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
What’s included in a Medicare Annual Wellness Visit?
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.
What is not included in a Medicare Annual Wellness visit?
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
Are Medicare Annual Wellness visits covered?
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.
What’s the difference between a Medicare Annual Wellness Visit and a physical exam?
Both are important for maintaining your health, but they’re unique in many ways. Here's a breakdown of how they’re different.
Medicare Annual Wellness Visit
- Purpose: Focuses on preventive care and creating or updating a personalized health plan.
- Coverage: Fully covered by Part B (no out-of-pocket costs if your provider accepts assignment).
- What’s included:
- Review of your medical and family history
- Health risk assessment (lifestyle, diet and exercise habits)
- Vital measurements (height, weight, blood pressure)
- Cognitive assessment to check for memory or thinking issues
- Personalized prevention plan, including recommended screenings and vaccines
- Optional advance care planning
Physical exam
- Purpose: A hands-on evaluation of your overall physical health.
- Coverage: Not covered by Medicare unless it’s medically necessary. You may have to pay out-of-pocket or use other insurance.
- What’s included:
- Full physical exam (checking your heart, lungs, abdomen, reflexes and more)
- Evaluation of current health issues
- Discussions about health concerns
- Diagnostic tests if needed (blood work, urinalysis)
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.
What is the difference between a Medicare Annual Wellness Visit and 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.2
What should I bring to my Annual Wellness Visit?
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
Learn more about Medicare
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 .