Medicare Annual Wellness Visit
Key Takeaways
- Medicare covers one Annual Wellness Visit (AWV) every 12 months, at no cost, for Medicare Part B beneficiariesA beneficiary is a person who enrolls in a health insurance plan and receives benefits. .
- 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 BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. .
What’s 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
- A brief physical exam, including height, weight, BMI, and blood pressure
- A cognitive function assessment
- A depression risk assessment
- A substance use disorder screening
- 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
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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. 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. Your doctor will provide personalized advice, referrals for services, and answers to any questions you have.What Medicare Advantage coverage is right for my specific situation?
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 routine yearly physical exams. Medicare Part B just covers one Initial Preventive Physical Examination (IPPE) within the first 12 months of signing up for Medicare Part B. 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.
Medicare Advantage plans may offer coverage for other services not included under Original Medicare. However, these benefits vary from plan to plan.
When Did Medicare Stop Paying for Annual Physicals?
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.Still have questions? GoHealth has the answers you need.
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FAQs
Do I need a referral to schedule an Annual Wellness Visit with my doctor?
Medicare does not require beneficiaries to have a referral for an AWV. Also, there’s not a Medicare Annual Wellness Visit template for the type of provider you visit. Your AWV can be performed by your primary care physician, or any other provider of your choice, as long as they accept Medicare assignment. If you choose to receive a wellness exam from a provider that does not accept Medicare, you will be responsible for the full cost of your visit.
Does an Annual Wellness Visit include a physical exam or diagnostic laboratory tests?
Medicare will not cover additional services, like physical exams or diagnostic laboratory testing, during your AWV. However, if you want or need additional services, your doctor may be able to provide you with a separate referral to have these services performed. Many of the additional services you might need, such as laboratory testing, are still covered by Medicare outside of the AWV.[i]
What out-of-pocket costs will I owe for my Annual Wellness Visit?
Medicare Part B will cover 100% of the costs of your AWV, as long as you receive this service from a Medicare provider. Medicare will not cover this service more than once every 12 months, so it is important not to schedule this appointment more than once per year. Also, it is important to remember that if you undergo additional services or testing during your AWV, you will be responsible for the costs of these services out-of-pocket.
Sources
- Medicare Wellness Visits. CMS.gov.
- Yearly “Wellness” visits. Medicare.gov.
- “Welcome to Medicare” preventive visit. Medicare.gov.
- CMS TO EXPAND MEDICARE PREVENTIVE SERVICES AND IMPROVE ACCESS TO PRIMARY CARE IN 2011. CMS.gov.
- Diagnostic laboratory tests. Medicare.gov.