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There are several different types of wellness visits that Medicare covers. The Medicare Annual Wellness Visit (AWV) (also called a “Medicare wellness exam”) is just one of them. Below, we’ll go over what you can expect during your Annual Wellness Visit and how it differs from other exams.
Types of Medicare wellness visits
There are Medicare Annual Wellness Visits and Welcome to Medicare visits.
The goal of the Annual Wellness Visit is to create a comprehensive prevention plan, which may include a health assessment including vitals, family history and risk factors, hearing impairments, fall risk, cognitive impairment screenings, among many other things.
The Welcome to Medicare visit is a preventive appointment that only occurs once within the first 12-months of joining Medicare Part B.
Medicare does not cover an annual physical.
What is the Medicare Annual Wellness Visit?
The Medicare Annual Wellness Visit is an opportunity for you and your primary care provider to review how well-being impacts everything from mental health, cognitive function, fitness levels, and illness prevention.
This exam will help you and your healthcare provider create a personalized prevention plan that’s tailored specifically to you based on your current health condition. This also includes evaluating any risk factors you may have been carrying with you over the years along with a cognitive assessment.
Who can perform the Medicare Annual Wellness Visit?
An Annual Wellness Visit may be performed by a healthcare provider or other practitioner recognized by Medicare, such as a clinical nurse specialist, nurse practitioner, and physician assistant. The exam can also be performed by a professional that’s working directly under the supervision of a physician.
What’s included?
Health risks vary for everyone, so your health care provider may ask you to fill out a questionnaire called a health risk assessment during this visit. Your visit may include:
- Height, weight, body mass index (BMI), blood pressure, and other routine measurements.
- An evaluation of your list of current providers and prescriptions
- A review of your family health history
- Cognitive impairment assessment
- Any health education or advice suggested by your healthcare provider
- Review risk factors and any family history of depression
- Level of safety and functional ability review
- Advance care planning
- A checklist of any recommended preventive services, like immunizations or screening schedules for certain health conditions
RELATED: Does Medicare cover vaccines?
Souhaila A. Richardson, MD, an internal medicine doctor at Ascension St. Vincent Hospital in Indianapolis regularly sees Medicare patients for their Annual Medicare Wellness Visits and focuses on the four M’s of the visit (mobility, mental wellness, medicines, and what matters most to the patient).
What questions are asked?
The health risk assessment is a comprehensive health questionnaire designed to help your physician come up with the best prevention plan for you. It will include questions about your lifestyle, medical history, and medications. There are also special Annual Wellness Visit questions that may be relevant in order to identify a list of risk factors or symptoms of certain conditions.
Examples of some questions include:
- Basics including your age and sex
- During the past four weeks, how much have you been bothered by emotional problems such as feeling anxious, depressed, irritable, sad, or downhearted and blue?
- During the past four weeks, has your physical and emotional health limited your social history and activities with family friends, neighbors, or groups?
- During the past four weeks, how much bodily pain have you generally had?
- During the past four weeks, was someone available to help you if you needed and wanted help? (For example, if you felt very nervous, lonely, or blue; got sick and had to stay in bed; needed someone to talk to; needed help with activities of daily living.)
- During the past four weeks, what was the hardest physical activity you could do for at least two minutes?
- Can you get to places out of walking distance without help? (For example, can you travel alone on buses or taxis, or drive your own car?)
- Can you go shopping for groceries or clothes without someone’s help?
- Can you prepare your own meals?
- Can you do your housework without help?
- Because of any health problems, do you need the help of another person with your personal care needs such as eating, bathing, dressing, or getting around the house?
- Can you handle your own money without help?
- During the past four weeks, how would you rate your health in general?
- How have things been going for you during the past four weeks?
- Are you having difficulties driving your car?
- Do you always fasten your seat belt when you are in a car?
- Have you fallen two or more times in the past year?
- Are you afraid of falling?
- Are you a smoker?
- During the past four weeks, how many drinks of wine, beer, or other alcoholic beverages did you have?
- Do you exercise for about 20 minutes three or more days a week?
- Have you been provided any health advice to help you with hazards in your house that might hurt you or to help keep track of your medications?
- How often do you have trouble taking medicines the way you have been told to take them?
- How confident are you that you can control and manage most of your health problems?
What’s not covered?
Since this exam is not a routine physical exam, there are a few tests and items that are not included in your Medicare Annual Wellness Visit. These include bloodwork, X-rays, diagnostics or treatments for illnesses, new health concerns, and a physical exam.
Is it required?
The Medicare Annual Wellness Visit with your healthcare provider may seem like a hassle, but it’s worth the time invested. Early detection and discussion about treatment options can save you money in costly treatments down the line. However, this exam is not mandatory.
How much does it cost?
Your Medicare Annual Wellness Visit will fall under Medicare Part B. Since it’s considered a Medicare preventive service, there are no out-of-pocket costs. The Medicare Part B deductible does not apply. There is no copay or coinsurance. Medicare covers 100% of the Medicare-approved amount if your healthcare provider is a participating Medicare provider.
Does Medicare cover annual physicals?
Medicare does not cover annual physicals. The Medicare Annual Wellness Visit differs from an annual physical exam since the AWV is more of an opportunity to create or update a personalized prevention plan—not just to get a health status evaluation.
While Medicare coverage does not include annual physical exams, it does cover a one-time Welcome to Medicare visit and an Annual Wellness Visit every 12 months.
While yearly physical exams with your healthcare provider are not covered by Medicare, early detection of illness or disease can lead you down an easier path when it comes time for treatment options. If your routine physical exam is not your Welcome to Medicare visit or Annual Wellness Visit, you may pay 100% out of pocket. A physical exam may cost $50 to $200 out of pocket. Additionally, if your doctor conducts tests to treat or diagnose a condition identified during your Annual Wellness Visit, you may get billed for that service.
Do Medicare supplement plans cover annual physicals?
Medicare supplement plans sometimes cover items that Medicare doesn’t, such as pints of blood, additional lifetime reserve days, etc. Review your Medigap information to find out if your policy covers annual physicals.
