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Home > Services & Specialties > Primary Care > Medicare Annual Wellness Visits
As part of your Medicare coverage, you are entitled to an Annual Wellness Visit once a year with a registered nurse. The goal of a wellness visit is to reduce your risk of illness or injury. A wellness visit focuses on prevention and is not a traditional head-to-toe physical.
If you have a new health problem that you need addressed or would like a medication refill, you should schedule a separate appointment with your primary care provider. If any needed non-preventative care is provided on the same day as your wellness visit, these services will not be covered as part of the visit and separate charges will apply.
View Frequently Asked Questions.
The only other preventative visit that is fully covered by Medicare (besides the Annual Wellness Visit) is a one-time Welcome to Medicare Visit. It is available within the first 12 months that you have Medicare Part B and covers similar criteria as the Annual Wellness Visit.
You are not required to have a Welcome to Medicare Visit. However, you won’t be eligible for an Annual Wellness Visit until you've been enrolled in Medicare for at least 12 months.
If you do have a Welcome Visit, you'll be eligible for your first Annual Wellness Visit 12 months after your Welcome Visit.
Note – The Welcome Visit is preventative, so if you have a new health problem you need addressed or are seeking a medication refill, these services will not be covered as part of the visit and separate charges will apply.
At your Medicare Annual Wellness Visit, you and the registered nurse will discuss your health and make a plan to address risk factors or illnesses you may have. The nurse will also recommend checkups, vaccinations and screenings you’ll need.
The registered nurse will talk with you about your health and will:
The registered nurse will also:
When you call to schedule your appointment, please mention that you'd like to schedule your “Yearly Annual Wellness Visit.” Please note, this appointment is not the same as your annual physical exam. Medicines are not refilled or prescribed in this exam.
No, Medicare does not pay for routine physical examinations. If you have secondary coverage, please call the customer service number located on the back of your card to determine covered services.
Medicare pays for two wellness visits: a one-time Welcome to Medicare Visit and an Annual Wellness Visit.
If you’ve had Medicare Part B for longer than 12 months (and have not had a Welcome to Medicare Visit in the last 12 months), you can get this yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. The visit includes the following:
Plan to bring the following items:
An annual physical is a much more extensive examination than the Annual Wellness Visit. In addition to collecting a medical history, a physical exam may also include a vital signs check, lung exam, head and neck exam, abdominal exam, neurological exam, dermatological exam and extremities exam.
If your provider needs to evaluate and treat a medical problem during an Annual Wellness Visit, he or she would need to charge for laboratory tests separately, and the cost of the tests would be applied to your deductible.
No.
No, there is no deductible or copay for the Annual Wellness Visit.
But keep in mind that the visit could cost you some money out-of-pocket, if you need to have a medical condition evaluated or treated in a way that goes beyond the purpose of a wellness visit. Which is why you should schedule a separate appointment with your primary care provider to address new health issues or get medications refilled.
Under Medicare rules, additional time or treatment during the Wellness Visit would be billed as an office visit, with Medicare paying 80% of the allowed charges and the rest being applied to your deductible or copay.
Medicare determines which preventive – or screening– tests are covered and when they should take place, and no copay or deductible is required for these.
A screening test is given to those who have no symptoms of a condition, such as measuring cholesterol levels in people who have no symptoms of cardiovascular disease. A diagnostic test is used to confirm a suspected condition once initial testing has revealed its possibility. Sometimes a screening test becomes diagnostic if potential abnormalities are found and more testing must be performed.
It’s a good idea to become familiar with Medicare’s rules about screening tests. Your Guide to Medicare’s Preventive Services explains in detail which are covered and how often. This guide is available online at: http://www.medicare.gov/Pubs/pdf/10110.pf.
Yes. If you experience physical symptoms or complaints after an Annual Wellness Visit, you can schedule a problem- oriented visit or “sick visit” with your doctor. The fees for the exam and related medical tests will be submitted to Medicare and applied to your deductible and copay.
