Preventative healthcare services can reduce the risk of developing many serious diseases. Medicare offers various free and low-cost preventative services helping to extend the quality and life of its beneficiaries.

The Medicare Annual Wellness Visit stands out as a pillar of the program’s preventative care benefits. This visit gives doctors and patients a chance to map out and update a personalized healthcare plan and take advantage of other wellness benefits, like shots, screenings, and counseling services.

What is the Medicare Annual Wellness Exam?

The wellness exam is a chance to collect a detailed health history to provide the physician and patient with a snapshot of the patient’s overall health. This helps assess risks and plan for future care. The doctor will perform various risk assessments during this annual wellness exam.

One part of the visit consists of completing a health risk assessment questionnaire. Information the provider will gather could include:

  • Family and personal medical history, including current prescriptions and medical issues.
  • Routine health measurements, like height, weight, and blood pressure.
  • Personalized health advice or treatment plans based on risk factors.
  • Screen and treatment schedules.

The doctor may also discuss advanced care planning. These plans include specifying the type of care received if the patients become incapacitated and cannot speak for themselves. Some examples of advanced planning documents include assigning medical power of attorney to a trusted friend or relative and completing do not resuscitate (DNR) orders.

How Much Does the Medicare Annual Wellness Visit Cost?

According to Medicare.gov, Medicare Part B will typically pay for an annual wellness exam after 12 months of Plan B enrollment and every 12 months afterward. So long as the doctor accepts Medicare assignment, the patient should typically pay nothing. Otherwise, patients may be responsible for the portion of the bill over the Medicare-approved amount. Some private health insurance, like a Medicare Supplement Plan (Medigap), may pay for excess charges.

The Part B deductible is not applicable to the Annual Wellness Visit. Sometimes, the patient may agree to let the doctor order tests or other healthcare services that Medicare covers but it won’t fall under the Annual Wellness Visit. In those scenarios beyond the scope of the visit the patient may need to pay the deductible or coinsurance.

Is the Annual Wellness Exam a Physical Exam?

Medicare clarifies that the Medicare Annual Wellness Visit doesn’t include a comprehensive physical exam. Medicare beneficiaries should understand the difference between a wellness exam and a routine physical exam for a couple of reasons:

  • The beneficiary should know to ask for an annual wellness exam when scheduling the appointment.
  • The patient and doctor may schedule further screenings or exams for specific medical issues during the visit.

What Should Patients Bring to the Annual Wellness Exam?

Providers differ slightly, so patients should ask what information to bring for a specific visit. For instance, an existing provider may already have records on file, so the patient won’t need to take them.

Typical records requests may include:

  • A completed Health Risk Assessment: The provider might mail or email the questionnaire to the patient before the appointment. Some providers may ask the patient to arrive a few minutes early to complete the form at the office.
  • Medical, prescription, and vaccine records: Some providers may ask to see prescription bottles, but many will accept printed documents from a doctor or pharmacy. Patients may have online access to these records or could request providers for a mailed or emailed copy.

Does Medicare Cover Routine Annual Physical Exams?

According to CMS, Medicare won’t cover an annual physical unrelated to a specific health complaint, symptom, injury, or illness. Thus, Medicare Part B could deny 100% of the cost of any services outside the scope of the wellness exam.

The covered wellness exam may provide aspects of a physical exam, like routine measurements and covered screenings. Still, patients and providers should understand the difference between a complete physical exam and a wellness visit.

Does Medicare Ever Cover a Preventative Physical Exam?

New Medicare beneficiaries can take advantage of the Initial Preventative Physical Exam (IPPE). Medicare offers this physical exam so long as the beneficiary enrolled in Medicare Part B within the past 12 months. Some documents may refer to this as the “Welcome to Medicare” exam.

As with the Medicare Annual Wellness Visit, CMS believes that the exam should not cost anything or trigger paying the Part B deductible as long as the healthcare provider accepts Medicare assignment. The patient should request an Initial Preventative Physical Exam when scheduling the appointment.