Medicare Annual Wellness Visit — What It Is and What It Costs — In Plain Words

What this visit is

Medicare.gov says you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors.

Medicare.gov calls it a conversation-based visit with your doctor or other health care provider to create a prevention plan.

It says: “It isn’t a routine physical exam.”

So this page never calls it a physical, and neither does Medicare.gov.

Medicare.gov also gives this advice about the visit’s focus.

If you have specific concerns about your health, you should schedule a separate appointment to discuss those, so your “Wellness” visit stays focused on prevention.

First, a questionnaire: the Health Risk Assessment

Medicare.gov says your health care provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit.

Answering the questions can help you and your doctor develop or update a personalized prevention plan.

That plan is meant to help you stay healthy and get the most out of your visit.

What happens during the visit

Medicare.gov lists what your provider will do during this visit:

• Take routine measurements, like height, weight, and blood pressure.
• Give you health advice.
• Review your medical and family history.
• Review your current prescriptions.
• Offer to talk with you about creating advance directives. Advance directives are legal documents that record your wishes about future medical treatment, in case you are ever unable to make decisions about your care.
• Give you a written plan, like a checklist, letting you know what screenings, vaccines, and other preventive services you need.
• Give you an optional “Physical activity and nutrition risk assessment” to help your provider understand your physical activity and nutritional habits and their impact on your health.

That is Medicare.gov’s list, as Medicare.gov prints it.

Three more things your provider will also do

Medicare.gov says your provider will also do these things.

A cognitive assessment.

Your provider will perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease.

Medicare.gov says signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life.

If your provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium.

A substance use disorder risk evaluation.

Your provider will evaluate your potential risk factors for substance use disorder and refer you for treatment, if needed.

If you use opioid medication, your provider will review your pain treatment, share information on non-opioid treatment options, and may refer you to a specialist, if appropriate.

Other tests, if necessary.

Your provider will order other tests, if necessary, depending on your general health and medical history.

Who can get this visit

Medicare.gov states the timing rule this way:

Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit.

However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.

Those are the eligibility words Medicare.gov prints on this page.

This page does not add other rules to them.

What it costs

Medicare.gov states the costs this way.

You pay nothing if your provider accepts assignment.

The Part B deductible doesn’t apply.

However, you may have to pay coinsurance, and the Part B deductible may apply, if your provider performs additional tests or services during the same visit that Medicare doesn’t cover under this preventive benefit.

If Medicare doesn’t cover the additional tests or services, like a routine physical exam, you may have to pay the full amount.

That is the whole cost section, as Medicare.gov prints it.

No other cost figures appear on this page, because Medicare.gov prints no other cost figures on its page.

How often

Once every 12 months.

That is how often Medicare.gov says this visit is covered.

This page is general information only. It is not medical advice.