The Medicare Annual Wellness Visit: What Older Adults Should Know

Making the most of your Medicare coverage means understanding all the benefits and services available to you. One important benefit that many older adults don’t know about is the Medicare Annual Wellness Visit.

What is a Medicare Annual Wellness Visit?

Introduced in 2011 as part of the Affordable Care Act, the Medicare Annual Wellness Visit focuses on health promotion and preventive care. It allows you and your provider to create a personalized prevention plan that can help you stay healthy and avoid injury, illness, and disease. This visit is also an opportunity to address a range of issues that may be affecting your quality of life—such as depression, memory loss, and dementia.

The Annual Wellness Visit is only for preventive care and not for the diagnosis and treatment of an illness. If you want to discuss a specific health problem with your doctor, you’ll need to schedule a separate appointment.

Who can get a Medicare Annual Wellness Visit?

You can get an Annual Wellness Visit if you’ve been receiving Medicare Part B benefits for at least one year (12 months). Also, you must not have had an initial preventive physical exam (“Welcome to Medicare” exam) or a previous Wellness Visit within the past year.

When you call your provider’s office for an appointment, be sure to ask to schedule an “Annual Wellness Visit” by name. This will help ensure that Medicare covers the appointment as a preventive service.

Are Medicare Annual Wellness Visits free?

Medicare Annual Wellness Visits are 100% covered under Medicare Part B. This means that if you have Part B, you pay nothing if you go to a health care professional who accepts Medicare assignment. Assignment is an agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance. You won’t have to worry about out-of-pocket costs such as coinsurance and copayments, and the Part B deductible does not apply to this visit.

However, you can expect to pay a copayment or coinsurance and any unmet portion of your Part B deductible if:

• Your provider performs tests or services to treat an existing illness or health problem.
• You get any follow-up screenings or other preventive services recommended by your provider during your Wellness Visit.

How often can you have a Medicare Annual Wellness Visit?

Medicare covers one Wellness Visit per calendar year (12 months).

What happens during a Medicare Annual Wellness Visit?

During your visit, you will be asked to fill out a questionnaire called a Health Risk Assessment. Your responses will help your provider gain a better understanding of your current health and your risk factors. The appointment may also include:

• Recording of height, weight, body mass index (BMI), blood pressure, and other routine measurements
• Review of your medical and family history
• Review of your current health care providers and any prescriptions, vitamins, and/or supplements you’re taking
• Creation of a health screening schedule for the next 5-10 years based on your age, family history, and unique risk factors
• Review of functional ability (your ability to perform everyday tasks on your own) and safety (first visit only)
• Creation of a list of risk factors/conditions along with recommendations/treatment options
• Discussion of advance care planning (care you would receive if you could not speak for yourself)
• Personalized health advice and referrals for issues such as weight management, falls prevention, diet and nutrition, and smoking cessation

During your Annual Wellness Visit, you’ll also receive a cognitive assessment to check for dementia, memory loss, depression, anxiety, and other conditions. If your provider spots any issues, they will likely recommend a separate visit to perform a more thorough review of your cognitive function.

Additionally, if you're currently taking any prescription opioid medications, your provider will talk to you about the risks involved with taking opioids (including substance use disorder). They'll evaluate the severity of pain you're experiencing, review your existing treatment plan, and explain your non-opioid treatment options.

What is the difference between a Medicare Wellness Visit and a physical?

The Annual Wellness Visit may be like a routine physical in some ways, but it is not a comprehensive physical exam. This visit does not typically include:

• Physical examination
• Diagnosis of illness
• Lab tests (such as bloodwork and x-rays)
• Treatments for current conditions

While the goal of a physical exam is to identify any health issues, the goal of a Medicare Annual Wellness Visit is to help you maintain your current health and prevent problems down the road. In many cases, this visit doesn't need to be completed in an exam room.

Who can perform the Medicare Annual Wellness Visit?

This visit can be performed by different types of health care professionals who are recognized by Medicare, including:

• Doctor
• Nurse practitioner (NP)
• Physician assistant (PA)
• Clinical nurse specialist
• Registered dietitian
• Health educator

You may want to do your Medicare Wellness Visit with your primary care doctor or other provider in your doctor’s office. They know you best and will be able to monitor any changes in your health over time.

What should I bring to my Medicare Annual Wellness Visit appointment?

Bring your completed Health Risk Assessment to your visit along with a list of any medications, vitamins, and/or supplements you're taking (both prescription and over the counter). It’s a good idea to have your immunization records handy if the provider does not already have this information. You should also write down any questions or concerns you have about your medications or your health in general. This visit is a great opportunity to get all your questions answered.

Does Medicare require a Wellness Visit every year?

Medicare does not require that you have a Medicare Wellness Visit every year. But it’s important to take advantage of all the Medicare benefits available to you. This free yearly visit is an extra tool in your health care toolbox. It can help you prevent disability, illness, and chronic disease, so you can stay well and live your best life possible. You may want to set a reminder for yourself every year to schedule your Annual Wellness Visit.