Beyond the Annual Physical: Medicare Benefits Your Family Is Probably Leaving on the Table

An Entitlement Nobody Claims

Here's a statistic that should concern every American family: a substantial majority of Medicare beneficiaries have never taken advantage of benefits they are fully entitled to — including services that could prevent hospitalizations, slow cognitive decline, and extend independence at home.

These aren't obscure loopholes. They are core Medicare benefits, paid for through decades of payroll contributions. The problem is rarely eligibility; it's awareness. This guide walks through five of the most underused covered services, with practical enrollment guidance for patients and the family members who often serve as their health advocates.

1. The Annual Wellness Visit (Not a Physical)

What it is

Medicare Part B covers one Annual Wellness Visit (AWV) every 12 months at no cost to the patient — no coinsurance, no deductible. Unlike a traditional head-to-toe physical, the AWV is a prevention-focused planning session: a review of medical and family history, screening schedules, cognitive assessment, and creation of a personalized prevention plan.

How to use it

Simply schedule the appointment and say "I'd like to schedule my Medicare Annual Wellness Visit." That exact phrasing matters — front-desk staff sometimes book a standard office visit instead, which can trigger a cost-sharing charge. Bring a complete medication list and any records from other providers. Caregivers are welcome and, for patients with memory concerns, encouraged to attend.

2. Chronic Care Management: A Monthly Lifeline

What it is

For beneficiaries living with two or more chronic conditions — diabetes, hypertension, COPD, arthritis, depression, and many others — Medicare covers Chronic Care Management (CCM). This gives patients access to a clinical team that coordinates care between visits: medication reconciliation, appointment scheduling, and roughly 20 minutes per month of non-face-to-face support by phone or portal.

How to enroll

CCM must be offered and initiated by the physician's practice — but patients can and should ask. At the next appointment, say: "Do you offer chronic care management for Medicare patients?" Be aware there may be a small monthly copayment (typically around $8), though many practices waive it. For families coordinating care remotely, as we often discuss at Matrix Health & Care, CCM is one of the most valuable services available — a designated point of contact between appointments.

3. Diabetes Self-Management Training

What it is

Newly diagnosed or struggling patients with diabetes are entitled to Diabetes Self-Management Training (DSMT) — up to 10 hours of education in the first year, covering nutrition, glucose monitoring, and complication prevention, delivered by certified educators.

How to enroll

A physician referral is required, so raise it at the next appointment. Sessions are offered at hospitals, community health centers, and increasingly through telehealth. Programs accredited by the CDC or the Association of Diabetes Care & Education Specialists are covered.

4. Fall Prevention and Balance Programs

What it covers

Falls send an older American to the emergency room every 11 seconds, and many falls are preventable. Medicare Advantage plans frequently cover evidence-based programs such as Stepping On or Tai Ji Quan: Moving for Better Balance, and Original Medicare covers physical therapy when a provider documents fall risk. Additionally, the AWV includes a mandatory fall risk assessment — a natural entry point.

How to enroll

Ask the physician for a fall risk evaluation and a physical therapy referral if indicated. Beneficiaries in Medicare Advantage plans should call the member services number on their card and ask specifically about covered fall prevention or fitness programs — many include SilverSneakers or Renew Active gym memberships at no additional cost.

5. Depression Screening and Behavioral Health Integration

What it covers

Medicare Part B covers annual depression screening in primary care settings at no cost, along with Mental Health Integration (MBI) services in participating practices and up to eight hours of annual diabetes-related nutrition therapy. For isolated seniors — particularly those grieving a spouse or managing chronic illness — these benefits matter enormously.

How to enroll

Screening typically happens during the Annual Wellness Visit; patients can also request it directly. If a referral to a therapist is needed, confirm the provider accepts Medicare assignment using Physician Compare at medicare.gov.

The Caregiver's Role: Closing the Gap

If you help manage an aging parent's healthcare, you are often the difference between a benefit that's used and one that lapses. Three actions to take this month:

1. Check the calendar. Has your loved one had an AWV in the past 12 months? If not, book it.
2. Ask about CCM at the next appointment and get the answer in writing.
3. Call the Medicare Advantage plan and request a printed list of supplemental wellness benefits — transportation to appointments, meal delivery after hospitalization, and gym memberships are commonly included and rarely used.

A Note on Costs and Eligibility

All five benefits above fall under Medicare Part B preventive services, meaning most carry zero out-of-pocket cost when billed correctly. Beneficiaries enrolled in Medicare Advantage should verify network requirements before scheduling. The official resource for eligibility and enrollment is 1-800-MEDICARE or medicare.gov — and benefits counseling through every state's State Health Insurance Assistance Program (SHIP) is free.

The Bottom Line

These benefits were designed with a simple philosophy: preventing illness is cheaper and kinder than treating it. Every unused wellness visit and unclaimed care management service represents a missed opportunity for earlier detection, better coordination, and more years of independent living. The enrollment headache, in most cases, amounts to a single phone call. Make it this week.