The Medicare wellness visit is an annual visit with your primary care provider to create a personalized plan to help prevent disease and disability, based on your health and risk factors.
This free Medicare wellness visit is covered once every 12 months. You become eligible after you have been enrolled in Part B for a year or longer.
What is covered in the annual wellness visit?
The wellness visit is different from an annual physical exam where a doctor conducts a lot of tests. This exam focuses more on reviewing your medical history and risk factors and creating a prevention plan.
You’ll usually fill out a questionnaire, called a health risk assessment, as part of the visit. It can help you and your provider develop a personalized plan to stay healthy. Your provider may do the following during your wellness exam:
- Review your medical history and your family’s medical history
- Review your current providers and prescriptions
- Record your vital information, including your height, weight and blood pressure
- Provide personalized health advice
- Review potential health risks and treatment options
- Create a screening checklist for recommended preventive services
- Discuss advance care planning, such as who you want to be able to make medical care decisions on your behalf if you’re unable to do so yourself.
- Perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. If your provider thinks you may have cognitive impairment, Medicare covers a separate visit to review your cognitive function.
- Review potential risk factors for opioid problems if you have a current prescription for opioids.
How does this differ from a Welcome to Medicare visit?
You are entitled to one free Welcome to Medicare visit any time during the first 12 months after you enroll in Medicare Part B. That checkup is an opportunity for your doctor to assess your health and provide a plan of future care. It serves as a baseline for monitoring your health during the annual wellness visits in subsequent years.
You do not need the Welcome to Medicare visit to qualify for later annual wellness visits. However, Medicare won’t pay for a wellness visit during the first 12 months you have Part B.
Will I face extra charges for the Medicare wellness visit?
You’ll have no deductible or copayments for your annual Medicare wellness visits if you’re enrolled in original Medicare and your provider accepts assignment, meaning he or she accepts the Medicare-approved amount as full compensation.
If you’re enrolled in a Medicare Advantage plan that has a provider network, such as an HMO or PPO, you may need to go to a doctor in the plan’s provider network to get the annual wellness visit without deductibles, copayments or coinsurance.
Keep in mind
If your health care provider performs additional tests or provides additional services during the visit that aren’t covered as part of the annual wellness benefit, you may have to pay your deductible and copayments for the additional expenses.
Updated July 14, 2022