Medicare Annual Wellness Visit
Key Takeaways
Medicare covers one Annual Wellness Visit (AWV) every 12 months, at no cost, for Medicare Part B beneficiaries .
Medicare’s AWV includes a Health Risk Assessment (HRA) and a Personalized Prevention Plan (PPP) to help beneficiaries prepare for the future.
Medicare also covers one Initial Preventive Physical Examination (IPPE) within 12 months of joining Medicare Part B .
What is Included in an Annual Medicare Wellness Visit?
Medicare’s Annual Wellness Visit (AWV) is a preventive service in which your doctor assesses your current health to create a personalized health plan for your future. [i] Medicare Part B covers an AWV once every 12 months. During your AWV, your doctor will gather information about the following components of your health:
- Your medical history
- Your family history
- Your current medications and supplements
- Your ability to perform daily activities
- Your safety level, including fall risk, hearing impairment, and safety at home
- Your current medical providers
Your doctor will also perform a series of assessments and screenings, including:
- A brief physical exam, including height, weight, BMI, and blood pressure
- A cognitive function assessment
- A depression risk assessment
- A substance use disorder screening
When you visit your doctor for your AWV, they will also perform a Health Risk Assessment (HRA), which is a questionnaire that gathers information about the following subjects:
- Your mental health, including depression, stress, anger, pain, fatigue, and social activity
- Your tobacco and alcohol use
- Your physical activity
- Your nutrition habits
- Your sexual health
- Your safety inside and outside the home
- Your ability to perform activities at home, such as getting dressed
- Your ability to perform activities outside of the home, such as grocery shopping
Once you’ve had your first AWV with your doctor, you and your doctor will continue to update your information and personalized health plan at each follow-up visit.
How Much Does Medicare Pay for Annual Wellness Visit?
Medicare Part B will completely cover the cost of your AWV once every 12 months, as long as this service is performed by a provider who accepts Medicare assignment. [i] This means that you will not have to pay any out-of-pocket costs, including a copayment, coinsurance, or deductible, for this service.
You can receive additional services or tests during your Medicare wellness visit, but you will be responsible for the cost of other care not considered part of a Medicare wellness exam.
What Happens at a Medicare Wellness Visit?
When you arrive for your AWV, your doctor will likely begin the appointment by having you fill out an HRA questionnaire. Your HRA should take roughly 20-30 minutes to complete and can be filled out by yourself or with the help of your physician. After completing your HRA, your doctor will continue to collect information about your health, such as your personal and family history, your current state of health, and any other relevant information to assess your health and disease risk. Also, if you have Medicare wellness exam questions, your doctor can provide answers.
Once your doctor has finished collecting all the relevant information during your wellness visit, they can provide you with personalized advice and referrals for services to maintain or improve your health. Also, if you have Medicare wellness exam questions, your doctor can provide answers.
Is Medicare’s Annual Wellness Visit mandatory?
Medicare’s Annual Wellness Visit is not mandatory, so you are not required to book this visit with your doctor if you don’t want to. However, since Medicare does not cover annual physical exams, an AWV is one of the best ways to be proactive about your health and prepare for your future. In addition, since Medicare’s AWV covers cognitive testing, it can play a crucial role in the early diagnosis of cognitive disorders such as dementia and Alzheimer’s disease.
Can I refuse the Medicare Annual Wellness visit?
Since Medicare’s AWV is not mandatory, you can refuse this service if your doctor offers it to you. However, an AWV can help your doctor uncover potential health concerns and provide an action plan for moving forward. During your AWV, your doctor can also provide you with referrals for bloodwork, specialists, and any other Medicare-covered services you might need.
If you are enrolled in Medicare Part B, you should consider taking advantage of this no cost annual exam.
Does Medicare Pay for Yearly Physicals?
Original Medicare does not cover or pay for yearly physical exams. Instead, Medicare Part B covers one Initial Preventive Physical Examination (IPPE) within the first 12 months of signing up for Medicare Part B. [i] During an IPPE, your doctor will cover many of the same services as the AWV. However, the IPPE is considered more of a “welcome” visit for first-time Medicare beneficiaries looking to establish care.
Original Medicare does not pay for yearly physicals. Medicare Advantage plans may offer coverage for annual physical exams and other services not included under Original Medicare. Still, Medicare Advantage plans are private insurance, and the benefits provided can vary from plan to plan.
When Did Medicare Stop Paying for Annual Physicals?
You’re not alone if you’ve asked, does Medicare cover annual physicals? The answer is, no. Unfortunately, Medicare has never offered annual physical exams as part of their covered services. Medicare didn’t even offer the IPPE or AWV until they expanded their preventive services in 2011. [i] However, with the introduction of Medicare Advantage plans in 2003, some private Medicare plans may have offered services like annual physicals as part of their additional benefits.
