What Is the Medicare Health Risk Assessment?

Your Medicare health risk assessment is part of your Medicare annual wellness check. The health risk assessment helps your doctor identify health behaviors and risk factors — such as tobacco use or diet — that pose health threats. It helps you and your doctor develop a plan to reduce those risks.

What Is a Medicare Health Risk Assessment?

The Medicare health risk assessment (HRA) gathers information during your Medicare annual wellness visit that can expose potential health problems. Your doctor or other qualified health care professional can then use this information to create a personalized prevention plan specifically for you.

The purpose of the annual wellness visit is to keep Medicare beneficiaries healthy or make them healthier. This is accomplished through promoting healthy lifestyles and instilling healthy habits.

The Medicare health risk assessment takes this concept a step further — aiming to customize this approach to individuals and each person’s unique health situation.

Risks the Medicare Health Risk Assessment Can Identify
  • Chronic diseases
  • Injury risks
  • Health risk factors you can modify
  • Your most urgent health needs

The goal is to prevent disability and disease and to slow the progression of any existing condition you may have. In short, to keep you as healthy as possible for as long as possible.

Did You Know?
The Medicare health risk assessment was created by the Affordable Care Act of 2010. It creates a “customized wellness or personal prevention plan, without cost to [Medicare] beneficiaries.”

What’s Included in a Health Risk Assessment?

During your annual wellness visit, you will be asked several questions to determine your potential health risks.

The assessment may be done by your primary care doctor or one of several other licensed health care providers.

Qualified Providers Who May Perform the Medicare Health Risk Assessment
  • Doctors
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Health educators
  • Registered dieticians
  • Nutrition professionals
  • Other licensed professionals
  • A team consisting of the above professionals under a physician’s direct supervision

Your HRA may be furnished through an interactive program over the phone or through the internet. It can also be done through your primary care physician, other health care professional or through a community-based prevention program.

You may also be asked to fill out a form before your visit to help the doctor identify behaviors and risk factors.

Topics Your Provider Will Cover During Your Health Risk Assessment
  • Your ability to perform daily activities including bathing, dressing and walking.
  • Your ability to perform other tasks including housekeeping, shopping and managing your medications and finances.
  • Your behavioral risks including tobacco use, diet and physical activity.
  • Your demographic and personal health or medical history.
  • Your mental health risks including stress, depression and pain.
  • Your self-assessment of your current health conditions.

The assessment will consist of several dozen questions covering these topics. You may fill these out before meeting with your doctor or other health care provider — or your provider may ask you about these topics as part of the assessment.

There is no nationally standardized Medicare questionnaire for the health risk assessment. But some states or Medicare Advantage plans may have standardized questions.

Your Costs for the Medicare Health Risk Assessment

Your annual Medicare health risk assessment is covered by Medicare. You will have no out-of-pocket costs for the assessment.

However, it is part of your Medicare annual wellness visit — also typically covered in full by Medicare. But in certain circumstances, the Medicare Part B deductible will apply and you may have to pay coinsurance for the visit.

When Out-of-Pocket Costs Apply for Annual Wellness Visits
  • Your doctor or other primary care provider performs additional services or tests during your visit.
  • These additional services and tests are not covered under Medicare Part B preventive care benefits.

Medicare covers a wellness visit once every 12 months after you’ve had Medicare Part B for longer than 12 months. The health risk assessment is included in each annual visit.

Last Modified: March 18, 2021

5 Cited Research Articles

  1. Cigna. (2020, October 1). Health Risk Assessment. Retrieved from https://www.cigna.com/medicare/resources/health-risk-assessment
  2. Hughes, C. (2012, March). Medicare Annual Wellness Visits: Don’t Forget the Health Risk Assessment. Retrieved from https://www.aafp.org/fpm/2012/0300/p11.html
  3. Hughes, C. (2011, July). Medicare Annual Wellness Visits Made Easier. Retrieved from https://www.aafp.org/fpm/2011/0700/p10.html
  4. Goetzel, R.Z. et al. (2011). A Framework for Patient-Centered Health Risk Assessments. Retrieved from https://www.cdc.gov/policy/hst/HRA/FrameworkForHRA.pdf
  5. U.S. Centers for Medicare & Medicaid Services. (n.d.). Yearly “Wellness” Visits. Retrieved from https://www.medicare.gov/coverage/yearly-wellness-visits