Medicare Annual Wellness Visit

Regular health checkups are a great way to plan ahead and may help maintain your health. If you have Medicare, you could be eligible for a covered Annual Wellness Visit (AWV) every 12 months with your primary care provider.

Let’s explore the details of a Medicare Annual Wellness Visit.

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 Physical Exam (IPPE). Also known as the “Welcome to Medicare Visit,” an IPPE is a 1-time benefit that Medicare covers within the first 12 months you have Medicare Part B. During your IPPE, you’ll fill out your first Health Risk Assessment (HRA) so your care provider can start a plan to maintain or improve your health and help prevent disease.

After your IPPE, your next appointment will be your First Annual Wellness Visit. Each yearly appointment after that is known as a Subsequent Annual Wellness Visit.

Note: You do not need a Medicare Advantage Plan (Part C) to qualify for an AWV.

You’re eligible for a Medicare Annual Wellness Visit if:

• You’ve been enrolled in Medicare Part B for more than 12 months
• You haven’t received an Annual Wellness Visit in the past 12 months
• It’s been more than 12 months since your IPPE

Your provider may ask you to complete a Health Risk Assessment. The HRA will help your provider understand your needs and create or update a personalized prevention plan to help you maintain your health.

Your provider may also:

• Review your current prescriptions and providers
• Update your medical and family history
• Order recommended tests and immunizations
• Measure height, weight, BMI and blood pressure
• Discuss activities of daily living (ADLs) such as dressing, feeding, bathing and toileting

Another key part of an AWV is 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 for a more thorough review. The separate visit will check for conditions like dementia, depression, anxiety or delirium. If needed, your provider will develop a care plan.

Annual Wellness Visits do not include:

• A physical exam
• Diagnosing of new conditions
• Treatment of existing or new conditions
• Lab tests or X-rays for existing or new conditions
• Prescribing or making medication changes

You pay nothing (no deductible or coinsurance) if your doctor is a participating provider. Part B covers 100% of the Medicare-approved amount.

However, Medicare doesn’t cover additional tests or services during an AWV. If your doctor or provider performs additional tests or services during the same visit, you’ll likely have to pay the full amount of the test, including coinsurance and the Part B deductible.

Note: Medicare Advantage plans (Part C) are required to cover Annual Wellness Visits without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.

Here’s a quick chart to show the differences between a Medicare Annual Wellness Visit and a routine physical exam:

Does Medicare cover annual physicals?

No, Original Medicare doesn’t cover annual physical exams. However, some Medicare Advantage plans offer wellness benefits that may include annual physicals. To see if an annual physical is covered, check the Explanation of Benefits or contact the plan carrier.

To get the most out of your AWV, gather up these essentials:

• Medical records, including immunization records
• Detailed family health history
• Full list of medications and supplements
• Full list of current providers and suppliers
• A list of questions or concerns

For information on the costs, coverage and types of Medicare plans, check out our library of Medicare articles. To see Medicare plans in your area with their premiums, copays and participating doctors and pharmacies, visit our Humana Medicare plans page.