What is a Medicare Wellness Visit?
A Medicare Annual Wellness Visit (AWV) is a yearly appointment covered by Medicare Part B focused on preventive health planning. It's designed to help you and your healthcare provider develop or update a personalized plan to maintain your health and prevent illness, based on your current health status and risk factors. This visit is not the same as a traditional physical exam and does not typically involve a hands-on examination or treatment for specific medical conditions. If medical issues requiring treatment are discussed, they may be handled in a separate appointment, potentially incurring additional costs.
Key Components of a Medicare Wellness Visit
During a Medicare wellness visit, the focus is on gathering information to create your personalized prevention plan. Key elements typically include:
- Completing a Health Risk Assessment (HRA) which covers your health status, injury and behavioral risks, and urgent health needs.
- Reviewing and updating your medical and family health history.
- Listing all current healthcare providers and medications, including supplements.
- Taking routine measurements such as height, weight, and blood pressure.
- Screening for cognitive impairment.
- Assessing your functional ability and safety, including fall risk.
- Providing personalized health advice and referrals to health education programs.
- Creating a preventive screening schedule for the next 5-10 years.
- Discussing advance care planning, if you choose.
What are the eligibility requirements?
To be eligible for an Annual Wellness Visit, you must meet specific Medicare Part B criteria:
- You must have been enrolled in Medicare Part B for over 12 months.
- You must not have had an Annual Wellness Visit in the past 12 months.
- You must not have had the "Welcome to Medicare" visit (Initial Preventive Physical Exam) within the first 12 months of your Part B coverage.
Medicare Wellness Visit vs. Annual Physical: A Comparison
It's important to understand how a Medicare wellness visit differs from a standard physical exam, as Medicare covers the wellness visit but generally not routine physicals.
| Feature | Medicare Wellness Visit (AWV) | Annual Physical Exam |
|---|---|---|
| Primary Goal | Proactive health planning and prevention of future illness and disability. | Comprehensive, hands-on health assessment to diagnose and treat current health concerns. |
| Covered Cost | 100% covered by Medicare Part B with no out-of-pocket costs if the provider accepts assignment. | Generally not covered by Original Medicare; costs are typically the patient's responsibility unless covered by a Medicare Advantage plan. |
| Key Components | Health Risk Assessment, medical history review, medication list, routine measurements, cognitive/functional screenings, personalized prevention plan, advance care planning. | Hands-on physical examination, checking reflexes, listening to heart/lungs; may include lab tests. |
| Focus | Discussion-based; creates a blueprint for maintaining wellness. | Examination-based; focuses on detecting and addressing current health issues. |
| Scope | Preventive services and identification of risk factors. | Diagnosis and treatment of new or existing conditions. |
| Eligibility | Once every 12 months after the first year of Medicare Part B. | Varies by insurance plan; not a Medicare-covered benefit. |
What to Expect During Your Visit
Your wellness visit is primarily a discussion. You'll likely spend time going over a Health Risk Assessment and your medical history with a healthcare professional.
To make the most of your visit, be prepared with:
- A list of all your medications, vitamins, and supplements with dosages.
- Your medical and family health history.
- A list of other healthcare providers you see.
- Any advance directive documents you have.
You will leave with a written prevention plan and a schedule of recommended screenings and vaccinations.
The "Welcome to Medicare" Visit: A Precursor
New Medicare Part B beneficiaries are eligible for a one-time "Welcome to Medicare" visit (Initial Preventive Physical Exam) within their first 12 months of coverage. This visit is also a free preventive service. It's similar to the AWV but may include a baseline physical exam and, if needed, an electrocardiogram (ECG). You can schedule your first Annual Wellness Visit 12 months after your "Welcome to Medicare" visit, and subsequent AWVs every 12 months thereafter.
Conclusion: The Value of the Medicare Wellness Visit
The Medicare wellness visit is a valuable preventive benefit. It serves as a tool for proactive health planning and risk identification, distinct from a diagnostic physical exam. Utilizing this yearly appointment allows you to collaborate with your provider to develop a personalized prevention strategy, ensuring you receive necessary screenings to support your health. This covered service is a key part of managing your health under Medicare and comes at no out-of-pocket cost when seeing a participating provider. Understanding what is considered a Medicare wellness visit helps you effectively utilize this important benefit.
