What Is the Medicare Annual Wellness Visit?

Updated on: October 6th, 2020

Reviewed by Louise Norris

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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.

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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.

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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

Actionable Advice

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
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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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  1. 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).

     

  2. 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).