Questions & answers · Health insurance
Medicare denied my "Welcome to Medicare" visit and I got a big bill. What can I do?
Health insuranceDeniedChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: Medicare.gov · "Welcome to Medicare" preventive visit View original ↗
In short
- The "Welcome to Medicare" visit is free only in your first 12 months of Part B.
- Extra tests or a routine physical in the same visit can cost you.
- Check your Medicare Summary Notice. You have 120 days to appeal.
What this means
Medicare.gov says you pay nothing for the "Welcome to Medicare" preventive visit if your provider accepts assignment, and the Part B deductible does not apply. It is covered once, within the first 12 months you have Part B [1]. The federal rule says you must get it not more than 1 year after your first Part B coverage starts [2].
Bills often come from two things. First, the visit was after your first 12 months. Second, the provider did extra tests or services. Medicare.gov says you may owe coinsurance and the deductible for extra services, and if Medicare does not cover them (like a routine physical exam), you may have to pay the full amount [1].
Look at your Medicare Summary Notice (MSN) to see what was denied and why. If you think it is wrong — for example, the visit was inside your first 12 months — you can appeal. The first appeal must be filed within 120 calendar days after you receive the notice [3].
Your next step
Compare the visit date with your Part B start date. Ask the doctor's office which services were billed besides the preventive visit. If the denial looks wrong, appeal on your MSN.
Deadline: 120 calendar days after you receive the MSN.
Check it yourself
Your Part B start date is on your Medicare card. Your MSN lists each billed service. The sources do not say whether a provider can rebill a visit under a different code after a denial — "Don't know yet"; ask the provider's billing office.
Where this comes from (3)
[1] Medicare.gov · "Welcome to Medicare" preventive visit · checked 2026-11-05
You pay nothing for the visit if your provider accepts assignment . The Part B deductible doesn't apply. However, 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. If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may h…
[2] eCFR · 42 CFR 410.16 · § 410.16(a) «Eligible beneficiary» · checked 2026-11-05
Eligible beneficiary means, for the purposes of this section, an individual who receives his or her initial preventive examination not more than 1 year after the effective date of his or her first Medicare Part B coverage period.
[3] eCFR · 42 CFR 405.942 · § 405.942(a) · checked 2026-11-05
any request for redetermination must be filed within 120 calendar days from the date a party receives the notice of the initial determination.
How we found this
We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-05.
What we don’t know yet
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
Related answers
- Do I need prior authorization before going to the emergency room?
- Medicaid denied my claim saying I have other insurance, but I don't. What can I do?
- My Medicaid application was denied. How long should a decision take, and how do I appeal?
- What percentage of health insurance claims are denied in the US?
Answer id CQ1008. Spotted an error? Tell us.