Medicare Annual Wellness Visit
A Medicare annual wellness visit is a chance for you to meet with your doctor to review your health and prevent future medical issues. This includes a health risk assessment but is different from an annual physical, which Medicare does not cover. You must be enrolled in Medicare Part B for 12 months before your first visit.
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 Part B 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), also known as the “Welcome to Medicare” visit. Medicare covers the IPPE and annual Medicare wellness visits, but annual physicals are not included in the services Medicare covers.
What’s Included in a Medicare Wellness Visit?
The purpose of a Medicare annual wellness visit is to create or update a tailored plan to help you prevent future health problems.
It is used to examine your health history and question you about current practices that may increase your risk of certain health issues. The annual wellness visit 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 for future health problems.
- A 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.
Does Medicare Cover an Annual Physical?
While Medicare Part B pays for an annual wellness visit, annual physicals are not covered.
Medicare will only pay for your IPPE when you first 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 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.
What Is the Medicare Health Risk Assessment?
During the Medicare health risk assessment (HRA), your doctor gathers information to identify potential risks to your health and uses that data to develop a plan to reduce those risks. Risk factors that can be identified include tobacco use and your diet.
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.
- 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.
What’s Included in a Health Risk Assessment?
During the health risk assessment, you will be asked several questions to determine your potential health risks.
Since the assessment is part of your annual wellness visit, it may be done by your primary care doctor or other licensed health care providers.
- Nurse practitioner
- Physician assistant
- Clinical nurse specialist
- Health educator
- Registered dietician
- A team of professionals working under a doctor’s supervision
Your health risk assessment 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.
- 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 health risk assessment is covered by Medicare since it is part of your Medicare annual wellness visit. You will not have out-of-pocket costs as long as your provider accepts the Medicare-approved cost of your wellness visit.
But in certain circumstances, the Medicare Part B deductible will apply and you may have to pay coinsurance for the visit.
Out-of-pocket costs apply to your annual wellness visit if your doctor or other primary care provider performs additional services or tests during your visit that are not covered under Medicare Part B preventive care benefits.
Frequently Asked Questions About Medicare Wellness Visits
11 Cited Research Articles
- Electronic Code of Federal Regulations. (2022, February 11). 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
- Cigna. (2021, October 1). Health Risk Assessment (HRA). Retrieved from https://www.cigna.com/medicare/resources/health-risk-assessment
- 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/
- 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
- Alzheimer’s Association. (2017, April). Medicare Annual Wellness Visit. Retrieved from https://www.alz.org/media/documents/factsheet-medicare-annual-wellness-visit-2017.pdf
- 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
- Hughes, C. (2011, July). Medicare Annual Wellness Visits Made Easier. Retrieved from https://www.aafp.org/fpm/2011/0700/p10.html
- 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
- 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