The Medicare Annual Wellness Visit is highly recommended, but it is not mandatory.
You are eligible for the Annual Wellness Visit (AWV) once you've had Medicare Part B for 12 months. During your first 12 months as a Medicare beneficiary, you are highly encouraged to schedule your Welcome to Medicare preventive visit. This appointment is very similar to the AWV but can only occur during that first year.
Medicare covers one Annual Wellness Visit each year.
What Is the Medicare Annual Wellness Visit?
The Medicare Annual Wellness Visit is a preventive screening designed to help Medicare beneficiaries take a more active role in their health and wellness. During your AWV, your healthcare provider gathers a wide range of information, from height and weight to family and personal medical history to discovering risk factors for a variety of health conditions.
Your provider should also work with you to develop a plan to address health issues, such as increasing physical activity, managing weight, and scheduling preventive screenings.
What Happens During the Medicare Annual Wellness Visit?
The Annual Wellness Visit starts with a Health Risk Assessment (HRA). Your HRA includes self-reported information, often in the form of a questionnaire. It should include:
- Personal medical history, including surgeries, illnesses, allergies, injuries, and medications (both prescription and over-the-counter)
- Family history, including the medical background of your parents, siblings, and children, to determine possible hereditary risks
- Demographics, such as age, race, gender, and where you live, all of which may increase your risk for certain chronic conditions
- Personal habits, such as smoking, drinking, and recreational drug use
Your provider may ask you to complete your part of this assessment ahead of time. It typically takes anywhere from 15 to 20 minutes. Be sure to bring a list of your current providers and any medications you take, including supplements and vitamins.
Taking Measurements During Your AWV
Your AWV isn't just about answering health questionnaires. Your provider will also take certain measurements, such as height, weight, blood pressure, and body mass index (BMI).
Expect to talk about your ability to perform the activities of daily living (ADLs), such as bathing, dressing, eating, and walking. Your provider will also ask about the instrumental activities of daily living, which includes paying bills, housekeeping, managing medications, and shopping. All of this information is designed to help your provider understand your current health status and determine whether there is any cognitive impairment.
Your provider will also look at risk factors for depression and other mood disorders.
Providing Personalized Health Advice
Based on the information you provide as well as their personal assessment, your medical provider should offer information and/or referrals for any relevant services of programs covered by Medicare. This may include:
- Nutrition information
- Physical activity recommendations
- Tobacco use cessation assistance
- Weight loss
Medicare's preventive services include a variety of programs, like personal and group counseling, designed to support a holistic approach to wellness. For example, if you are at risk of diabetes, your provider would likely suggest nutrition counseling to develop healthy eating habits and an exercise regimen. Both of these would help reduce your risk of developing diabetes. Or, if you already have diabetes, they will help you manage your condition.
Planning for the Future
Your Medicare Annual Wellness Visit also includes a variety of planning services.
- A written schedule or checklist of recommended preventive screenings for the next 5 to 10 years
- List of immunizations recommended by your doctor
- Advance care planning services, including advance directives, identifying who you want to serve as caregiver should the need arise, the level of care you prefer, and how to have these conversations with your loved ones
Medicare Annual Wellness Visit Eligibility
You're eligible for the Medicare Annual Wellness Visit as long as you are enrolled in Part B and it's been 12 months since your last AWV. In addition, you cannot be in your first year of having Medicare Part B.
The list of Medicare-approved providers who can perform this screening includes:
- Either a medical doctor or a doctor of osteopathy
- Physician assistant (PA)
- Nurse practitioner
- Certified clinical nurse specialist
- Other licensed medical professional, such as registered dietician, health educator, or nutrition professional
Your AWV may also be performed by a team of medical professionals, under the guidance of your doctor.
Future Annual Wellness Visits
Medicare covers an AWV every 12 months. During your subsequent Annual Wellness Visits, your provider will update all information as required, including healthcare providers, medical equipment suppliers, and medications you take. They'll also take routine measurements and update your screening schedule. Basically, they'll do everything they did during that first visit. Only this time, they're updating those baseline findings and making alterations to planned preventive services as needed.
How Much Do You Pay for the Medicare Annual Wellness Visit?
Assuming you use a provider who accepts Medicare, Part B covers 100 percent of the cost for the Annual Wellness Visit. However, if you receive any diagnostic tests or have your yearly physical on the same day, charges for those services may include the Part B coinsurance (usually 20 percent of the Medicare-approved amount). In addition, the Part B deductible applies.
There is also no out-of-pocket cost for the Annual Wellness Visit if you have a Medicare Advantage plan, assuming you use an in-network provider. This is because all Medicare Advantage plans must provide the same services and benefits that you get with Original Medicare (Parts A and B).
Are the Welcome to Medicare and Annual Wellness Visits the Same?
Although very similar, the Welcome to Medicare visit is not the same thing as the Annual Wellness Visit. Mainly because you only get one Welcome to Medicare visit, and that occurs within the first 12 months that you have Medicare Part B. If you do not schedule your Welcome to Medicare preventive visit within the first year of enrollment, you will not have another opportunity.
Sometimes referred to as an initial preventive physical examination (IPPE), the Welcome to Medicare visit includes a few items not covered by the AWV:
- Simple vision test
- Some preventive screenings deemed necessary by your healthcare provider
- Flu and pneumococcal shots if needed
Missing the Welcome to Medicare screening does not prevent you from having an Annual Wellness Visit.
Why Does Medicare Cover Preventive Services?
Medicare covers a variety of preventive services and screenings. The goal is twofold:
- Help Medicare beneficiaries maintain optimum health and wellness
- Discover potential health issues in the early stages, while they're easier – and less expensive – to treat
In addition to your Annual Wellness Visit, Medicare coverage for preventive services includes mammograms, prostate cancer screenings, and vaccines against flu, pneumonia, and hepatitis B. You can find the full list of covered preventive services on Medicare.gov.
Is the Annual Wellness Visit the Same as a Yearly Physical?
The Annual Wellness Visit is not the same thing as a yearly physical. Its goal is promoting overall health and preventing disease. It is not a physical exam. You can, of course, schedule an annual physical – and your primary care doctor will likely recommend it. But while the Annual Wellness Visit is provided at zero cost to you, a yearly physical carries the standard Part B coinsurance and the deductible applies.
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