What Is the Medicare Annual Wellness Visit?
A Medicare annual wellness visit is an opportunity for your doctor to review and update your health risk factors to adjust a personalized plan for you to avoid future health problems. You must be enrolled in Medicare Part B for 12 months before your first visit. It should not be confused with an annual physical exam.
What Is a Medicare Wellness Visit?
A Medicare wellness visit is designed to create a personalized prevention plan, based on your health and risk factors, with the goal of preventing future medical issues, disease or disability.
Medicare will cover an annual wellness visit every year, once you have been enrolled in Medicare for 12 months.
A wellness visit should not be confused with an annual physical or with the Initial Preventive Physical Exam (IPPE) that you are entitled to during your first year on Medicare. Medicare covers the IPPE and annual Medicare wellness visits, but not annual physicals.
- Initial Preventive Physical Exam
- The IPPE reviews your medical, family and social health history and provides you with preventive services education. Medicare Part B covers only one IPPE and you must take it within 12 months of enrolling in Medicare Part B. You have no out-of-pocket costs if the doctor agrees to the Medicare-approved cost.
- Medicare annual wellness visit
- These are visits to update your personalized prevention plan and to perform an annual health risk assessment. Medicare Part B covers one wellness visit every 12 months. You pay no out-of-pocket costs for the visit if the doctor accepts the Medicare-approved cost.
- Routine annual physical examination
- These are annual exams requiring the doctor to physically examine you. Medicare does not cover these unless they are required to diagnose and treat a specific condition. Otherwise, you will have to pay 100 percent of the cost.
What’s Included in a Wellness Visit?
The purpose of a Medicare annual wellness visit is to create or update a tailor-made plan to help you prevent future health problems.
It relies on examining your health history and questioning you about current practices that may increase your risk of certain health problems. It includes basic measurements used to determine your health, but no physical exams or lab tests.
- A cognitive impairment assessment to look for signs of Alzheimer’s disease or dementia
- Advance care planning – planning for care if you become unable to speak for yourself
- A “Health Risk Assessment” questionnaire to develop a personalized prevention plan to head off future health problems
- Review of your family medical history
- Measuring and recording height, weight, blood pressure and other routine measurements
- Developing or updating list of current doctors and other health care providers
- Developing or updating list of current prescriptions
- A checklist and schedule for preventive services – screenings, shots and other preventive health care
- Personalized health advice
The annual wellness visit can be performed by a doctor or other Medicare-approved health care professional.
- Nurse practitioner
- Physician assistant
- Clinical nurse specialist
- Health educator
- Registered dietitian or nutrition professional
- A team of medical professionals working under a doctor’s direct supervision
You will need to complete the Health Risk Assessment before your appointment. The answers you give provide your doctor with vital information in creating the best possible preventive health plan possible for you, so it’s important to answer the questions truthfully and accurately.
You will also need to bring a complete list of all your medications including prescriptions, over-the-counter drugs and vitamins. You should also list the dosages and how often you take each. You may want to bring in all your medication bottles.
Does Medicare Cover an Annual Physical?
While Medicare Part B pays for an annual wellness visit, it does not pay for annual physicals.
Medicare will only pay for one physical — called the Initial Physical Examination (IPPE) — when you enroll in Medicare. You are required to take the IPPE within the first 12 months after you enroll.
Annual physical exams are more detailed than the annual wellness visit. In addition to many of the wellness visit services, a physical includes exams and tests that require the doctor to physically examine you. These are not included in the wellness visit.
- Check of vital signs
- Head and neck exam
- Lung exam
- Abdominal exam
- Neurological exam
- Measure reflexes
- Possible urine and blood samples for lab tests
Medicare will typically only pay for these physical examinations if you have been diagnosed with a condition that requires a doctor to perform one of these specific tests or examinations.
7 Cited Research Articles
- Electronic Code of Federal Regulations. (2020, October 29). Sec. 410.15 Annual Wellness Visits Providing Personalized Prevention Plan Services: Conditions for and Limitations on Coverage. Retrieved from https://www.ecfr.gov/cgi-bin/text-idx?SID=b88181e2130f26ae6c4741f95a518bbf&mc=true&node=se42.2.410_115&rgn=div8
- Community Care Physicians. (2017, September 28). Medicare Annual Wellness Visit vs. an Annual Physical. Retrieved from https://www.communitycare.com/News/Health-Blog-Article?URLName=Medicare-Annual-Wellness-Visit-vs-an-Annual-Physical
- Andrews, M. (2019, March 20). Costly Confusion: Medicare’s Wellness Visit Isn’t the Same as an Annual Physical. Retrieved from https://khn.org/news/medicare-covers-wellness-visit-not-annual-physical/
- Alzheimer’s Association. (2017, April). Medicare Annual Wellness Visit. Retrieved from https://www.alz.org/media/documents/factsheet-medicare-annual-wellness-visit-2017.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Yearly “Wellness” Visits. Retrieved from https://www.medicare.gov/coverage/yearly-wellness-visits
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Wellness Visits. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html
- American Academy of Family Physicians. (n.d.). FAQ on the Medicare Annual Wellness Visit (AWV) and Initial Preventive Physical Examination. Retrieved from https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/annual-wellness-visits/faq.html