Yearly "Wellness" visits
If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.
Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.
Your costs in Original Medicare
You pay nothing for this visit if your doctor or other health care 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 doctor or other health care 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 have to pay the full amount.
Your doctor or other health care provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your doctor develop a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include:
- Routine measurements (like height, weight, and blood pressure).
- A review of your medical and family history.
- A review of your current prescriptions.
- Personalized health advice.
- Advance care planning .
Your doctor or other health care provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your doctor or other health care provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium and design a care plan.
If you have a current prescription for opioids, your doctor or other health care provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your doctor or other health care provider will also review your potential risk factors for substance use disorder, like alcohol and tobacco use , and refer you for treatment, if needed.
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The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical. Also, this service is similar to but separate from the one-time Welcome to Medicare preventive visit .
Eligibility
Medicare Part B covers the Annual Wellness Visit if:
- You have had Part B for over 12 months
- And, you have not received an AWV in the past 12 months
Additionally, you cannot receive your AWV within the same year as your Welcome to Medicare preventive visit.
Covered services
During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:
- Check your height, weight, blood pressure, and other routine measurements
- This may include a questionnaire that you complete before or during the visit. The questionnaire asks about your health status, injury risks, behavioral risks, and urgent health needs.
- This includes screening for hearing impairments and your risk of falling.
- Your doctor must also assess your ability to perform activities of daily living (such as bathing and dressing), and your level of safety at home.
- Learn about your medical and family history
- Medications include prescription medications, as well as vitamins and supplements you may take
- Your PCP should keep in mind your health status, screening history, and eligibility for age-appropriate, Medicare-covered preventive services
- Medicare does not require that doctors use a test to screen you. Instead, doctors are asked to rely on their observations and/or on reports by you and others.
- Screen for depression
- Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.
AWVs after your first visit may be different. At subsequent AWVs, your doctor should:
- Check your weight and blood pressure
- Update the health risk assessment you completed
- Update your medical and family history
- Update your list of current medical providers and suppliers
- Update your written screening schedule
- Screen for cognitive issues
- Provide health advice and referrals to health education and/or preventive counseling services
If you qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider . This means you pay nothing (no deductible or coinsurance ). Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During the course of your AWV, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.
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Staying healthy as you age: Medicare Annual Wellness Visits explained
- Family Medicine
Getting older has many advantages. You have the wisdom that comes with experience, plenty of stories to share and are usually more comfortable with who you are. If you have Medicare Part B coverage, another benefit is that you qualify for an Annual Wellness Visit.
This visit aims to keep you healthy and give you the tools to have a good quality of life as you age. The Medicare Annual Wellness Visit allows your health care team to review your health status, design a personalized prevention plan and connect you with critical preventive services covered by Medicare Part B.
Medicare Annual Wellness Visits create a snapshot of your health and provide a reference point for future visits. This improves the chances that a potentially serious health issue is caught early.
It's important to understand that Medicare Annual Wellness Visits differ from a physical exam conducted by your primary care provider.
Here are three major differences between these types of appointments:
1. provider seen.
A nurse or nurse practitioner typically conducts a Medicare Annual Wellness Visit. In most cases, you will not see your primary doctor or health care provider during this appointment.
A physical exam is conducted by your primary care provider, who may be a doctor, nurse practitioner or physician assistant.
2. What's included
A Medicare Annual Wellness Visit is meant to enhance your health and focuses on your well-being through interviews and assessments of your lifestyle factors. You will also be asked to fill out a health risk assessment before your appointment.
During a Medicare Annual Wellness Visit, the nurse will:
- Evaluate your fall risk.
- Measure your height, weight and blood pressure.
- Offer referrals to other health education or preventive services.
- Provide information related to voluntary advance care planning.
- Screen for cognitive impairments like dementia.
- Screen for depression.
- Update your medical and family history.
A physical exam includes an age and gender-appropriate comprehensive head-to-toe checkup. This exam is completed to detect and prevent illnesses or injuries.
During a physical exam, your primary care provider may:
- Check your vital signs.
- Discuss acute or urgent health issues.
- Review chronic health conditions.
- Review your medications.
- Perform a physical exam.
- Ask about your activity level, relationships and home environment.
3. Frequency and cost
A Medicare Annual Wellness Visit can be scheduled after you have Medicare Part B coverage for at least 12 months and each year after that. Subsequent visits must be at least 365 days, or one full year, after your previous year's visit. Medicare offers the Annual Wellness Visit at no cost for those who have Medicare Part B coverage.
A physical exam can be scheduled at any time. You or your insurance carrier will be responsible for the cost of this exam. The total will vary based on what tests and services are completed during the visit. Ask your insurance carrier for coverage details.
Medicare Annual Wellness Visits and physical exams are best scheduled for the same day, with the wellness visit occurring first. Contact your health care team and ask if you qualify for a Medicare Annual Wellness Visit.
Robert Stroebel, M.D. , is a Community Internal Medicine, Geriatric and Palliative Care physician at Mayo Clinic Primary Care in Rochester and Kasson, Minnesota.
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Medicare for Older Adults
The medicare annual wellness visit: what older adults should know.
Jul 28, 2022
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Kathleen Cameron
Senior Director of NCOA's Center for Healthy Aging
Ann Kayrish
Senior Program Manager, for Medicare
Key Takeaways
Introduced in 2011, the Medicare Annual Wellness Visit is a free benefit focused on health promotion and preventive care.
During your visit, you and your provider will create a personalized prevention plan that can help you avoid injury, illness, and disease.
The Medicare Annual Wellness Visit is 100% covered by Medicare Part B and can be scheduled once every 12 months.
Making the most of your Medicare coverage means understanding all the benefits and services available to you. One important benefit that many older adults don’t know about is the Medicare Annual Wellness Visit.
What is a Medicare Annual Wellness Visit?
Introduced in 2011 as part of the Affordable Care Act, the Medicare Annual Wellness Visit focuses on health promotion and preventive care . It allows you and your provider to create a personalized prevention plan that can help you stay healthy and avoid injury, illness, and disease. This visit is also an opportunity to address a range of issues that may be affecting your quality of life—such as depression , memory loss, and dementia .
The Annual Wellness Visit is only for preventive care and not for the diagnosis and treatment of an illness. If you want to discuss a specific health problem with your doctor, you’ll need to schedule a separate appointment.
Who can get a Medicare Annual Wellness Visit?
You can get an Annual Wellness Visit if you’ve been receiving Medicare Part B benefits for at least one year (12 months). Also, you must not have had an initial preventive physical exam (“Welcome to Medicare” exam) or a previous Wellness Visit within the past year.
When you call your provider’s office for an appointment, be sure to ask to schedule an “ Annual Wellness Visit ” by name. This will help ensure that Medicare covers the appointment as a preventive service.
Are Medicare Annual Wellness Visits free?
Medicare Annual Wellness Visits are 100% covered under Medicare Part B . This means that if you have Part B, you pay nothing if you go to a health care professional who accepts Medicare assignment. Assignment is an agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance. You won’t have to worry about out-of-pocket costs such as coinsurance and copayments , and the Part B deductible does not apply to this visit.
However, you can expect to pay a copayment or coinsurance and any unmet portion of your Part B deductible if:
- Your provider performs tests or services to treat an existing illness or health problem.
- You get any follow-up screenings or other preventive services recommended by your provider during your Wellness Visit.
How often can you have a Medicare Annual Wellness Visit?
Medicare covers one Wellness Visit per calendar year (12 months).
What happens during a Medicare Annual Wellness Visit?
During your visit, you will be asked to fill out a questionnaire called a Health Risk Assessment . Your responses will help your provider gain a better understanding of your current health and your risk factors. The appointment may also include:
- Recording of height, weight, body mass index (BMI), blood pressure, and other routine measurements
- Review of your medical and family history
- Review of your current health care providers and any prescriptions, vitamins, and/or supplements you’re taking
- Creation of a health screening schedule for the next 5-10 years based on your age, family history, and unique risk factors
- Review of functional ability (your ability to perform everyday tasks on your own) and safety (first visit only)
- Creation of a list of risk factors/conditions along with recommendations/treatment options
- Discussion of advance care planning (care you would receive if you could not speak for yourself)
- Personalized health advice and referrals for issues such as weight management , falls prevention , diet and nutrition , and smoking cessation
During your Annual Wellness Visit, you’ll also receive a cognitive assessment to check for dementia, memory loss, depression, anxiety, and other conditions. If your provider spots any issues, they will likely recommend a separate visit to perform a more thorough review of your cognitive function.
Additionally, if you're currently taking any prescription opioid medications, your provider will talk to you about the risks involved with taking opioids (including substance use disorder). They'll evaluate the severity of pain you're experiencing, review your existing treatment plan, and explain your non-opioid treatment options.
What is the difference between a Medicare Wellness Visit and a physical?
The Annual Wellness Visit may be like a routine physical in some ways, but it is not a comprehensive physical exam. This visit does not typically include:
- Physical examination
- Diagnosis of illness
- Lab tests (such as bloodwork and x-rays)
- Treatments for current conditions
While the goal of a physical exam is to identify any health issues, the goal of a Medicare Annual Wellness Visit is to help you maintain your current health and prevent problems down the road. In many cases, this visit doesn't need to be completed in an exam room.
Who can perform the Medicare Annual Wellness Visit?
This visit can be performed by different types of health care professionals who are recognized by Medicare, including:
- Nurse practitioner (NP)
- Physician assistant (PA)
- Clinical nurse specialist
- Registered dietitian
- Health educator
You may want to do your Medicare Wellness Visit with your primary care doctor or other provider in your doctor’s office. They know you best and will be able to monitor any changes in your health over time.
What should I bring to my Medicare Annual Wellness Visit appointment?
Bring your completed Health Risk Assessment to your visit along with a list of any medications, vitamins, and/or supplements you're taking (both prescription and over the counter). It’s a good idea to have your immunization records handy if the provider does not already have this information. You should also write down any questions or concerns you have about your medications or your health in general. This visit is a great opportunity to get all your questions answered.
Does Medicare require a Wellness Visit every year?
Medicare does not require that you have a Medicare Wellness Visit every year. But it’s important to take advantage of all the Medicare benefits available to you. This free yearly visit is an extra tool in your health care toolbox. It can help you prevent disability, illness, and chronic disease , so you can stay well and live your best life possible. You may want to set a reminder for yourself every year to schedule your Annual Wellness Visit.
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Your Medicare annual wellness visit: Preventive care, health planning at no extra cost
Most of us know that it’s important to see a doctor for an annual checkup. During your working years, that annual checkup typically means a full physical. But once you become eligible for Medicare, you’ll likely start hearing about something called an annual wellness visit .
Unlike a standard head-to-toe physical, an annual wellness visit is primarily focused on preventive care, health screenings and wellness planning. It gives you an opportunity to have a conversation with your doctor about your health status and goals – then create a long-term plan to help you meet those goals and maximize your well-being.
While Original Medicare doesn’t cover an annual physical, some Medicare Advantage plans do. However, everyone enrolled in Original Medicare or Medicare Advantage is eligible for an annual wellness visit at no additional cost. If your Medicare Advantage plan includes coverage for an annual comprehensive physical exam, ask your provider if the annual wellness visit and the physical can be scheduled during the same visit.
Below you’ll find an overview of what to expect from your annual wellness visit – and hopefully the motivation to schedule one.
Taking stock of your medical history
Your primary care provider , whether in person or virtually , will review your relevant medical history, including major illnesses, surgeries, plus any current medical conditions and medications you’re taking.
Your doctor’s office may send you a form ahead of your appointment that includes a list of questions.
To-do : Fill out this form in advance to help ensure your doctor has a thorough understanding of your health history. It may also remind you of questions you might want to raise at the appointment.
If you don’t get a form before your visit, you should still be prepared to be as detailed as possible when describing any past medical procedures and illnesses. Knowing specific diagnoses and dates will certainly help, but even giving a rough description of any major medical events in your life will help your physician understand both your past and current medical issues.
The who’s who of your health care team
Keeping you healthy is a group effort, and the primary care provider you see for your wellness visit will want to know who’s part of your health care team. He or she may also want to work closely with other health care professionals involved in your care.
To-do : Be prepared to give the person conducting your visit a list of your current health care providers, including contact information and fields of specialty.
If you see several specialists to help you manage chronic conditions or haven’t seen some of your doctors in the past year, it can be easy to forget their names. That’s why it’s a good idea to create a list of your doctors and bring it with you to your wellness visit.
You may have chosen a health care surrogate or a proxy who will speak on your behalf should you ever become too sick to speak for yourself. If so, bring a copy of your completed forms to your appointment. If you haven’t made your choices yet, this is a good time to get your physician’s advice on your personal advance care planning .
An Rx for a productive medication review
Getting a full rundown of all your vitamins, minerals, herbal supplements and prescription medications can help the doctor spot potential drug interactions that could be harmful to your health. He or she will also want to ensure you have a complete understanding of each medication, its purpose and any potential side effects.
To-do: Make a list, including how often you take each medication and the dosage. Or, bring all your pill bottles with you to your appointment and show them to the provider.
Stats and screenings
A clinician will check your height, weight and blood pressure, and then your provider will likely ask you some questions, including how you have been feeling recently. These questions are designed to test your cognitive function and screen you for depression. Answer them as honestly as possible and come to the appointment well-rested so you can perform your best on the tests.
Creating a wellness plan
After completing all tests and assessments, your provider will be ready to assess your current health status and work with you to develop a plan to meet your health goals. That plan will address how to treat your current conditions and how to help prevent future health problems. If you have any risk factors for developing new conditions, your provider will give you some options for managing those risks.
You can also set up a schedule for preventive care or screening tests and discuss treatment options for any newly diagnosed conditions.
To-do : Be prepared to get the most out of this planning by developing a list of questions you would like to ask at the appointment. And don’t be shy with your questions. During the annual wellness visit, your provider may have more time than usual to listen to your concerns and answer your questions.
It’s also important to be honest about your health goals. Not everyone sets out to exercise daily or lose 10 pounds in the next year – and that’s OK. Maybe your goal is to ride a bike with your grandkids around the neighborhood or to cut back on your alcohol consumption. Whatever your health goals are, your provider can’t help you reach them if he or she doesn’t know about them. So be as open and honest as possible during your visit.
Things to keep in mind
To avoid surprises, pay attention to these details as you get your visit on the calendar:
- Make sure the appointment is scheduled specifically as an annual wellness visit, or the provider may bill it as a normal office visit, which could be subject to a copay, depending on your plan. If you’re a UnitedHealthcare member, our dedicated customer service advocates can even help schedule your appointment for you.
- If your provider orders a test during the annual wellness visit, you may be charged any applicable lab or diagnostic copay for the recommended services.
When you are prepared, your annual wellness visit is more than just an office visit. It is your opportunity to take charge of your health and help ensure you’re on the right path to living the life you want. If you haven’t scheduled yours yet, use this as the push you need to get it on your calendar. It could be one of the most important conversations you have all year.
To learn more about how your how your UnitedHealthcare Medicare plan can help you access the care you need, visit UHCMedicareHealthPlans.com .
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Doctor Visits
Get Your Medicare Wellness Visit Every Year
Take Action
If you have Medicare, be sure to schedule a yearly wellness visit with your doctor or nurse. A yearly wellness visit is a great way to help you stay healthy.
What happens during a yearly wellness visit?
First, the doctor or nurse will ask you to fill out a questionnaire called a health risk assessment. Answering these questions will help you get the most from your yearly wellness visit.
During your visit, the doctor or nurse will:
- Go over your health risk assessment with you
- Measure your height and weight and check your blood pressure
- Ask about your health history and conditions that run in your family
- Ask about other doctors you see and any medicines you take
- Give advice to help you prevent disease, improve your health, and stay well
- Look for any changes in your ability to think, learn, or remember
- Ask about any risk factors for substance use disorder and talk with you about treatment options, if needed
If you take opioids to treat pain, the doctor or nurse may talk with you about your risk factors for opioid use disorder, review your treatment plan, and tell you about non-opioid treatment options. They may also refer you to a specialist.
Finally, the doctor or nurse may give you a short, written plan to take home. This plan will include any screening tests and other preventive services that you’ll need in the next several years. Preventive services are health care services that keep you from getting sick.
Learn more about yearly wellness visits .
Plan Your Visit
When can i go for a yearly wellness visit.
You can start getting Medicare wellness visits after you’ve had Medicare Part B for at least 12 months. Keep in mind you’ll need to wait 12 months in between Medicare wellness visits.
Do I need to have a “Welcome to Medicare” visit first?
You don’t need to have a “Welcome to Medicare” preventive visit before getting a yearly wellness visit.
If you choose to get the “Welcome to Medicare” visit during the first 12 months you have Medicare Part B, you’ll have to wait 12 months before you can get your first yearly wellness visit.
Learn more about the “Welcome to Medicare” visit .
What about cost?
With Medicare Part B, you can get a wellness visit once a year at no cost to you. Check to make sure the doctor or nurse accepts Medicare when you schedule your appointment.
If you get any tests or services that aren’t included in the yearly wellness visit (like an extra blood test), you may have to pay some of those costs.
Who Can Get Medicare?
Medicare is a federal health insurance program. You may be able to get Medicare if you:
- Are age 65 or older
- Are under age 65 and have a disability
- Have amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease
- Have permanent kidney failure (called end-stage renal disease)
You must be living in the United States legally for at least 5 years to qualify for Medicare. Answer these questions to find out when you can sign up for Medicare .
Make an Appointment
Take these steps to help you get the most out of your Medicare yearly wellness visit.
Schedule your Medicare yearly wellness visit.
Call your doctor’s office and ask to schedule your Medicare yearly wellness visit. Make sure it’s been at least 12 months since your last wellness visit.
If you're looking for a new doctor, check out these tips on choosing a doctor you can trust .
To find a doctor who accepts Medicare:
- Search for a doctor on the Medicare website
- Call 1-800-MEDICARE (1-800-633-4227)
- If you use a TTY, call Medicare at 1-877-486-2048
Gather important information.
Take any medical records or information you have to the appointment. Make sure you have important information like:
- The name and phone number of a friend or relative to call if there’s an emergency
- Dates and results of checkups and screening tests
- A list of vaccines (shots) you’ve gotten and the dates you got them
- Medicines you take (including over-the-counter medicines and vitamins), how much you take, and why you take them
- Phone numbers and addresses of other places you go to for health care, including your pharmacy
Make a list of any important changes in your life or health.
Your doctor or nurse will want to know about any big changes since your last visit. For example, write down things like:
- Losing your job
- A death in the family
- A serious illness or injury
- A change in your living situation
Know your family health history.
Your family's health history is an important part of your personal health record. Use this family health history tool to keep track of conditions that run in your family. Take this information to your yearly wellness visit.
Ask Questions
Make a list of questions you want to ask the doctor..
This visit is a great time to ask the doctor or nurse any questions about:
- A health condition
- Changes in sleeping or eating habits
- Pain or discomfort
- Prescription medicines, over-the-counter medicines, or supplements
Some important questions include:
- Do I need to get any vaccines to protect my health?
- How can I get more physical activity?
- Am I at a healthy weight?
- Do I need to make any changes to my eating habits?
Use this question builder tool to make a list of things to ask your doctor or nurse.
It can be helpful to write down the answers so you remember them later. You may also want to take a friend or relative with you for support — they can take notes, too.
What to Expect
Know what to expect at your visit..
The doctor or nurse will ask you questions about your health and safety, like:
- Do you have stairs in your home?
- What do you do to stay active?
- Have you lost interest in doing things you usually enjoy?
- Do you have a hard time hearing people on the phone?
- What medicines, vitamins, or supplements do you take regularly?
The doctor or nurse will also do things like:
- Measure your height and weight
- Check your blood pressure
- Ask about your medical and family history
Make a wellness plan with your doctor.
During the yearly wellness visit, the doctor or nurse may give you a short, written plan — like a checklist — to take home with you. This written plan will include a list of preventive services that you’ll need over the next 5 to 10 years.
Your plan may include:
- Getting important screenings for cancer or other diseases
- Making healthy changes, like getting more physical activity
Follow up after your visit.
During your yearly wellness visit, the doctor or nurse may recommend that you see a specialist or get certain tests. Try to schedule these follow-up appointments before you leave your wellness visit.
If that’s not possible, put a reminder note on your calendar to schedule your follow-up appointments.
Add any new health information to your personal health documents.
Make your next wellness visit easier by updating your medical information in the personal health documents you keep at home. Write down any vaccines you got and the results of any screening tests.
Medicare offers an online tool called MyMedicare to help you track your personal health information and Medicare claims. If you have your Medicare number, you can sign up for your MyMedicare account now .
Healthy Habits
Take care of yourself all year long..
After your visit, follow the plan you made with your doctor or nurse to stay healthy. Your plan may include:
- Getting important screenings
- Getting vaccines for older adults
- Keeping your heart healthy
- Preventing type 2 diabetes
- Lowering your risk of falling
Your plan could also include:
- Getting active
- Eating healthy
- Quitting smoking
- Watching your weight
Content last updated February 9, 2023
Reviewer Information
This information on Medicare wellness visits was adapted from materials from the Centers for Medicare and Medicaid Services
Reviewed by: Rachel Katonak Centers for Medicare and Medicaid Services Division of Policy and Evidence Review Coverage and Analysis Group
November 2022
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What is the annual Medicare wellness visit?
The Medicare wellness visit is an annual visit with your primary care provider to create a personalized plan to help prevent disease and disability, based on your health and risk factors.
This free Medicare wellness visit is covered once every 12 months. You become eligible after you have been enrolled in Part B for a year or longer.
What is covered in the annual wellness visit?
The wellness visit is different from an annual physical exam where a doctor conducts a lot of tests. This exam focuses more on reviewing your medical history and risk factors and creating a prevention plan.
You’ll usually fill out a questionnaire, called a health risk assessment, as part of the visit. It can help you and your provider develop a personalized plan to stay healthy. Your provider may do the following during your wellness exam:
- Review your medical history and your family’s medical history
- Review your current providers and prescriptions
- Record your vital information, including your height, weight and blood pressure
- Provide personalized health advice
- Review potential health risks and treatment options
- Create a screening checklist for recommended preventive services
- Discuss advance care planning, such as who you want to be able to make medical care decisions on your behalf if you’re unable to do so yourself.
- Perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. If your provider thinks you may have cognitive impairment, Medicare covers a separate visit to review your cognitive function.
- Review potential risk factors for opioid problems if you have a current prescription for opioids.
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How does this differ from a Welcome to Medicare visit?
You are entitled to one free Welcome to Medicare visit any time during the first 12 months after you enroll in Medicare Part B. That checkup is an opportunity for your doctor to assess your health and provide a plan of future care. It serves as a baseline for monitoring your health during the annual wellness visits in subsequent years.
You do not need the Welcome to Medicare visit to qualify for later annual wellness visits. However, Medicare won’t pay for a wellness visit during the first 12 months you have Part B.
Will I face extra charges for the Medicare wellness visit?
You’ll have no deductible or copayments for your annual Medicare wellness visits if you’re enrolled in original Medicare and your provider accepts assignment, meaning he or she accepts the Medicare-approved amount as full compensation.
If you’re enrolled in a Medicare Advantage plan that has a provider network, such as an HMO or PPO, you may need to go to a doctor in the plan’s provider network to get the annual wellness visit without deductibles, copayments or coinsurance.
Keep in mind
If your health care provider performs additional tests or provides additional services during the visit that aren’t covered as part of the annual wellness benefit, you may have to pay your deductible and copayments for the additional expenses.
Updated July 14, 2022
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What Is the Medicare Annual Wellness Visit?
By Rachel Lustbader HealthCare Writer
Rachel Lustbader HealthCare Writer
Rachel is a writer and editor working in the marketing, tech, and health care industries.
Reviewed by Louise Norris
Louise Norris Expert Reviewer
Since 2006, Louise has analyzed and written about all aspects of health insurance and health care reform at both the state and federal level. She has written extensively for healthinsurance.org, Verywell, medicareresources.org, HSA Store, ADP’s Spark and Boost platforms, the Colorado Health Insurance Insider, and Anthem’s Benefits Guide, along with various other publications.
Her work has also been published by Health Affairs, as she was part of a team of health policy analysts who initially addressed how the lack of federal funding for cost-sharing reductions would affect premiums and premium tax credits in the individual health insurance market.
In this Article
We aim to help you make informed healthcare decisions. While this post may contain links to lead generation forms, this won’t influence our writing. We follow strict editorial standards to give you the most accurate and unbiased information.
A number of preventive services are available free of cost or at low cost to people with Medicare, one of them being the Medicare Annual Wellness Visit.
If you’re a Medicare enrollee but have yet to take advantage of the Annual Wellness Visit or have chosen to opt out due to confusion, read on to learn more about the benefits of the program.
What Is the Annual Wellness Visit?
The Annual Wellness Visit is a yearly checkup that Medicare covers for most enrollees. The visit is intended to help people with Medicare maintain good health by catching signs of disease early on and taking a preventive approach to healthcare.
The Annual Wellness Visit, which was created as part of the Affordable Care Act in 2010, is a recent addition to your Medicare benefits. It was introduced by the Centers for Medicare & Medicaid Services in 2011 to help address health risks faced by older populations and encourage Medicare recipients to take charge of their health.
Research shows that people with Medicare who take advantage of the AWV are more likely to receive important preventive care services like vaccines and cancer screenings than those who skip out on the visit. 1
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The purpose of the Medicare Annual Wellness Visit is to establish and maintain a personal preventive care plan. Upon enrolling in Medicare, everyone is entitled to a “Welcome to Medicare” visit, during which an initial preventive care plan will be written. The ensuing Annual Wellness Visit appointments are meant to update your existing preventive care plan and make any necessary changes.
The AWV is also a great way for your doctor to stay up-to-date on your health. It’s an opportunity for him or her to offer actionable advice that helps you maintain or improve your health for the coming year.
Limited Examinations
It is important to note that the Medicare Annual Wellness Visit is not a full head-to-toe physical exam. It is more of a “hands off” visit that focuses on your health history, risk factors, and some age-appropriate screenings. You may still want to see your physician for an annual physical exam.
“It’s very important that someone, when they call to make an appointment, uses those magic words, ‘annual wellness visit,’” Leslie Fried, senior director of the Center for Benefits Access at the National Council on Aging, told Kaiser Health News. 2 Otherwise, “people think they are making an appointment for an annual wellness visit and it ends up they are having a [costly] physical.”
Still, the Annual Wellness Visit is a great way to get personalized health advice that can lower the risk of diseases like cancer, or help manage existing chronic conditions like diabetes , in a way that’s tailored specifically to you and your needs.
What to Expect From the Annual Wellness Visit
During or before your visit, your physician will ask you to complete a “ Health Risk Assessment .” The assessment is basically a questionnaire that asks about your health status, injury risks, and urgent health needs.
Your first annual wellness visit will be the most comprehensive. In addition to completing the Health Risk Assessment, you can expect your physician to:
- Record your height, weight, blood pressure, other basic measurements
- Assess your functional ability and safety risks (hearing screening, falling risk, ability to complete activities of daily living, and home safety)
- Ask about your medical and family history
- Document all of your medications
- Screen for cognitive impairment (Alzheimer’s and dementia) and depression
Post Visit Follow-Ups
Your physician will use all of this information to update your preventive health plan and a screening schedule or preventive measures checklist, and provide applicable health advice. They may also refer you to necessary health education or preventive counseling services to reduce any risk factors, regarding things like weight loss, fall prevention, smoking cessation, or physical activity.
What Gets Updated Each Year
Although subsequent wellness visits may not be as comprehensive as the first, your doctor should still check your major health markers like weight, blood pressure, and cognitive function, and will update your information and health plan accordingly. For each Annual Wellness Visit, you should come prepared with your medical and family history, immunization records, and a list of your current prescriptions .
Who Is Eligible for Medicare’s Annual Wellness Visit?
Original Medicare (Medicare Part A and Part B) or Medicare Advantage enrollees who have been enrolled for 12 months and have not had their “Welcome to Medicare” visit in the last 12 months are eligible for the Annual Wellness Visit. You can have one visit per 12-month period.
How Much Does the Annual Wellness Visit Cost?
Like many preventive services, people with Medicare can access the Annual Wellness Visit free of cost so long as they meet the eligibility requirements. However, you may have to pay coinsurance or a deductible if your physician performs tests or services that are not considered to be Medicare preventive services.
Original Medicare
Medicare Part B covers 100% of the visit with a participating provider. You will not have to provide a deductible, copayment, or coinsurance when you visit a doctor who accepts Medicare .
Medicare Advantage
Medicare Advantage, also known as Part C, plans fully cover an identical Annual Wellness Visit if you meet the eligibility requirements. You’ll have to stay within your Medicare Advantage network to use this benefit, and you might be required to see your designated primary care physician.
Is the Annual Wellness Visit Mandatory?
No. Medicare’s Annual Wellness Visit is not mandatory, but it is beneficial. If you meet the eligibility requirements, you have nothing to lose by taking advantage of the program. The visit is a simple way to manage your health and prevent complications down the line, all free of charge to you.
Making An Appointment
You can schedule your Annual Wellness Visit with your regular primary care doctor, as long as they participate in Medicare. There’s no doctor referral needed, so get in touch with your physician’s office about arranging your visit.
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Article sources.
Camacho, Fabian, Nengliang (Aaron) Yao, and Roger Anderson. “ The Effectiveness of Medicare Wellness Visits in Accessing Preventive Screening .” Journal of Primary Care & Community Health, October 2017 (accessed September 2018).
Andrews, Michelle. “ Costly Confusion: Medicare’s Wellness Visit Isn’t The Same As An Annual Physical .” Kaiser Health News, March 20, 2019 (accessed February 2020).
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What Does a Medicare Wellness Visit Include?
Routine medical care is important when you’re sick or suffering from an ailment, but what about when you’re feeling fine? The truth is, scheduling an annual doctor’s visit to assess your health, often referred to as a wellness visit, is just as important to do when you’re feeling fine as it is when you’re feeling under the weather. These visits provide your physician the chance to discuss any healthcare concerns you may have, and they also give you the opportunity to ask questions about any medications or supplements you’re taking or about changes to your diet or exercise routine.
The Difference Between a Physical and a Wellness Visit
For many people, the terms “physical” and wellness visit” are used interchangeably, but they are actually quite different. During a physical, your doctor carries out a physical exam of your major systems, takes measurements, documents any changes and reviews concerns. During a wellness visit, there is typically no examination that takes place other than a general inspection of the body. A wellness visit is more like checking in with your doctor while a physical is more like an in-depth examination to assess body systems and functions. During a wellness visit, you may bring up a medical concern which prompts a physical exam, and during a physical, you may discuss wellness concerns, but the two are billed as separate types of visits.
Fortunately for Medicare recipients, an annual wellness visit is included with Part B coverage. During a wellness visit under Medicare, patients will have the chance to discuss any changes to existing conditions that have previously been documented, and the physician will review medical history to ensure that the patient is still in need of any prescribed medications. A doctor may also provide the patient with a preventive health plan designed to encourage healthy lifestyle choices. This plan may detail dietary changes or weight loss exercises, smoking or alcohol cessation information, a list of support groups or therapeutic care providers and more.
While wellness visits usually do not include any type of treatment in the doctor’s office unless an emergency occurs, patients are often directed to make a follow-up appointment for further screening if the wellness visit brings to light concerns that need to be addressed in detail. Keep in mind that this follow-up visit will not be covered as a wellness visit under Medicare and will be billed as a regular outpatient visit.
Additionally, a cognitive assessment is typically performed during the wellness visit, but this is usually done simply by conversing in the office. Finally, patients will fill out a wellness questionnaire while waiting to see the doctor, and the answers will be assessed to ensure that the doctor is able to address any symptoms that are deemed problematic that may not have been expressed directly by the patient.
Medicare Coverage Beyond Wellness Visits
If further medical treatment is required subsequent to a wellness visit, the good news is that Medicare provides a range of coverage options in the forms of inpatient, outpatient and prescription drug benefits. Medicare Part A covers things like inpatient hospitalization and skilled nursing care, and Medicare Part B provides coverage for outpatient care when it comes to doctor’s visits and treatments at clinics or testing at a lab. Medicare Part D is the prescription drug benefit and covers most medications that can be purchased at a retail pharmacy to be administered at home.
If you’re unsure as to your benefits or you’re considering Medicare in the future and would like to know more about your options, contact your current plan and/or research your options to find the Medicare coverage that will meet your needs.
Related articles:
Retiring under the age of 65? Understanding Your Medicare Benefits (Opens in a new browser tab)
Do Medicare Advantage Plans Cover Wellness Exams? (Opens in a new browser tab)
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Questions and Answers About Medicare Annual Wellness Visits
February 8, 2022
pp , Primary Care , Wellness
An annual wellness visit is a yearly appointment with a healthcare provider that Medicare covers at no cost to you. Why should you get one, what does it cover and how is it different from an annual physical?
We spoke with UNC Health family medicine physician Rachael Hollifield, DO , and Jill Godfrey-Olson, MS, RN, manager of embedded care management at UNC Health, to learn more.
What is an annual wellness visit?
An annual wellness visit is a yearly visit with a healthcare primary care provider, who can be a nurse or a doctor, and/or a licensed social worker (often called a care manager). It includes a review of your medical and social history and is designed to help prevent illness based on your current health and risk factors.
The visit may include education or counseling about the following services:
- Immunizations, including flu, shingles and pneumococcal vaccines
- Height, weight and blood pressure measurements
- A calculation of your body mass index
- A review of your potential risk for depression and your level of safety
- Referrals for other care, if needed
- Certain screenings, such as mammograms, bone density scans, and dementia and depression screenings
- A falls risk assessment
- An opportunity to discuss creating an advance directive
- A written plan letting you know which screenings, shots and other preventive services you need
Typically, your first annual wellness visit—which occurs after your 65th birthday—is more comprehensive. It may include labs and an electrocardiogram and will verify that you are up to date on vaccines. After your initial visit, you will continue to have yearly visits where you can discuss problems, concerns and other necessary screenings.
Who should get an annual wellness visit?
Anyone who is covered by Medicare federal health insurance should get an annual wellness visit. Typically, Medicare patients are 65 and older, but patients with disabilities who are younger than 65 may also be eligible.
Why should I have an annual wellness visit?
Annual wellness visits are a benefit provided by Medicare to patients at no cost to you. They are an opportunity for you to sit down once a year to review your medical history and discuss preventive care that can keep you from getting very sick or ending up in the hospital.
“What makes them unique is they do a really good job at closing some gaps that we may not close in our regular office visits, such as a dementia screening and a falls risk assessment,” Dr. Hollifield says.
Care managers also will review whether a patient needs additional help, such as assistance with meals or taking their medications. They also talk to patients about advance care planning, including living wills and advance directives.
“We help them get their medical wishes for their care documented and have a plan in place should they ever not be able to speak for themselves regarding their medical care and wishes,” Godfrey-Olson says.
How is an annual wellness visit different from a physical?
An annual wellness visit is not a head-to-toe physical. Instead, you usually sit down to discuss problems or concerns you have as well as preventive care to keep you healthy and out of the hospital.
The structure of an annual wellness visit allows more time for you and your care team to discuss concerns that you may not have time to talk about during your physical or other visits to your provider during the year. Most appointments last about 45 minutes.
The purpose of the annual wellness visit is to try to prevent future issues that could result if a problem isn’t addressed promptly.
“We are looking at risk factors for this population, making sure that the patients have what they need to keep them healthy and independent in the home as long as they’d like to be,” Godfrey-Olson says.
How much do annual wellness visits cost?
There is no cost. It is a benefit provided by Medicare to patients. Medicare will pay for an annual wellness visit once every 12 months. While a benefit to Medicare recipients, these visits are not required to keep your Medicare benefits.
How can I make the most out of my annual wellness visit?
It’s a good idea to prepare for your annual wellness visit to make sure you cover everything and stay on task. Bring a complete list of your medications, including vitamins, supplements and over-the-counter medication, for your provider to review. You also can put all your medication bottles in a bag to bring.
“You should bring a list of top concerns or questions, as well as be prepared to discuss your medical history, including chronic illness and any past surgeries,” Godfrey-Olson says. “This visit is intended to help you take control of your health and prevent future problems, and your care team is there to assist with that.”
Eligible for an annual wellness visit? Contact your doctor. Don’t have one? Find a doctor near you.
A systematic approach will help prevent these visits from overwhelming your practice.
CYNTHIA HUGHES, CPC
Fam Pract Manag. 2011;18(4):10-14
Cindy Hughes is the AAFP's coding and compliance specialist and a contributing editor to Family Practice Management . Author disclosure: no relevant financial affiliations disclosed.
This is a corrected version of the article that appeared in print.
In two previous articles, I explained the elements required for the new Medicare annual wellness visit (AWV). 1 , 2 In this article, I share ideas and emerging best practices for providing the components of the AWV in a way that most benefits your patients while protecting your practice from loss of income and productivity. From educating patients about what to expect at a wellness visit to planning the delivery of the related services, there are opportunities to make the most of the AWV for patients and your practice.
Manage patient expectations
Although the AWV has been referred to as a “physical” in ads encouraging Medicare beneficiaries to take advantage of this new benefit, a head-to-toe exam is not required. Patients may also expect to receive diagnosis and management of problems at this encounter without charge. To set the right expectations and give patients fair warning of additional expenses they may incur, a simple one-page letter may be effective.
SAMPLE LETTER: A WORD TO OUR PATIENTS ABOUT MEDICARE AND WELLNESS CARE
Dear Patient,
We want you to receive wellness care – health care that may lower your risk of illness or injury. Medicare pays for some wellness care, but it does not pay for all the wellness care you might need. We want you to know about your Medicare benefits and how we can help you get the most from them.
The term “physical” is often used to describe wellness care. But Medicare does not pay for a traditional, head-to-toe physical. Medicare does pay for a wellness visit once a year to identify health risks and help you to reduce them. At your wellness visit, our health care team will take a complete health history and provide several other services:
Screenings to detect depression, risk for falling and other problems,
A limited physical exam to check your blood pressure, weight, vision and other things depending on your age, gender and level of activity,
Recommendations for other wellness services and healthy lifestyle changes.
Before your appointment, our staff will ask you some questions about your health and may ask you to fill out a form.
A wellness visit does not deal with new or existing health problems. That would be a separate service and requires a longer appointment. Please let our scheduling staff know if you need the doctor's help with a health problem, a medication refill or something else. We may need to schedule a separate appointment. A separate charge applies to these services, whether provided on the same date or a different date than the wellness visit .
We hope to help you get the most from your Medicare wellness benefits. Please contact us with any questions.
Develop scheduling protocols
Since the AWV has a lot of components, it may take generous amounts of both staff and physician resources to provide the service. Taking some time to determine how these appointments best fit into your existing schedule and to create a scheduling protocol should save more time and frustration later. For example, do you want to schedule these appointments on certain days of the week, in the morning with patients fasting in anticipation of lab testing, or after specified tests have been ordered and results charted? You should also consider whether you will schedule both an AWV and a problem-oriented evaluation and management service for the same appointment and advise staff on how to address this issue with patients.
Do pre-visit planning
Your staff will need to verify up front not only the patient's Medicare Part B effective date but also whether the patient has received an AWV from any physician in the last 11 months. Otherwise, your service may be denied, leaving the patient with an unexpected bill.
The same verification will be needed for other preventive services that you might advise patients to receive in conjunction with the AWV. It may be ideal to have staff note the last date of these preventive services on an AWV documentation form in advance of the visit. This information can be obtained in several ways. A chart review or phone interview could be conducted soon after the visit is scheduled to gather a pre-visit history. More reliably for purposes of payment, staff could use an electronic insurance inquiry or Internet eligibility service to verify eligibility for preventive services. Whatever the approach, having this information before the visit will help you to determine which preventive services are needed and whether the patient is eligible to have these paid for by Medicare.
A pre-visit history can also identify whether the patient needs tests such as the cardiovascular and diabetes screening blood tests, which should be completed prior to the AWV to allow discussion of the results at the encounter. Additional considerations might include whether the patient should be instructed to not eat before the visit and whether occult blood test cards should be provided before the visit with instructions for the patient to return the cards at his or her appointment (since compliance with this test is low, you might ask that the patient bring the cards to the visit, whether completed or not).
Define the encounter
It is important to work through the required elements of the AWV, define each step, determine which staff will perform each step and identify any tools or resources needed. The annual wellness visit encounter form published in the January/February 2011 issue of FPM is a useful reference for this purpose.
History . To begin with, you'll have an extensive patient history and medication list to complete. Do you want to send a form to the patient for completion prior to the visit, conduct phone interviews prior to the visit, or have ancillary staff gather this information when the patient arrives for the appointment? However you approach it, this information can be documented and ready for you to review with the patient when you enter the exam room.
Screening for depression, functional ability and safety . Depending on the scope of practice and skill levels of your staff, the depression screening and the functional ability and safety screening may also be conducted by ancillary staff in advance of your visit with the patient.
Cognitive assessment . The assessment that the Centers for Medicare & Medicaid Services (CMS) envisioned when establishing the AWV requirements will be based on your interactions with the patient and input from family members or other caregivers present during the encounter. Gathering impressions from the staff who obtained the patient history or performed other elements of the encounter may also be beneficial. Documentation should include evidence of assessment, such as notations of the patient's general appearance, affect, speech, memory and motor skills. You may also wish to use an instrument such as the Mini-Cog, the Montreal Cognitive Assessment or the Mini-Mental State Exam.
Screening for hearing and vision loss . This component may be met by questioning the patient or caregiver about the patient's hearing. You may wish to conduct the whisper test. A visual acuity test should also be performed.
The remainder of the physical exam . Medicare regulations do not set forth requirements for other aspects of the physical exam. These are for you to determine based on the patient's age, gender, level of physical activity, last exam and known medical conditions. One decision you will have to make is whether to perform the clinical breast and pelvic exam at the same encounter as the AWV. They are separately defined Medicare benefits, but at least one Medicare contractor has said that, if both services are provided at the same encounter, the fee for performing the breast and pelvic exam should be carved out of the fee for the AWV (equivalent to not charging for the breast and pelvic exam but reporting it). You may wish to clarify this with your Medicare contractor up front.
Plan for efficient follow-up care
Patient risks and problems identified through the history, screening and exam must be addressed by continuing interventions already in place, ordering further screening or recommending new interventions. Your documentation should reflect your discussions of the risks and benefits of each of these. Referrals to other providers and community services should be documented as appropriate. A preventive service plan for the next five to 10 years should be developed, and a screening plan or checklist should be provided to the patient following the visit. Discussing advance directives or surrogate decision makers may also be appropriate but is not required.
You and your staff can save significant time by establishing protocols for responding to positive screening results and identifying resources you'll use for follow-up. You'll want to consider questions like these:
If a patient gives a positive response to both questions in the simple depression screening, will you be prepared to conduct further screening such as PHQ-9? If depression is diagnosed, how will you address it?
If a patient has been recently injured in a fall or has other indications of impaired functional ability or safety hazards in his or her home, how will these be addressed?
Can you implement standing orders for influenza and pneumococcal vaccinations?
Will your practice provide brief behavioral health, medical nutritional and perhaps even minimal physical therapy services as part of the AWV? If you don't offer these services, are you prepared to make referrals? Note that although Medicare contractors still pay separately for these services, it is likely that these codes will soon be bundled with codes for the AWV. If your practice includes licensed professionals who provide these services, you may wish to bring the patient back on a different date to continue this care.
What patient handouts may be most helpful, and where will you find them?
What community services would benefit your patients (for example, meals and transportation services for the elderly), and can you share this information easily?
You likely have many of these resources already, and the resource list below includes links to additional screening tests, tools and information that can facilitate AWV care. If staff are trained in your practice protocols and can easily access information at the encounter, care management and coordination will be easier. See “ The annual wellness visit: Putting it all together ” for a vignette that describes an efficient annual wellness visit.
THE ANNUAL WELLNESS VISIT: PUTTING IT ALL TOGETHER
Jim Smith calls his doctor's office to ask about the free Medicare physical he's heard about. Sally at the scheduling desk explains that an annual wellness visit (AWV) is paid in full by Medicare but that there may be other charges if the doctor addresses problems or orders certain testing. She checks the effective date of Part B coverage on the file copy of Mr. Smith's Medicare card noting that he is eligible for the AWV. Mr. Smith accepts an appointment with Dr. Williams for a time designated for preventive visits. Sally mails Mr. Smith information on what to expect and what to bring to the visit and history forms for him to complete and return.
Ann in the billing office verifies Mr. Smith's eligibility using the Medicare contractor's online system. She confirms the effective date, deductible remaining and next eligibility dates for covered preventive services. She forwards these details to Kelly, the LPN who will develop a pre-visit plan.
Before Mr. Smith's visit, Kelly calls him to verify his appointment, discuss his expectations and provide information. Kelly explains that the Medicare eligibility records indicate he has not received a pneumococcal vaccination but did receive an influenza vaccination several months ago. She also asks whether he has received the herpes zoster vaccine covered under Medicare Part D. Kelly explains Dr. Williams' recommendation and the importance of these vaccines. Mr. Smith agrees, so Kelly plans for doses to be available at the visit pending verification of the herpes zoster vaccination coverage. Kelly asks if he wishes to address specific medical concerns at this visit. He asks if he can get refills on the GERD medication prescribed two months ago, noting it has had good results. Kelly makes a note to ask Dr. Williams.
Kelly meets briefly with Dr. Williams on the morning of Dr. Smith's visit to review the day's visits. Dr. Williams confirms that the vaccines should be given and approves the refill.
When Mr. Smith arrives for his appointment, Sally greets him and asks for the completed history forms, which she scans into the electronic health record (EHR) system.
Kelly escorts Mr. Smith to an exam room where she reviews his history, adding this and further information to the EHR's AWV template. She also reviews each medication with Mr. Smith, noting whether he is taking each as prescribed.
She then inquires about falls in the past year, noting none but discussing safety features. Mr. Smith notes that a home health agency that cared for his wife provided a safety checklist last year and he did install rails in the bathroom.
Next Kelly obtains and notes measurements including blood pressure, height, weight, BMI, pulse and respiration. She proceeds with a simple two-question depression screening, which is negative. She conducts a simple gait assessment in the hall and documents the results. She also asks Mr. Smith to read an eye chart posted in the hall and documents this as well. She asks about his last eye appointment. He has not had one for several years because new glasses seemed unaffordable. Kelly offers a patient handout that lists vision center discounts for AARP and AAA members.
Kelly confirms that Mr. Smith still wishes to receive vaccinations. She reviews the vaccine information sheets with Mr. Smith and informs him about his Part D plan's coverage of the herpes zoster vaccine. She then administers the vaccines and records them in the EHR.
Dr. Williams reviews Kelly's notes and Mr. Smith's lists of medications and other health care providers. He asks Mr. Smith's reason for taking a garlic supplement and then discusses the pros and cons with him. Dr. Williams explains the need for vision care to detect changes or early signs of disease, and Mr. Smith agrees to make an appointment soon. Dr. Williams notes a negative response to questions about hearing difficulty and steps behind the patient to whisper, “Can you hear me now?” Mr. Smith clearly hears and chuckles. No one accompanied Mr. Smith to this visit, so Dr. Williams does not get family input but sees no evidence of cognitive deficit; Mr. Smith has normal appearance, evidence of good hygiene and ably counts backwards from 100 by 7s.
Because Mr. Smith was seen just two months earlier and reports no new problems, Dr. Williams only examines his eyes, ears, nose and throat and listens to his heart and lungs.
Having completed the history, screenings and exam, Dr. Williams turns to discussions of health risks, current interventions and recommendations. Mr. Smith's BMI indicates that exercise and dietary changes are recommended. They discuss these, and Dr. Williams provides a patient handout on strengthening and balance exercises that they discuss.
Dr. Williams reminds him to get a flu shot in the fall and notes this on the recommendations list that Mr. Smith will take with him. Kelly previously noted the dates of Mr. Smith's last PSA test, colonoscopy and cholesterol check. Dr. Williams recommends repeating these at intervals that he specifies in his notes. He orders a fasting glucose test to screen for diabetes since Mr. Smith qualifies for this Medicare benefit based on his weight and hypertension.
Mr. Smith indicates understanding of the prevention plan and other materials provided during the visit, so Dr. Williams thanks him for coming in and then asks Kelly to schedule Mr. Smith's fasting glucose test. Kelly schedules the test and assures Mr. Smith that the doctor ordered his prescription refill. He wants to schedule an ophthalmology visit on his own, so she provides information. She shows him to the check-out desk, where he is told there is no charge for today's visit and is reminded to fast prior to his upcoming diabetes screening test.
The final step in providing the AWV is to get paid for all you do. Be sure your documentation is complete and signed. Establish processes to capture ancillary services such as lab testing or vaccines administered. Many have asked what ICD-9 code should be reported, but Medicare has not specified a code. Codes in the V70 series should suffice for the primary diagnosis, with additional codes for problems identified and addressed or any preventive services delivered.
These tips should ease the delivery of the AWV. If you have tips of your own, please share them with FPM . With some preparation and teamwork, this service can be one that is beneficial to both patients and physicians.
Articles on preventive care for older patients
Answers to Your Questions About Medicare AnnualWellness Visits (FPM)
What You Need to Know About the Medicare PreventiveServices Expansion (FPM). Features an annual wellness visit encounter form
The Geriatric Assessment (AFP)
Weight loss and exercise
Americans in Motion – Healthy Interventions (AIM-HI)
First Step to Active Health for Providers
New Health Partnerships self-management resources
Cognitive assessment
Mental Status Examination in Primary Care: A Review (AFP)
Soapnote online calculators (with printable results)http://www.soapnote.org/mental-health/folstein-mini-mental-status-exam/ and http://www.soapnote.org/elder-care/mini-cog-screen-for-dementia/
Montreal Cognitive Assessment
Society for Hospital Medicine mini-cog form
Depression screening and treatment
Depression: What You Should Know (AFP patient handout)
PHQ-9 depression screening tool
U.S. Preventive Services Task Force recommendation
Patient safety
Ambulatory Devices for Chronic Gait Disorders (AFP)
Gait and Balance Disorders in Older Adults (AFP)
Prevention of Falls in Older Patients (AFP)
Vision Loss in Older Persons (AFP)
AARP home safety checklist
Assessing and Counseling Older Drivers (AMA)
Tobacco cessation
AAFP Ask and Act Practice Toolkit
Preventive service recommendations
AHRQ Preventive Service Selector
2011 recommended adult immunization schedule
Referrals to other providers and resources
American Dietetic Association – Registered Dietitian Finder
American Physical Therapy Association – Find a PT
Eldercare Locator
Full Circle of Care
National Council on Aging
Hughes C. What you need to know about the Medicare preventive services expansion. Fam Pract Manag . January/February 2011:22–25. https://www.aafp.org/fpm/2011/0100/p22.html .
Hughes C. Answers to your questions about Medicare annual wellness visits. Fam Pract Manag . March/April 2011:13–15. https://www.aafp.org/fpm/2011/0300/p13.html .
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Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.
Medicare Annual Wellness Exam: What You Need to Know
- by Lisa Eramo, MA
- January 12, 2024
- Reviewed by John Krahnert
If you have Medicare Part B insurance, you may have heard about the Medicare annual wellness exam , which is a free benefit. However, you may still have questions about the purpose of the exam and how it can help you. For instance, it’s important to know that the annual wellness exam is covered in full by Medicare, but it’s not the same as a routine physical exam , which isn’t covered by Medicare.
This article answers some of the most common questions about the Medicare Annual Wellness Visit (AWV) so that you can make the most of this important yearly health checkup.
What is the purpose of the Medicare annual wellness exam?
The purpose of the Medicare annual wellness exam is to develop or update your personalized prevention plan and perform a health risk assessment .
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It’s an opportunity for you and your primary care doctor to touch base about preventable health diseases and keep you on the right track toward living a healthy and active lifestyle.
What’s included in the Medicare annual wellness exam?
First, your primary care doctor will ask you to fill out a questionnaire called a Health Risk Assessment that evaluates your health status, frailty and physical functioning.
It also assesses other aspects of your health, such as:
- Psychosocial risks (e.g., depression/life satisfaction, stress, anger, loneliness/social isolation, pain, and fatigue)
- Behavioral risks (e.g., tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety and home safety)
- Activities of daily living (e.g., dressing, feeding, toileting, bathing, grooming, physical ambulation including balance and your risk of falls)
After reviewing this assessment, your primary care doctor will likely provide a variety of other services and talk to you about preventable health diseases.
In particular, they will:
- Review your medical and family history
- Develop or update a list of your current providers and prescriptions
- Take routine measurements such as height, weight and blood pressure
- Assess for any cognitive impairment
- Talk to you about screenings, vaccinations and other preventive services .
They may also provide advance care planning , which refers to planning for care you would receive if you became unable to speak for yourself.
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1-800-557-6059 | TTY 711, 24/7
When am I eligible for the Medicare annual wellness exam?
You’re eligible as soon as you’ve had Medicare Part B for 12 months . At that point, you can get a yearly wellness exam once every 12 months thereafter.
Does Medicare require a wellness exam?
Medicare does not require a wellness exam; however, it’s still important to take advantage of this important benefit. That’s because the wellness exam gives you an opportunity to get personalized health advice.
You can talk about any healthcare concerns you may have, ask questions about your medications, talk about changes to your diet or exercise routine and more.
Is the Medicare wellness exam free?
Yes, the Medicare annual wellness exam is a Medicare-covered service as long as your primary care doctor accepts Medicare. It won’t cost you anything unless your doctor performs additional tests or services during the same exam. If they do, you may owe a coinsurance or copayment depending on the service provided.
What’s the difference between a Medicare annual wellness exam and the Initial Preventive Physical Exam?
The Initial Preventive Physical Exam (sometimes referred to as the “Welcome to Medicare” exam) is a one-time exam also focused on preventable health diseases that occurs within the first 12 months of your Medicare Part B coverage.
Many of the services you receive during the Welcome to Medicare visit are the same as ones you get during the annual wellness exam (e.g., medical history review, personalized prevention plan and social health history review), and like the wellness exam, there is no cost to you if your doctor accepts Medicare.
What’s the difference between a Medicare annual wellness exam and a routine physical exam?
A routine physical exam is an exam that is not related to a specific illness, symptom, complaint or injury.
A routine physical exam is not a Medicare-covered service, meaning you will typically owe 100% of the amount due.
What can I do to prepare for the Medicare annual wellness exam?
There are several ways you can prepare for this exam. For example, you can write down all medications (and doses) you take or put them in a bag to bring with you to the appointment. This includes prescriptions, non-prescriptions, vitamins, supplements and herbal medications. Also write down your family medical history so you don’t forget anything.
Likewise, you can compile a list of all the healthcare providers you see, including their full names, addresses and phone numbers.
Another helpful way to prepare is to jot down any health-related questions or concerns in advance. You can hand the paper directly to your physician, or you can read the questions aloud. Bring a notebook with you to write down important information and advice.
If your appointment is via telehealth , be sure you know the steps to log onto the telehealth platform, and have your computer or mobile device fully charged and ready to go.
Make an appointment with your doctor today for your Medicare Annual Wellness Visit, or call a licensed insurance agent to learn about additional preventive care benefits that may be available in some Medicare Advantage (Medicare Part C) plans.
Find Medicare Advantage plans in your area
Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Lisa Eramo is an independent health care writer whose work appears in the Journal of the American Health Information Management Association, Healthcare Financial Management Association, For The Record Magazine, Medical Economics, Medscape and more.
Lisa studied creative writing at Hamilton College and obtained a master’s degree in journalism from Northeastern University. She is a member of the American Health Information Management Association, American Academy of Professional Coders, Society of Professional Journalists, Association of Health Care Journalists and the American Society of Journalists and Authors.
Lisa currently resides in Cranston, Rhode Island with her wife and two-year-old twin boys.
Website : LisaEramo.com
LinkedIn : Lisa Eramo
Twitter : @Lisa_Eramo
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Medical Report: Medicare’s Annual Wellness Visit isn’t your average physical exam
PHILADELPHIA (KYW Newsradio) — One of the most overused health entitlements in the Medicare program is the Annual Wellness Visit (AWV). Most people think that an AWV is a physical exam, but Medicare says the AWV is anything but.
It’s a chance for people on Medicare and their doctors to review a health risk assessment, which can be everything from your medical and family history to a review of your prescriptions and advance care planning.
Despite the name, it is not a physical exam. Nevertheless, it is worth going over the paperwork with a professional.
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Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly "Wellness" visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly "Wellness" visit isn't a physical exam. Your first yearly "Wellness" visit can't take ...
All Medicare Advantage Plans are required to offer annual wellness visits for their members. A nurse or nurse practitioner reviews your health status and helps you plan for health and wellness needs. In most cases, the annual wellness visit will be followed by a separate medical visit with your primary care professional to close any health care ...
Initial Preventive Physical Exam. The initial preventive physical exam (IPPE), also known as the "Welcome to Medicare" preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE per lifetime if it's provided within the first 12 months after the patient's Part B coverage starts. IPPE Components.
The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical. Also, this service is similar to but separate from the one ...
During a Medicare Annual Wellness Visit, the nurse will: Evaluate your fall risk. Measure your height, weight and blood pressure. Offer referrals to other health education or preventive services. Provide information related to voluntary advance care planning. Screen for cognitive impairments like dementia. Screen for depression.
Introduced in 2011, the Medicare Annual Wellness Visit is a free benefit focused on health promotion and preventive care. During your visit, you and your provider will create a personalized prevention plan that can help you avoid injury, illness, and disease. The Medicare Annual Wellness Visit is 100% covered by Medicare Part B and can be ...
Taking stock of your health with an annual wellness visit can be an important and underutilized part of one's Medicare experience.
With Medicare Part B, you can get a wellness visit once a year at no cost to you. Check to make sure the doctor or nurse accepts Medicare when you schedule your appointment. If you get any tests or services that aren't included in the yearly wellness visit (like an extra blood test), you may have to pay some of those costs.
Published July 14, 2022. The Medicare wellness visit is an annual visit with your primary care provider to create a personalized plan to help prevent disease and disability, based on your health and risk factors. This free Medicare wellness visit is covered once every 12 months. You become eligible after you have been enrolled in Part B for a ...
Annual Wellness Visits are yearly appointments with your primary care provider. An AWV is not a routine physical and usually doesn't involve lab work or hands-on testing. Instead, it's more like a planning session to update a custom preventive care plan to meet your needs. Annual Wellness Visits are different from an Initial Preventive ...
Medicare Visit and the Annual Wellness Visit? Your first Annual Wellness Visit has a lot in common with the Welcome to Medicare Visit. The main difference is the timing. If you are newly enrolled in Medicare, you are eligible for the one-time Welcome to Medicare Visit only within the first year. The Annual Wellness Visit can take place every 12 ...
is intended for Medicare Fee-For-Service physicians, providers, suppliers, and other health care professionals who furnish or provide referrals for and/or file claims for the Medicare-covered preventive benefit discussed in this brochure. As a result of the Affordable Care Act, Medicare can now cover an Annual Wellness Visit (AWV), providing
The Annual Wellness Visit is a yearly checkup that Medicare covers for most enrollees. The visit is intended to help people with Medicare maintain good health by catching signs of disease early on and taking a preventive approach to healthcare. The Annual Wellness Visit, which was created as part of the Affordable Care Act in 2010, is a recent ...
Fortunately for Medicare recipients, an annual wellness visit is included with Part B coverage. During a wellness visit under Medicare, patients will have the chance to discuss any changes to existing conditions that have previously been documented, and the physician will review medical history to ensure that the patient is still in need of any ...
Typically, your first annual wellness visit—which occurs after your 65th birthday—is more comprehensive. It may include labs and an electrocardiogram and will verify that you are up to date on vaccines. After your initial visit, you will continue to have yearly visits where you can discuss problems, concerns and other necessary screenings.
The Annual Wellness Visit (AWV) can be added to your small practice with existing staff and minimal impact to your operations. The AWV identifies care gaps and preventive services, increases ...
In addition, the AWV is well reimbursed. The 2017 Medicare allowances for HCPCS codes G0438 (initial AWV) and G0439 (subsequent AWV) are $173.70 and $117.71, respectively. By comparison, the rate ...
Medicare does pay for a wellness visit once a year to identify health risks and help you to reduce them. At your wellness visit, our health care team will take a complete health history and ...
Yes, the Medicare annual wellness exam is a Medicare-covered service as long as your primary care doctor accepts Medicare. It won't cost you anything unless your doctor performs additional tests or services during the same exam. If they do, you may owe a coinsurance or copayment depending on the service provided.
Scheduling patients for a wellness visit removes the time constraints of trying to assess the patient's preventive needs during a problem-oriented visit, as well as offer providers the opportunity to be reimbursed for this important work. There are three types of Medicare Advantage wellness visits: Initial preventive physical exam (IPPE)
The Annual Wellness Visit (AWV) is an added opportunity for providers to comprehensively review and screen the patient's health status at no cost. However, Medicare provides generous reimbursement for this service which not only helps the provider financially, but also helps with improving clinical outcomes and quality measure performance.
Medicare Benefit: Annual Wellness Visits Covered. Back on January 1, 2011, Medicare started to provide coverage for Annual Wellness Visits. This benefit was included in the Affordable Care Act of 2010. Medicare has two HCPCS codes for these wellness visits for medical billing purposes. The codes are G0438 and G0439.
It's time to rethink the Medicare annual wellness visit. I n 2011, the Centers for Medicare and Medicaid Services created the annual wellness visit (AWV), a new visit type with no cost to ...
PHILADELPHIA (KYW Newsradio) — One of the most overused health entitlements in the Medicare program is the Annual Wellness Visit (AWV).Most people think that an AWV is a physical exam, but ...