What Is the Medicare Annual Wellness Visit?

The Medicare Annual Wellness Visit (AWV) is a yearly appointment where you meet with your healthcare provider to create or update a personalized prevention plan to stay on top of your health. Medicare does not cover routine physical exams.

You can take advantage of AWVs once you’ve had Medicare Part B for at least 12 months. After that, you’re eligible for the visit once a year.

The Importance of Preventative Care

You might have heard the classic line, “An ounce of prevention is worth a pound of cure.” And it’s true. Early detection of certain diseases, such as diabetes and cancer, can often mean the difference between life and death. For this reason, the Medicare Annual Wellness Visit is crucial because it establishes a personalized prevention plan to help you catch disability, illness, and chronic diseases early on.

And, since Medicare covers one wellness visit per year with your healthcare provider, there’s no reason not to take advantage of it.

How Does the Medicare Annual Wellness Visit Work?

During the Medicare Annual Wellness Visit, you and your doctor will comprehensively review your health, risk factors, and potential preventive services.

Eligibility

There are two main requirements to be eligible for a Medicare Annual Wellness Visit:

The appointment is available for anyone enrolled in Medicare Part B for longer than 12 months.
You must not have received an AWV in the past 365 days.

You will not have to pay for the visit if you meet these requirements and your healthcare provider accepts Medicare assignment.

How to Prepare For the Annual Wellness Visit

To get the most out of your AWV, prepare the following before heading to your appointment:

Your medical records, including immunization records and any recent health changes
Your family medical history
Your insurance card and ID
A full list of your current medications and supplements
A complete list of your current healthcare providers and suppliers
Any questions or concerns you’d like to discuss

What’s Included in the Annual Wellness Visit

During the annual check-up, you can expect an evaluation of your well-being, focusing on preventative measures and discussing your health goals.

In your appointment, your healthcare provider may

Take your measurements, like height, weight, and blood pressure
Review your medical history and current prescriptions
Order recommended immunizations or tests
Perform a cognitive assessment to look for signs of dementia like Alzheimer’s disease.
Review your functional ability
Review your preventative care needs and identify risks or conditions

What’s Not Included

While AWVs offer a relatively comprehensive health assessment, they do not cover everything. Here’s what is not included in the visit:

Diagnosis of new health issues
X-rays or lab tests for existing or new conditions
Medication prescription changes
Management of chronic medical issues like diabetes or asthma
Treatment of existing health problems
Exams or immunizations required for work, immigration, travel, or other types of insurance

How Much Does the Medicare Annual Wellness Visit Cost?

If you’re eligible for an AWV and your healthcare provider accepts Medicare assignment, Medicare Part B will cover the visit at 100% of the Medicare-approved amount. In other words, you are not responsible for any out-of-pocket costs like coinsurance or deductible — provided that you pay your monthly Part B premium each month.

Medicare Advantage Plans must provide the same coverage as Original Medicare. So, MA plans will also fully cover AWVs as long as you visit an in-network provider and meet Medicare’s eligibility requirements.

If your healthcare provider discovers an existing or new medical condition during your AWV, they may need to investigate further and treat the issue. In this case, Medicare may bill you for additional services, like diagnostic care, which is not included in the annual visit. Typically, you’re responsible for a 20% Part B coinsurance for most covered services

Annual Wellness Visit vs. Welcome to Medicare Appointment

Both the AWV and the Welcome to Medicare Appointment are free for qualified beneficiaries and prioritize preventive health, but they differ in timing and frequency. You’re eligible for the Medicare Wellness Visit annually after you’ve been enrolled in Medicare for at least 12 months.

However, the Welcome to Medicare Visit is a one-time assessment only available for new enrollees within the first 12 months of enrollment. Its primary purpose is to establish a baseline for your health by assessing your medical history, current health status, and risk factors.

The Annual Wellness Visit builds on the baseline established in the Welcome to Medicare Appointment. Both types of doctor appointments are important parts of maintaining your health, but they are not the same.

All in All

The Medicare Annual Wellness Visit is an invaluable opportunity to assess your health, discuss preventive measures, and create a tailored plan for your overall well-being. Plus, it comes at no cost since it’s fully covered by Medicare Part B for eligible beneficiaries. If you have not already, take advantage of this benefit and prioritize your health by scheduling your Annual Wellness Visit.

Frequently Asked Questions

For Medicare to cover your Annual Wellness Visit, your primary care physician must accept Medicare as full payment. You cannot visit any doctor or healthcare provider for a free AWV. To determine whether your physician accepts Medicare, call their office directly or contact Medicare at 1-800-633-4227. You can also use the Medicare Care Compare tool to check.

Having private insurance alongside Medicare would not directly affect your eligibility for the Annual Wellness Visit since AWV is a Medicare-covered benefit. However, if your healthcare provider orders additional screenings or services that Medicare does not fully cover during the AWV, your private health insurance could help shoulder some of the cost.

No. You will not face any penalties or repercussions from Medicare if you skip or refuse the Annual Wellness Visit. AWV is voluntary and not mandatory and is meant to help uncover potential health conditions early on. Though skipping or refusing AWV will not incur negative consequences, it’s still recommended that you take advantage of it.

If you’ve recently experienced significant health changes, you may want to schedule a dedicated appointment rather than waiting for the annual wellness visit since you can only use the AWV every 12 months. However, everyone’s situation is different. Always contact your doctor’s office to clarify the most appropriate action to address your specific health concerns.

Yes. A family member or caregiver may accompany you on your Medicare Annual Wellness Visit. But it’s important to note that, though they can accompany you, they will not receive a complimentary wellness check simply because of your eligibility.

Depending on your situation and healthcare provider, you can expect a Medicare Annual Wellness Visit to last anywhere from 45 to 60 minutes. While a standard appointment may address specific health concerns or acute issues, the purpose of AWV is to comprehensively assess your overall health and create a personalized prevention plan. For this reason, AWVs could take longer than regular doctor appointments.

Understanding the Medicare Annual Wellness Visit