August 22nd 2023
By Ari Parker
Your Medicare annual Wellness exam is different from a physical. Learn what is and is not covered, how much you’ll pay, what to do after your Wellness visit.
Rather than a standard “physical” examination each year, Medicare covers a yearly “Wellness” visit. During a physical exam, your doctor will focus on early diagnosis and preventive care. During your Wellness visit, your doctor will look at your current health and risk factors to help you develop a personalized plan to maintain your health and avoid disease or disability. Read on to learn more about what the annual Wellness visit includes.
The Medicare annual Wellness visit is free to Medicare beneficiaries who’ve been enrolled in Medicare Part B for at least 12 months.
When you first enroll in Medicare, you’re eligible for a “Welcome to Medicare” preventive visit, which is slightly different from the annual wellness visit.
The Medicare annual wellness visit doesn’t include everything you’d get with a standard, annual physical exam.
After your yearly Wellness visit, you may have additional preventive services to schedule.
The Medicare yearly Wellness visit is Medicare’s replacement for the annual physical, but it’s not as inclusive. Either before or during your visit, your doctor will ask you to fill out a Health Risk Assessment questionnaire. Your doctor will also:
Review your personal and family health history
Ask about your current prescriptions and providers
Take down standard health measurements (your height, weight, and blood pressure)
Perform a cognitive assessment to catch early signs of dementia
Provide personalized health advice
Evaluate your risk factors for substance use disorder
Help you develop a screening schedule (or checklist) for additional preventive services you should schedule
Assist with advance care planning (a plan for care, should you become unable to speak for yourself)
Many of the services listed above help you and your doctor determine additional preventive services you should receive. Because many Medicare-covered preventive services require a doctor to order them, your annual Wellness visit is important to receive the best healthcare.
The “Welcome to Medicare” preventive visit is a one-time preventive service you can receive within your first 12 months of having Medicare Part B. During this visit, your doctor will perform all evaluations included in the yearly Wellness visit, and also:
Calculate your body mass index (BMI)
Perform a basic vision test
Determine your risk for depression and level of safety
While you can show up to your Wellness visit empty-handed, you should bring the following to get the most out of the appointment:
Your medical and immunization records
Notes about your family’s health history
A list of your prescriptions and over-the-counter drugs and supplements you’re taking, including daily dosages
If your doctor accepts Medicare assignment, your yearly Wellness visit shouldn’t cost you anything. If your doctor performs additional tests and services during your visit, you may owe for those services.
Note: Medicare assignment is an agreement signed by your provider to be paid directly by Medicare and accept the payment amount approved by Medicare.
The Medicare yearly Wellness visit is not the same as a physical exam. This means that certain things you would expect during your standard, annual visit to the doctor before you enrolled in Medicare will not be covered.
During a physical, medical exam, your provider will:
Listen to your body
Look at your body
Feel your body with their fingers or hands
Tap or produce sounds on specific areas of your body
The list of what is included in a Wellness exam is explicit, and doesn’t involve touching, tapping, or listening.
Unlike during an annual physical, during your Wellness visit, your doctor will not:
Listen to your heart and lungs
Examine your ears with a otoscope
Look at your tonsils
Feel your lymph nodes
Feel your abdomen to check for swollen organs
Look at your skin for unusual moles and rashes
Perform a breast and pelvic exam (women) or a genital and prostate exam (men)
Give you vaccines
Perform a standard blood test
Test your vision
You will need to pay for any services performed during your visit that are not covered by the Wellness visit. You may be responsible for coinsurance, and the Part B deductible may apply.
If your doctor determines that you need additional preventive services during your Wellness exam, you’ll develop a screening checklist to schedule these services at a later date.
During your Wellness visit, you and your doctor will determine what additional services you should seek, based on your health status and risk factors. After your visit, you should schedule the appropriate appointments. You should also take note of the personalized health advice your doctor gave you and implement it into your day to day.
Have questions about your annual Wellness visit or Medicare coverage? Give us a call at (855) 900-2427 for free Medicare advice and support.
