and the yearly wellness visit at $0, exactly as Original Medicare does. Beyond that, three things change.

Some plans add a routine physical. A plan can offer an annual physical exam as a supplemental benefit, the same way plans add dental or a fitness benefit, and a number of plans in Maricopa County do. It is listed in the Evidence of Coverage, usually under preventive or supplemental services, and it can appear or disappear from one plan year to the next.

The visit has to be in network. The wellness visit is covered when it is with a plan provider. On an HMO that means your assigned primary care doctor, and on the Peoria–Glendale–Sun City seam a practice a mile from home can sit on the other side of a contract line. The networks explainer covers how to check, and the referral question covers what happens when the wellness visit turns up something that needs a specialist.

The plan wants you to have it. Plans are rewarded for high preventive-visit completion, so the reminder letters, the outreach calls and the occasional gift card for completing your wellness visit are not a coincidence. Take the visit. Just go in knowing what it is.

Why this comes up so much in north Peoria

Three things about this end of the city sharpen the question.

The new arrivals. The 85383 corridor and Vistancia are full of households that moved in during the last few years and are only now establishing with a primary care doctor near Lake Pleasant Parkway and Happy Valley Road, at Arrowhead, or down in Sun City. A first appointment with a new doctor is almost always a “new patient” visit, which is a diagnostic visit and not the wellness visit. If you want the covered wellness visit, ask for it by name when you book, and ask whether the practice will do both on the same day and bill them separately, which most will. And if you moved from another state on a Medicare Advantage plan, the plan itself may need to change before the network question even makes sense.

The clock runs from Part B, not from your birthday. Vistancia and Trilogy hold a lot of people who kept working past 65 and took Part B when they retired. The Welcome to Medicare visit is available in the first 12 months you have Part B, so someone who enrolled at 68 has the window at 68, not at 65. If your Part B started in the spring, the window closes next spring. The turning-65 timeline covers the enrollment side of that.

The seasonal residents. Trilogy and Westbrook Village both hold households that spend four or five months a year out of state. The wellness visit has to be 12 months apart, so a visit in November of one year and October of the next is not covered, and on an HMO the visit has to happen inside the plan’s Arizona network anyway, so the appointment gets squeezed into the months you are here. On Original Medicare with a Supplement you can have it with any doctor who accepts Medicare, in either state. That is a small point on its own, and it is the same point that decides the bigger Advantage versus Supplement question for a household that splits the year.

Medicare in Peoria and Medicare in Glendale have the local picture for each side of the seam.

How to book the visit so it goes as expected

Five things to say when you call the practice.

1. “I want to schedule my Medicare annual wellness visit.” Use the words. “Annual physical” or “my yearly checkup” gets you scheduled as something else.
2. “When was my last one?” If you have had one at this practice, they can see the date. If it was elsewhere, or if you are within 12 months of your Part B start, say so. If this is your first year of Part B, ask for the Welcome to Medicare visit instead.
3. “Is anything else being done at this appointment?” If you have a problem to discuss, that is fine and often sensible, but it is a separate billed service and you want to know that in advance.
4. “Which of my screenings are due?” That is the point of the visit. Arrive with your vaccine record and the date of your last colonoscopy, mammogram or bone scan, because the written plan is only as good as what you bring.
5. On a Medicare Advantage plan, “does my plan include a routine physical, and is this provider in network?” The first is in your Evidence of Coverage. The second is a phone call to the plan, not to the practice, because a practice that “takes” a carrier does not necessarily take every plan the carrier sells.

What to check before December 7

The Annual Enrollment Period opens October 15, and the annual physical is one of the smaller lines on a plan comparison that is worth reading anyway.

• If your plan includes a routine physical as an extra benefit, find it on the Annual Notice of Change and confirm it is still there for 2027. Supplemental benefits come and go.
• Check the primary care copay, because that is what a problem visit alongside your wellness visit will cost you.
• Check that your primary care doctor is still in network by name, especially if the practice was bought by a larger group this year, which happens constantly along the Happy Valley corridor.

The short version

• Original Medicare does not cover a routine annual physical. It never has.
• It covers a Welcome to Medicare visit once in your first 12 months of Part B, and a yearly wellness visit once every 12 months after that. Both are $0 with a provider who accepts assignment, and the deductible does not apply.
• Neither is a physical. They are a history, medications and risk review, a few measurements, a cognitive check, and a written schedule of the screenings you are due.
• A problem discussed at the same visit is billed separately at the $283 deductible and 20% coinsurance, or your plan’s copay. A routine physical done at the same visit may be your full cost.
• Blood work is not part of the wellness visit, but specific screening tests are covered at $0 on their own schedule.
• Some Medicare Advantage plans add a routine physical. Check the Evidence of Coverage, use an in-network doctor, and confirm the benefit survives into 2027 on your Annual Notice of Change.
• The 12-month clock runs from your Part B start, not from your 65th birthday, which matters for everyone in north Peoria who retired later.

If you would rather have someone check it for you

The wellness visit is one of the better things in Medicare and one of the most misunderstood, and most of the misunderstanding is fixed by knowing what to ask for on the phone. If you are newly settled in Peoria and not sure whether your current plan’s network reaches the doctor you want, or whether the plan you brought from another state still fits, that is a 2026 conversation worth having before the 2027 plans arrive in October.

The office is in Anthem, roughly 25 minutes from north Peoria out the Carefree Highway and down Lake Pleasant Parkway, and most of this happens by phone anyway. Call (602) 844-6002 or book a time — and if you call or text, that is your consent for me to reply the same way.