Medicare Annual Wellness Visit & Preventive Care Services
Medicare provides a variety of preventive care services at no cost to beneficiaries. These services, including exams and screenings, are designed to help you stay healthy and catch potential health issues early. One of the most widely used of these is the Medicare Annual Wellness Visit.
What Is the Medicare Annual Wellness Visit?
The Annual Wellness Visit is a free, optional check-in with your Medicare provider. It’s not a full physical exam but rather a structured appointment focused on preventive care planning. During this visit, you and your doctor will work together to create or update a personalized wellness plan based on your current health and risk factors.
What Happens During the Appointment?
This visit is more of a review than a traditional physical. Your provider will go over a checklist of items to evaluate your overall wellness and identify steps to reduce health risks. Typical components include:
- Basic health measurements (height, weight, blood pressure)
- A Health Risk Assessment (questions about your health, lifestyle, and risks)
- Review of your personal and family medical history
- Medication review (including prescriptions, supplements, vitamins)
- Functional ability assessment (daily living tasks like dressing, bathing)
- Screenings for cognitive issues, hearing, and depression
- Updates to your list of preferred providers
- Preventive health advice (diet, exercise, smoking cessation, fall prevention)
Your provider may also schedule additional preventive services like mammograms or diabetes screenings if appropriate.
How Often Can You Get a Wellness Visit?
You’re eligible for a Medicare Annual Wellness Visit once every 12 months, starting after you’ve had Medicare Part B for at least a year. The first visit sets a baseline, and each subsequent visit builds on that.
Medicare Part B covers 100% of the cost when you see a participating provider. If you see a non-participating provider, you may be responsible for additional charges.
Note: If your doctor treats a new or existing condition during the visit, that part of the appointment becomes diagnostic care, which may result in out-of-pocket costs. Medicare will pay 80% after your Part B deductible is met, and if you have a Medigap (Medicare Supplement) plan, it may cover the remaining amount, depending on your plan.
Is a Wellness Visit the Same as a Physical?
Not quite. An annual physical is more comprehensive and may include lab work, a full-body exam, and other diagnostic testing. Medicare does not cover this kind of physical as part of the Annual Wellness Visit. If your doctor performs any physical exam or tests beyond the scope of the wellness visit, it could result in additional charges.
For many years, Medicare didn’t cover any wellness visits at all—until the “Welcome to Medicare” exam and Annual Wellness Visit were introduced. So while it’s not as thorough as a traditional physical, it’s still a valuable benefit.
Who’s Eligible?
You qualify for the Annual Wellness Visit if:
- You’ve had Medicare Part B for at least 12 months
- You haven’t had a Wellness Visit or a Welcome to Medicare exam in the past 12 months
Note: You must have Part B. If you only have Part A, you’ll need to enroll in Part B to qualify.
Who Can Perform the Visit?
A range of Medicare-recognized healthcare professionals can conduct the visit, including:
- Physicians
- Nurse practitioners
- Physician assistants
- Clinical nurse specialists
These professionals must be working under the supervision of a Medicare-enrolled doctor.
Does Medicare Advantage Cover It?
Yes. Medicare Advantage plans (Part C) are required to cover everything Original Medicare covers, including the Annual Wellness Visit. In fact, some plans go beyond this and offer more comprehensive physical exams, often at no cost to you. Be sure to review your plan’s Summary of Benefits to understand what’s included.
How to Prepare for Your Wellness Visit
Before your appointment, you may receive a Health Risk Assessment form. Fill this out in advance so your doctor has a clearer picture of your overall health.
To make the most of your visit, bring:
- A complete list of all medications, vitamins, and supplements (include dosages and whether they’re brand-name or generic)
- Information about your personal and family medical history
- A list of your top 3–5 health questions or concerns
Feel free to bring a friend or family member along to help take notes and keep track of the information discussed.
Important Tips
One common issue we see is billing errors. When scheduling your appointment, specify that you want an “Annual Wellness Visit”—not a general office visit. If the visit is coded incorrectly, you might be billed unnecessarily, and it won’t be covered at 100%.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
