What is a Medicare Annual Wellness Visit?

There’s an important benefit to being an older adult on Medicare: You qualify for the Medicare Annual Wellness Visit (AWV) if you have Medicare Part B coverage.

“It’s aimed at creating a personalized prevention plan to avoid future illnesses and diseases rather than doing a head-to-toe physical exam,” says Sophia Casely-Hayford, MD, a primary care physician with Atlantic Health.

Questions about how to make the most of this no-copay benefit? We’ve got answers.

Who qualifies for a Medicare Annual Wellness Visit?

You’re eligible for this yearly preventive care visit after you’ve been enrolled in Medicare Part B for more than 12 months. Medicare is available for:

• Adults age 65 and older
• Younger people with certain disabilities
• People with end-stage renal disease (ESRD) or ALS (Lou Gehrig’s disease)

Though you’re not eligible for the Medicare AWV during your first 12 months, you may still receive a preventive visit during your first year of enrollment. At this “Welcome to Medicare” visit, you can catch up on important screenings and vaccines, and talk with your provider about your family history and how to stay healthy. You’ll want to note that this visit isn’t a routine physical exam.

What happens during a Medicare Annual Wellness Visit?

Jessica Petilla, MD, an Atlantic Health primary care physician who specializes in geriatric medicine, notes that, “It’s called a wellness visit because it doesn’t only look at medical issues or chronic diseases. It really looks at the patient as a whole.”

Based on your needs, you and your doctor will focus on preventive measures, including:

• Breast cancer screening
• Colon cancer screening
• Vaccinations
• Living wills and health care directives
• Patient goals and preferences
• Cognitive assessment
• A review of current prescriptions
• Health education on lifestyle, diet, exercise, and physical and mental wellness

“You get a whole picture of the patient,” says Dr. Petilla. “You’re not just looking at hypertension, diabetes, heart failure or COPD.”

Patients also receive a care plan they can take home that summarizes what they talked about with the provider during the visit.

What’s the difference between a Medicare AWV and an annual physical?

Medicare recommends the AWV because it’s been proven to help keep patients healthy. It focuses on preventive care and long-term health planning. Studies show the visits encourage members to use important preventive services more often. These are services such as cancer screenings and vaccinations that help improve health outcomes and detect diseases earlier.

Unlike a standard physical exam, the AWV is a strategic way to check in and prevent illnesses in the future. This chart helps explain the differences between the AWV and a yearly physical:

What's the difference?	Medicare Annual Wellness Visit	Routine physical exam
Main purpose	Focuses on prevention and staying healthy	Preventive checkup to evaluate your overall health and identify potential health problems early
What happens during the visit	Reviews memory, fall risk, medications, lifestyle and preventive care needs	Includes a hands-on physical exam and more detailed medical testing
Physical exam included?	Usually no full physical exam	Yes
Cost to patients	Usually $0 if your provider accepts Medicare	May include copays, deductibles or other out-of-pocket costs
Covered by Medicare?	Yes, once every 12 months	Medicare does not usually cover routine annual physicals
Best for	Planning for healthy aging and preventive care	Checking for new medical concerns or symptoms

Does a Medicare AWV focus on the needs of older adults?

“The concerns of an older person are different from those of a younger patient,” says Dr. Petilla. “The Medicare Annual Wellness Visit lets physicians spend more time discussing concerns that become more important as patients age.”

Your doctor may focus on:

• Fall prevention
• Balance exercises
• Maintaining muscle mass
• Advance care planning
• Social and emotional support
• Life goals

Adds Dr. Casely-Hayford, “We also discuss activities of daily living and home safety. Those are not typically part of a routine physical for younger patients.”

What does the Medicare AWV not cover?

Because it is a preventive health planning session and not a physical exam, a Medicare wellness visit is covered at no cost to you. This means you won’t have a copay. However, let’s say you decide to tell your doctor about a new health problem during the AWV. Here’s an example of what might happen: 

• During your AWV, you tell your doctor you have a new pain in your body.  
• Your doctor does an exam to check you over and learn what it might be.
• Then it becomes a “sick visit” instead of an annual wellness visit.
• It will then be billed separately and not covered by Medicare as a wellness visit.

Several things are not covered by the Medicare AWV and may mean you have a copay or an out-of-pocket bill. They include:

• Blood tests 
• Checking new symptoms
• Diagnosing a new health issue 
• Physical exams
• Review, adjustment or change of medicines
• Treating acute illnesses
• Vaccinations and immunizations
• X-rays

While Medicare Part B doesn’t cover these items as part of the annual wellness exam, many of them are still covered as part of a different kind of visit. For instance, if you have an office visit to talk with your provider about new back pain you’re having, Medicare will cover part of that appointment cost.

If you want a wellness visit and a hands-on physical exam, your doctor can often perform both during the same appointment. But it’s important to note that they will bill them as two separate services.

How does Atlantic Health handle scheduling for the wellness visit?

Patients usually don’t need to switch doctors. A primary care physician can keep seeing the same patient they always have. The patient simply transitions from only yearly physicals to AWVs and physical exams once the patient enrolls in Medicare. If the patient wants a wellness visit and a hands-on physical exam, the doctor can often perform both during the same appointment. But it’s important to note that the doctor will bill them as two separate services.

“I only refer patients to geriatrics specialists when additional expertise is needed, such as for Alzheimer’s disease or behavioral concerns,” notes Dr. Casely-Hayford.

Adds Dr. Petilla, “Internal medicine physicians, family medicine physicians and geriatricians can all perform Medicare Annual Wellness Visits. Patients don’t have to look far.” Atlantic Health will guide patients through the transition once they enroll in Medicare.

“It’s definitely a team effort,” agrees Dr. Casely-Hayford.