Does Medicare Require a Wellness Visit Every Year?
Understand Medicare's annual wellness visit: is it required? Get clear answers on its purpose, eligibility, and how this preventive benefit supports your health.
Medicare offers various benefits to support the health of its beneficiaries. The Medicare Annual Wellness Visit promotes preventive care and proactive health management. Understanding this visit helps individuals navigate their healthcare options and partner with providers for long-term health.
Understanding the Medicare Annual Wellness Visit
The Medicare Annual Wellness Visit (AWV) functions as a preventive health planning tool, distinct from a comprehensive physical examination. Its primary purpose is to assess health risks and develop a personalized prevention plan. During the visit, a healthcare provider typically conducts a health risk assessment, which may involve a questionnaire about lifestyle and daily activities. The visit also includes a review of medical and family history, routine measurements like height, weight, and blood pressure, and a cognitive assessment to check for signs of dementia. Providers may also discuss advance care planning and review current opioid prescriptions.
The Annual Wellness Visit does not include a traditional physical exam, laboratory tests, or X-rays. It also does not cover treatment for new or existing conditions, diagnosis of illnesses, or medication adjustments. If a healthcare concern arises that requires diagnosis or treatment, it is addressed separately and may incur additional charges. This visit focuses on preventive strategies and establishing a health baseline.
Frequency and Eligibility for the Visit
Medicare beneficiaries are eligible for an Annual Wellness Visit once every 12 months, after being enrolled in Medicare Part B for at least 12 months. This visit is an optional benefit.
The Annual Wellness Visit differs from the one-time “Welcome to Medicare” preventive visit. This visit is available within the first 12 months of Medicare Part B enrollment. After this initial visit, beneficiaries must wait 12 months before their first Annual Wellness Visit.
Preparing For and Receiving Your Visit
To ensure a productive appointment, gather specific information beforehand. This includes medical records, immunization history, and a comprehensive list of all current medications (prescriptions, over-the-counter drugs, vitamins, and supplements) with their dosages. Also, bring a list of all healthcare providers and specialists you see, along with their contact information for coordinated care.
During the visit, you will complete a Health Risk Assessment questionnaire. Your provider will review your medical and family health history, discuss your current health, and take routine measurements. This discussion helps create or update your personalized prevention plan, which may include a screening schedule for recommended preventive services.
Costs Associated with Your Visit
The Medicare Annual Wellness Visit is generally covered at 100% by Medicare Part B, meaning beneficiaries typically incur no out-of-pocket costs, such as deductibles or copayments. This full coverage applies as long as the healthcare provider accepts Medicare assignment. This benefit is designed to encourage preventive care without financial barriers.
If additional services are provided during the same visit, separate costs may apply. For example, if a physical exam is performed, lab tests are ordered, or a new medical problem is addressed and treated, these services are not part of the standard Annual Wellness Visit. Such additional services may be subject to deductibles, copayments, or coinsurance under Medicare Part B. Providers typically bill these additional services separately, often using a modifier on the billing code, to distinguish them from the preventive wellness visit.