What to Know About Medicare Annual Wellness Visits

Medicare is a program with many benefits but also with a great deal of complexity. Knowing about the options available to Medicare beneficiaries will help you understand and navigate the system. Let’s look at Medicare’s annual wellness visits.

What Are Annual Wellness Visits?

Medicare’s annual wellness visits (AWVs) are preventive care appointments with your primary care provider. They are designed to help you maintain your health by identifying potential risks and creating a personalized prevention plan for wellness. Often misunderstood as a traditional physical exam, these visits are a distinct service focusing on preventive care rather than diagnostic or treatment measures. AWVs are covered under Medicare’s Plan B, whereas physical exams are not covered.

In other words, Medicare offers two types of wellness visits:

1. The “Welcome to Medicare” Visit:

The initial preventive physical exam (IPPE), also known as the “Welcome to Medicare” preventive visit, is a one-time visit available to beneficiaries within the first 12 months of enrolling in Medicare Part B. It includes the following:

• A review of your medical and social history.

• Measurement of your height, weight, and blood pressure.

• Screening for depression and other mental health concerns.

• Education and counseling about preventive services like vaccines and screenings.

• A written plan for future care tailored to your health needs.

2. Annual Wellness Visits (AWVs):

These are yearly visits available after the initial 12 months. They involve:

• Establishing your medical and family history

• Updating your health history and risk factors

• Screening for cognitive impairment

• Discussing options for advance care planning

• Reviewing your current medications

• Personalized health advice and a preventive services checklist

• A health risk assessment, including lifestyle questions about diet, physical activity, and more

What Medicare Wellness Visits Are Not

AWVs are not the same as what most of us think of as an annual physical exam. Unlike physicals, AWVs don’t involve a head-to-toe physical examination, lab tests, diagnostic imaging, or treatment of new health problems. If specific medical issues arise during a wellness visit, you may need a separate appointment, which could involve additional costs depending on your Medicare coverage.

Who Is Eligible for Medicare Wellness Exams?

Most Medicare Part B beneficiaries are eligible for AWVs. The “Welcome to Medicare” visit is available only during the first 12 months of Medicare Plan B enrollment. You are eligible for your first AWV after your first year of being enrolled in Medicare Plan B or 12 months after your “Welcome to Medicare” visit.

After your first AWV, you are entitled to one of these appointments to one per year. These visits are free when conducted by a health care provider who accepts Medicare. However, additional costs may apply if you receive any tests or services during the visit that are not covered under the preventive care umbrella.

Benefits of Annual Wellness Visits

AWVs offer numerous benefits, including:

• Preventive Focus: Identifying risk factors before they develop into serious conditions.
• Personalized Care Plans: Tailored advice based on your unique health profile.
• Cost-Free Access: No copayment or deductible when using a Medicare-approved provider.
• Early Detection: Regular cognitive screenings and other evaluations can help catch issues like dementia or chronic conditions early.

Potential Drawbacks of Annual Wellness Visits

Though AWVs are beneficial, they may not meet everyone’s expectations. Those expecting a full physical exam or treatment may be disappointed. If additional tests or follow-ups are required, these may not be covered as part of the visit. Some patients may feel the AWVs are too short to fully address their concerns.

Again, any extra services performed during your AWV that are not considered preventative care could mean you will be billed for it. To avoid unexpected charges, consider communicating with your health care provider before the visit. You can ask which services will be included in the AWV and whether any additional tests or procedures might be necessary. This way, you can ensure you understand what is covered and what might result in out-of-pocket expenses.

Being informed and proactive can help you make the most of your Medicare benefits while minimizing unexpected expenses.

Tips for Making the Most of Your Annual Wellness Visits

To maximize the value of your AWVs:

• Prepare a list of questions or concerns in advance. For instance, if you have existing health issues, it’s important to discuss management strategies during your visit. You may want to inquire about referrals to specialists that can help you maintain or improve your health or ask your provider how best to communicate with them if you have health concerns that come up throughout the year. Knowing what the right channels are can ensure that you get timely advice and support.
• Bring a complete list of medications and supplements you take.
• Share any significant changes in your health or lifestyle since your last visit.
• Discuss preventive services and screening tests you may be eligible for based on your age and health status.

Learn More About AWVs and Other Medicare Benefits

AWVs are a helpful Medicare benefit to allow you to stay proactive about your health. By focusing on prevention and risk assessment, these visits can help you identify potential health issues. However, they are not a substitute for traditional medical care or physical exams.

You may want to weigh the benefits and limitations, consult your health care provider, and decide whether these visits align with your health care goals. Note that these visits are not mandatory, and you do have the option of refusing them without facing a penalty.

You can also consult an experienced elder law attorney near you to learn more about Medicare’s benefits and limitations, as well as other elder law issues.

For additional reading about Medicare, check out the following articles:

• Beware Medicare’s Penalties for Late Enrollment
• Medicare Advantage Plans Often Wrongly Deny Necessary Care, Study Finds
• Who Is Eligible for Both Medicare and Medicaid?
• Medigap: Plugging the Holes in Medicare