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Medicare Annual Wellness Visit


You may be asking yourself, what is a Medicare annual wellness visit? What will my doctor go over at this visit? What sort of outcomes can I expect from this appointment?

We’ll go over Medicare coverage of these appointments, what is and isn’t included in your visit, and the key factors that differ between an Annual Wellness Visit (AWV), Medicare preventative visit, and your welcome to Medicare visit.

What is the Medicare Annual Wellness Visit?

When you attend Medicare annual wellness visit, your physician will have you complete a “Health Risk Assessment”. This is a fancy term for a health questionnaire. Completing this can help your physician come up with a tailored prevention plan.

Topics this questionnaire may include:

  • both personal and family medical history
  • an up-to-date list of current medications you’re taking
  • current providers, you’re seeing
  • current height and weight
  • possible risk factors and treatments
  • health advice

Medicare Coverage For My Annual Wellness Exam Visit

Your annual visit coverage is under your Medicare Part B. You should be aware that you must carry Part B for more than 12 months to qualify for this visit.

The Part B deductible doesn’t apply to your annual wellness visit. If you qualify, Medicare will cover the AWV at 100% of the Medicare amount when services come from a participating provider.

During your AWV appointment, your physician might find a need to review or treat a new or existing problem. This is considered additional care and would be considered diagnostic.

This means your provider is treating you because of your symptoms or risk factors. You may be billed for diagnostic care received during your AWV because of this additional service.

Welcome to Medicare Visit vs Medicare Annual Wellness Visit

While these two exams have many similarities, they carry some differences. What is the main difference between a Welcome to Medicare Preventative Visit and a Medicare Wellness Visit you might ask?

The Welcome to Medicare visit is a preventative appointment that you might receive when first joining Medicare. This is only once, within your first 12 months of Part B.

As discussed above, the Medicare Annual Wellness Visit is an exam that you receive if you’ve been a Medicare recipient for more than 12 months, and this appointment is once per year. The Annual Wellness Visit is a health evaluation, rather than a physical examination.

Furthermore, you can’t receive an AWV during the same calendar year as your Welcome to Medicare preventative visit.

Are Wellness Visits and Physical Exams the Same Thing

While both examinations are of great importance, annual physical exams are very different from annual wellness visits. A physical exam can include some of the components of the wellness visit (vitals check, neurological assessment), but not all.

These appointments may include abdominal assessments, head and neck exams, lung exams, heart assessments, etc. AWVs are great for Advance Care Planning and Directives, checking one’s level of safety and cognitive function, and overall health and general appearance.

What’s Included in your Annual Wellness Visit

Preparing for a visit can be overwhelming especially when you don’t know what to expect at your annual visit. For the most part, the doctor goes over standard wellness checks.

Below are some examples of what you may encounter:

  • Blood pressure check
  • Weight and height checks
  • Immunizations
  • Medication & supplement review
  • Verbal screening for depression
  • Counseling and health education
  • Cognitive Impairment (such as Alzheimer’s or dementia)
  • Personal and family health history
  • Health risk assessment
  • Vision checks

What’s Not Included in Your Visit

Since this is a pretty hands-off appointment, you’ll have quite a few procedures and tests that won’t be included in your annual visit.

Let’s take a look at some of those examples below:

  • Hands-on physical exam
  • Any new health concerns
  • X-rays
  • Bloodwork
  • Diagnosis or treatment of illnesses
  • Any new medical issues
  • Aches and/or wounds
  • Substance and alcohol abuse screening

What to Bring to the Visit

Make sure to remember to bring your current list of medications, vitamins, and supplements with you to your appointment. If family health history has updated or changed, it is important to let your physician know this.

This history is key in helping to determine any potential health issues you may be at risk for. Along with your current medical records, your doctor will then be able to discuss a personal health plan for you.

FAQ’s

Are Annual Visits mandatory?
While there are plenty of benefits in scheduling your annual visit with your doctor, it’s not a requirement. The benefits of attending your annual visit do seem to far outweigh those of not attending. Early detection of illness or disease is always great when it comes time to go over treatment options.
Is your Part B coverage dependent upon attending your Annual Wellness Visit?
No, your Part B doesn’t depend on you attending your Annual Wellness Visit. Although the visit is a free preventive visit that you should go to, it’ll help you stay on track to living a healthy lifestyle.
What is a Medicare Health Risk Assessment?
Each doctor likely has a slightly different Health Risk Assessment form, and you may have filled one out in the past. For the most part, the questionnaire will ask about your lifestyle; psychosocial risks, behavioral risks, and biometric assessment.
Can you refuse the Medicare Annual Wellness Visit?
As these visits are not mandatory, you can skip them. However, it is beneficial to check in with your doctor for preventive purposes.

How to Find Out More About the Medicare Annual Wellness Visit

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

4 thoughts on “Medicare Annual Wellness Visit

    1. Hi Carol! The form you fill out for the Medicare Annual Wellness Visit is unique to your doctors’ office. Most likely, they will either have it available on their website or have you complete the form when you check-in for your appointment.

  1. Each year our doctor expects us to fill out an 8-page set of forms for this annual visit, the “Medicare Annual Health and Risk Assessment.” Cannot find it on your website under “forms.” Why on earth is this not an on-line form, or at least a standard national PDF form, so we can stop doing this repetitive task over and over. Worse, doctors have to hire and pay people at their location to key all this data into a system and in so doing errors are made in transcribing the data from our handwriting into someone’s automated system. This needs to be a single national form that is generic to all Medicare subscribers and ON-LINE. For pete’s sake it’s 2020 and we’re still in the stupid paper-based forms business. It seems every doctor crafts their own version of this form, same data, different formats. So stupid.

    1. Hi Mike! Unfortunately, there is no national form or questionnaire for the Medicare Annual Health and Risk Assessment. The form you’re filling out is specific to your doctor’s office. However, most questionnaires that are specific to the Health and Risk Assessment are about two pages. The 8-page form you’re filling out might be for more than just this assessment, especially since you’re doing it annually. I do agree there should be a national generic form that you can access online and print out beforehand. Hopefully, CMS will implement this on all forms to make it easier for both the beneficiary and the doctors.

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