The “Welcome to Medicare” Visit — In Plain Words

What this visit is

Medicare.gov’s booklet “Your Guide to Medicare Preventive Services” describes the visit this way:

“The ‘Welcome to Medicare’ visit is a one-time preventive check-up to review your medical history, get up-to-date on important screenings and vaccines, and talk with your doctor or other provider about ways to stay healthy.”

Medicare.gov’s booklet “Medicare Coverage of Diabetes Supplies, Services & Prevention Programs” describes the same visit this way:

“This visit isn’t a physical exam—it’s a visit to review your health, give you education and counseling about preventive services (including certain screenings and shots), and get referrals for other care, if needed.”

That second booklet also says, in its summary chart: “Part B covers a one-time ‘Welcome to Medicare’ preventive visit within the first 12 months that you have Part B.”

Part B is Medicare Part B (Medical Insurance).

CMS uses one more name for this same visit. CMS calls it the Initial Preventive Physical Examination, shortened to IPPE. CMS lists “Initial preventive physical exam” under “Wellness visits” on its Preventive Services page, and its Medicare Learning Network tool puts the “Initial Preventive Physical Examination (IPPE)” in its own column, apart from the other visits.

In that CMS tool, the IPPE column is summed up in these words: “Review of medical and social health history, and preventive services education.”

What this visit is not

Medicare.gov is plain about this point. It says the visit is not a full physical exam.

Medicare.gov’s preventive services guide says: “The ‘Welcome to Medicare’ preventive visit isn’t a comprehensive physical exam.”

Medicare.gov’s diabetes booklet says the same thing in shorter words: “The ‘Welcome to Medicare’ preventive visit isn’t a physical exam.”

CMS’s tool also keeps a “Routine Physical Examination” in a separate column of its own. CMS describes that routine exam as an “Exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury,” and marks it “Not covered by Medicare.” A routine physical exam is not the visit this page is about.

The 12-month window

Medicare.gov states the window in its preventive services guide, under the heading “How often?”, in these words:

“You can get this one-time preventive visit within the first 12 months you have Medicare Part B.”

Medicare.gov’s diabetes booklet states the window this way:

“During the first 12 months that you have Part B, you can get a ‘Welcome to Medicare’ preventive visit.”

CMS’s tool states the same window for the IPPE in these words: “Covered only once, within 12 months of Part B enrollment.”

The visit is one-time. All three sources above say so, each in its own words.

Under the heading “Am I covered?”, Medicare.gov’s preventive services guide answers: “Yes. All people with Medicare can get a ‘Welcome to Medicare’ preventive visit.” That is Medicare.gov’s statement about the program. This page does not decide any reader’s own case. See the last section of this page.

What happens at the visit

This list is Medicare.gov’s own list, from its preventive services guide. Medicare.gov says: “During the visit, your provider will:”

• “Review your medical and social history related to your health.”
• “Give you information about preventive services, including certain screenings or vaccines (like flu, pneumococcal, and other recommended vaccines).”
• “Calculate your body mass index (BMI).”
• “Give you a simple vision test.”
• “Review your potential risk for depression.”
• “Offer to talk with you about creating advance directives.” Medicare.gov explains: “Advance directives are legal documents that record your wishes about future medical treatment, in case you’re ever unable to make decisions about your care.”
• “Review your potential risk factors for substance use disorder (like alcohol and tobacco use), and refer you for treatment, if needed.”
• “Give you a written plan (like a checklist) letting you know what screenings, vaccines, and other preventive services you need.”
• “Give you referrals for other care as needed.”

Medicare.gov adds one more part, for one group of people. It says: “If you have a current prescription for opioids, your provider will also:”

• “Review your potential risk factors for Opioid Use Disorder.”
• “Evaluate your pain level and current treatment plan.”
• “Give you information on non-opioid treatment options.”
• “Refer you to a specialist, if appropriate.”

Medicare.gov also says what to bring. Under “What should I bring to the visit?”, Medicare.gov says to bring:

• “Your medical records, including immunization records (if you’re seeing a new provider).” Medicare.gov adds: “Call your old provider to get copies of your medical records.”
• “Your family health history.”
• “A list of prescription and over-the-counter drugs that you currently take, how often you take them, and why.”

What Medicare.gov says about cost

This section prints Medicare.gov’s cost wording only, in Medicare.gov’s own words. No cost wording from any other source is used on this page.

Medicare.gov’s preventive services guide says, under “What are my costs?”:

“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 your 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.”

Medicare.gov’s diabetes booklet states the same cost wording in its summary chart, in the same terms: you pay nothing if your health care provider accepts assignment, the Part B deductible doesn’t apply, and you may have to pay a coinsurance, and the Part B deductible may apply if your provider does tests or services during your visit that Medicare doesn’t cover under this preventive visit.

This page prints no dollar amounts for this visit, because the Medicare.gov pages read in full for this page state the visit’s cost in words, not in dollar amounts. See the Sources box below.

How it differs from the yearly “Wellness” visit

Medicare.gov treats these as two different visits. This page keeps them apart, the same way.

The “Welcome to Medicare” preventive visit is the visit this page is about. Medicare.gov says it is one-time, and that it sits inside the first 12 months you have Medicare Part B. Its window and its list of what happens are printed in the sections above.

The yearly “Wellness” visit is a separate visit. Medicare.gov’s preventive services guide describes it this way:

“The yearly ‘Wellness’ visit is a check-up to develop or update your personalized plan to help prevent disease and disability, based on your current health and risk factors.”

The same guide says: “The yearly ‘Wellness’ visit is a conversation-based visit with your doctor or other provider to create a prevention plan. It isn’t a routine physical exam.”

On timing, that guide says: “If you’ve had Part B for longer than 12 months, you can get a yearly ‘Wellness’ visit.” Under “How often?”, it says: “Once every 12 months. Your first yearly ‘Wellness’ visit can’t take place within 12 months of when you first get Part B or your ‘Welcome to Medicare’ preventive visit.”

The same guide adds: “However, you don’t need to have had a ‘Welcome to Medicare’ preventive visit to qualify for a yearly ‘Wellness’ visit.” The word “qualify” in that sentence is Medicare.gov’s word, about the yearly “Wellness” visit. This page makes no such statement about any reader.

Medicare.gov’s diabetes booklet draws the same line. It says: “Part B covers a yearly ‘Wellness’ visit after you’ve had Part B longer than 12 months. This visit isn’t a physical exam—it’s a visit to develop or update your personalized plan to help prevent disease and disability, based on your current health and risk factors.”

CMS’s tool draws the line the same way. Its Annual Wellness Visit column is summed up as a “Visit to develop or update a personalized prevention plan, and perform a health risk assessment,” and marked “Covered once every 12 months.” That is a different column, and a different visit, from the IPPE column.

What this page does not cover

This page does not say if any reader can get this visit, or what any reader would pay. Only Medicare, or the reader’s own plan, can speak to that reader’s case.

This page does not list Medicare’s other preventive services. Medicare.gov’s guide covers many of them. They are outside the subject of this page, which is this one visit, and the one separate visit it is most often mixed up with.

This page is built from Medicare.gov booklets about Original Medicare. Medicare.gov’s preventive services guide says, in its front pages: “If you have a Medicare Advantage Plan, another Medicare health plan, or both Medicare and Medicaid, your coverage, costs, and rules might be different.” Readers in such a plan should check with their plan, as Medicare.gov directs there.

For more information about Medicare preventive services, Medicare.gov’s guide gives this line: “Visit Medicare.gov/coverage/preventive-screening-services, or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.”

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

Only Medicare, and your own plan, can speak to your own case. This page decides nothing.