Medicare Annual Wellness Visit: What Is It?

What Is the Medicare Annual Wellness Visit?

The Medicare annual wellness visit is a free preventive benefit available to Medicare beneficiaries every 12 months. Both Original Medicare and Medicare Advantage offer this visit with your doctor to review your mental and physical health and cognitive abilities. Together, you create a personalized plan to address concerns based on your current health and any risk factors. 

Key Takeaways

• The Medicare annual wellness visit is a check-in every 12 months with your healthcare provider.
• Your provider assesses your current and recent physical and mental state and looks for potential risk factors. 
• The annual wellness visit isn’t an appointment to address new health concerns or symptoms. Bringing these up could lead to additional charges from your doctor’s office.
• Both Original Medicare and Medicare Advantage plans offer Medicare annual wellness visits.

How the Medical Wellness Visit Works 

The annual wellness visit includes a health risk assessment, a review of your medical and family health history, a collection of your current healthcare providers and suppliers, and a self-assessment of your health status.

In advance, the doctor will likely give you a questionnaire. It takes about five minutes to fill out.

The Medicare annual wellness visit attempts to uncover any changes impacting your ability to care for yourself (such as dressing, shopping, and financial management) and increased health risks from behavioral factors (smoking, physical activity, seat belt use) and emotional factors (depression, anger, loneliness).

The doctor will measure and document: 

• Demographic information
• Height
• Weight
• Body mass index (BMI) or waist circumference
• Blood pressure
• Other measurements based on medical and family history
• Any cognitive impairments
• Potential depression risk factors
• Ability to perform daily activities
• Risk of a fall 
• Any hearing impairment
• Potential substance use disorders and opioid prescriptions
• Other safety concerns

Using this information, the doctor helps maintain a screening schedule based on your risk factors and conditions. You’ll get personalized advice and referrals to health services and programs to help address physical safety and mental health issues and control risk factors such as smoking. 

Your wellness visit can also include advance care planning, also known as advance directive planning. This is a face-to-face conversation between you and your healthcare professional about your healthcare wishes and medical treatment preferences should you become unable to communicate or make decisions about your care. 

You won’t pay anything for your visit (including the Part B deductible) if your doctor accepts the Medicare assignment. 

But to have the visit remain free, you’ll also need to stay within the Medicare annual wellness visit’s boundaries of discussion topics. Don’t talk about your new knee ache; make a separate appointment for that. 

Important

If your doctor orders additional tests or services outside the scope of a Medical wellness visit, you will have to pay the coinsurance and Part B deductible for those tests. 

Types of Medicare Annual Wellness Visits

There are two types of Medicare annual wellness visits (AWVs)—the initial AWV and follow-up AWVs that happen in subsequent years. 

Your first Medicare annual wellness visit will be more thorough than later ones. It will include establishing a baseline regarding your physical and mental health history, risk factors, and any signs of cognitive impairment. You’ll also set up a personalized screening schedule going forward. The doctor will discuss your advance care planning if you wish. 

After the first visit, the wellness visits review and update changes to the above, including:

• Health risk assessment
• Medical and family history 
• Current providers and suppliers
• Weight and blood pressure measurements
• Cognitive impairment assessment
• Written screening schedule 
• Risk factors and interventions 
• Referrals to services and programs
• Advance care planning
• Opioid prescriptions 

Routine Physical Exam vs. AWV

Your annual wellness exam reviews your personalized prevention plan of services and is focused on managing health risks. Medicare covers an annual AWV 12 months after the last AWV (date of service), paying all costs as long as the doctor accepts Medicare. The AWV can also incorporate advance care planning discussions.

In comparison, a routine physical is a medical exam performed without addressing treatment or diagnosis for a specific illness, symptom, complaint, or injury. 

Original Medicare does not cover routine physical exams; patients must pay all costs out of pocket. However, some Medicare Advantage plans cover annual physicals.

Physical exams don’t typically include discussions of advance care planning. However, the AWV and other Medicare benefits cover some aspects of the routine physical, so you may see some overlap.

Requirements for the Medicare Annual Wellness Visit

For Medicare to cover your Medicare annual wellness visit, it must be performed by a physician (doctor of medicine or osteopathic medicine) or a nurse practitioner, physician assistant, or clinical nurse specialist. 

You must have been enrolled in Medicare Part B for more than 12 months. In other words, your first yearly wellness visit can’t occur within 12 months of your Part B enrollment. 

Your Medicare annual wellness visit also can’t take place within 12 months of your “Welcome to Medicare” preventive visit, which happens when you first join Medicare. That visit reviews your health-related medical and social history and provides education on preventive services. The “Welcome to Medicare” visit is called the Initial Preventive Physical Exam or IPPE.

However, to qualify for your annual wellness visit, you don’t need to have completed the “Welcome to Medicare” preventive visit.

To prepare for your Medicare annual wellness visit, you’ll need to bring: 

• Medical records
• Immunization records
• Family health history
• A list of all medications, supplements, and vitamins, and information on how often and how much of each you take
• A list of your current healthcare providers and suppliers, including mental health specialists

Frequently Asked Questions (FAQs) 

What’s the Difference Between a Medicare Wellness Visit and an Annual Physical?

A wellness visit isn’t designed to incorporate a full panel of lab tests and in-office exams. It’s more of a quick check-in with your doctor using Medicare’s standardized list of questions concerning your overall mental and physical health and your ability to care for yourself. 

Does the Medicare Wellness Exam Include Blood Work?

No, the Medicare Annual Wellness Exam’s coverage doesn’t include clinical lab tests. Your doctor could make a referral for blood tests or lab tests as part of the AWV. Medicare Part B typically covers medically necessary lab work, such as blood tests.

Does Medicare Cover an Annual Physical?

Some Medicare Advantage plans cover an annual physical, but Original Medicare does not. However, Original Medicare Part B does cover dozens of preventive tests, screenings, and services that are usually part of a routine preventive physical, including screening for: 

• Colorectal cancer, prostate cancer, and breast cancer 
• Glaucoma 
• Abdominal aortic aneurysms (via ultrasound)
• Cardiovascular disease 
• Diabetes

The Bottom Line

The Medicare annual wellness visit allows you to discuss your overall health, quality of life, mental health, mood, and ability to think with your doctor. Your care provider can watch for changes and order more tests or help with necessary interventions. Catching problems early can keep you healthier and help you avoid expensive treatments later on. 

Read the original article on Investopedia.