Medicare's Free Preventive Benefits: What's Really $0

Last reviewed: July 2026

The $0 side of Medicare

Medicare has a reputation for deductibles, coinsurance, and premiums — and that reputation is earned. But there is a whole category of care where the program is designed to charge you nothing: preventive services. For most covered screenings, wellness visits, and vaccines, you pay no deductible and no coinsurance, as long as the provider accepts Medicare assignment (meaning they agree to Medicare's approved payment as full payment).

The catch is in the fine print. A visit that starts as "preventive" can generate a bill if it drifts into "diagnostic" territory, and two visits that sound identical — a wellness visit and a physical — are treated completely differently. This guide walks through what is genuinely free, what is not, and how to spot the line between the two. For the cost-sharing side of the ledger, see our companion guide to Medicare costs in 2026.

The Welcome to Medicare visit: one shot, first 12 months

The "Welcome to Medicare" preventive visit — officially the Initial Preventive Physical Examination, or IPPE — is a one-time visit available only during your first 12 months of Part B coverage. You pay nothing for the visit itself, and the Part B deductible does not apply.

Despite the word "physical" in its formal name, it is mostly a review and planning session: your medical and family history, current prescriptions, height, weight, blood pressure, a vision test, a review of your risk for depression and your safety at home, and a written plan for which screenings and shots you should get and when. Your provider may also discuss advance directives.

Two things to know. First, it is optional — you do not need it to "activate" your Medicare. Second, the window is real: if the first 12 months pass, the benefit is gone, though the Annual Wellness Visit picks up from there. If you delayed Part B because you were still on employer coverage, the clock starts when Part B actually begins — see Medicare and working past 65.

The Annual Wellness Visit — and why it is not a physical

Once you have had Part B for longer than 12 months, you can get an Annual Wellness Visit (AWV) once every 12 months at no cost. Like the IPPE, it skips the deductible and coinsurance entirely.

Here is the part that surprises people every year: the AWV is not a head-to-toe physical exam, and Original Medicare does not cover routine annual physicals at all. Federal law excludes routine physicals from Medicare coverage. The AWV is a conversation and planning visit — you fill out a health risk assessment, the provider checks routine measurements like blood pressure and weight, screens for cognitive impairment and depression risk, reviews your providers and medications, and updates a personalized prevention plan listing the screenings you are due for.

If you show up expecting bloodwork, a full hands-on exam, and discussion of that knee that has been bothering you, two things can happen: you may be disappointed, or you may get those services — and a bill. When a provider evaluates or treats a specific complaint during the same appointment, that portion is billed separately as a regular medical visit, subject to the Part B deductible and 20% coinsurance. That is not a billing error; it is how the system works. It is reasonable to ask, before or during the visit, "Is this part of the free wellness visit, or will it be billed separately?"

Screenings that cost nothing

Medicare Part B covers a long list of screenings at $0 when the provider accepts assignment. Highlights include:

Screening mammograms — once every 12 months for women 40 and older.
Screening colonoscopies — generally every 120 months, or every 24 months if you are at high risk, with no minimum age. Stool-based tests (such as an annual fecal occult blood test or a multi-target stool DNA test every 3 years for eligible people) are also covered at no cost.
Cervical and vaginal cancer screening — Pap test and pelvic exam every 24 months, or every 12 months if you are at high risk.
Prostate cancer PSA blood test — once every 12 months for men over 50. (Note: the companion digital rectal exam is not free — it carries the deductible and 20% coinsurance.)
Lung cancer screening (low-dose CT) — yearly for people 50–77 with at least a 20 pack-year smoking history who currently smoke or quit within the last 15 years.
Cardiovascular disease blood tests — cholesterol and related tests once every 5 years.
Diabetes screening — up to twice a year if you have risk factors.
Bone density measurement — once every 24 months for people who qualify.
Annual depression screening, plus counseling services such as obesity counseling and tobacco cessation counseling.

Each screening has its own eligibility rules and calendar. Your AWV prevention plan — or Medicare's own coverage lookup at medicare.gov/coverage — is the reliable way to see which ones apply to you and when you are next due.

Vaccines: now $0 across the board

Vaccine coverage is split between two parts of Medicare, but as of 2023 the practical answer is the same: recommended adult vaccines cost you nothing.

Part B covers flu, pneumococcal, COVID-19, and (for people at medium or high risk) hepatitis B vaccines at no cost.
Part D covers the rest — including shingles, Tdap, and RSV. Before 2023, these could cost real money: Part D enrollees who got the shingles vaccine in 2021 paid an average of about $77 out of pocket, and some paid considerably more. The Inflation Reduction Act eliminated all cost-sharing for adult vaccines recommended by the CDC's advisory committee (ACIP), so Part D plans must now cover them with no deductible, copay, or coinsurance.

To get the Part D vaccines at $0 you need to be enrolled in a Part D plan (or a Medicare Advantage plan with drug coverage) — see our Part D guide.

When "free" turns into a bill: preventive vs. diagnostic

Most surprise charges around preventive care come from one mechanism: the same service is billed differently depending on why it was done and what happened during it.

Screening vs. diagnostic tests. A screening mammogram is free; a diagnostic mammogram — ordered because of a symptom or to follow up an abnormal result — carries the deductible and 20% coinsurance. The same split applies broadly: tests ordered to investigate a problem are diagnostic, not preventive.
The colonoscopy polyp rule. If a polyp is found and removed during a screening colonoscopy, the procedure is reclassified in the moment. You will not owe the Part B deductible, but you will owe coinsurance — 15% through 2026, dropping to 10% for 2027–2029 and to zero in 2030 under a phase-out Congress enacted in 2020.
One genuine improvement: since January 2023, a colonoscopy performed to follow up a positive stool-based screening test counts as part of the screening itself, so it is covered with no cost-sharing rather than billed as diagnostic. (One caveat: if a polyp is removed during that follow-up colonoscopy, the polyp rule above still applies and you will owe the reduced coinsurance.)
Extra services during a free visit. As noted above, anything your provider does during an IPPE or AWV that falls outside the preventive benefit — evaluating a new symptom, ordering labs that are not covered screenings — is billed separately.

If you get a bill you believe miscodes a preventive service, you can challenge it — start with the provider's billing office, and see our guide to Medicare appeals and denials if that fails.

What about Medicare Advantage?

Medicare Advantage plans must cover the same preventive services as Original Medicare and cannot charge you for services that are free under Original Medicare when you use in-network providers. The network is the key difference: go out of network and the plan's own cost rules apply. Everything above about preventive-versus-diagnostic coding applies in Medicare Advantage too. For the broader tradeoffs, see Medicare Advantage vs. Original Medicare, and for what neither pathway covers, see what Medicare doesn't cover.

Getting the most out of the free benefits

Confirm the provider accepts Medicare assignment before a preventive visit — that is the condition attached to nearly every "$0."
Book the Welcome to Medicare visit before your first 12 months of Part B run out; after that, use the AWV every 12 months.
Say the words "Annual Wellness Visit" when scheduling, so the office books and codes it correctly — and ask whether anything discussed will be billed separately.
Which screenings you actually need depends on your age, history, and risk factors — that is a conversation for your own doctor, not a general guide. For coverage questions, use medicare.gov, call 1-800-MEDICARE, or get free one-on-one help from your State Health Insurance Assistance Program (SHIP).

New to how the parts fit together? Start with Medicare parts explained.

Sources

This guide is for general education only and is not medical, legal, insurance, or financial advice. For decisions about your own coverage, use official sources or free help from your SHIP counselor.