Watch Phil Capriotti on The Wealth Council

Sundays @ 1PM on Fox Business

LEARN MORE
CLIENT PORTAL

Is the Medicare Annual Wellness Visit Mandatory?

Key Points

  • While the Medicare Annual Wellness Visit is not mandatory, it is a 100% covered preventive service.
  • The Annual Wellness Visit differs from the typical annual physicals you were used to with group coverage.
  • If you’ve had Medicare Part B for more than 12 months, you qualify for an Annual Wellness visit once each year.

Medicare offers several preventive care services at no cost to beneficiaries. These exams and screenings can help you stay healthy and prevent illnesses. The most common preventive care service is the Medicare Annual wellness visit.

The Medicare Annual Wellness Visit is not mandatory. It is a medical visit that you can take advantage of voluntarily and free of charge. The wellness visit is intended to keep you in touch with your Medicare doctor and ensure that your doctor can help you with preventive care planning.

Let’s take a look at what this particular appointment includes and also review some of Medicare’s other preventive care services.

What is included in the Medicare Annual Wellness Visit?

The Annual Wellness Visit is an appointment with your primary care provider, during which they will update your prevention plan. The purpose of the appointment, after all, is to help you prevent sickness based on your health status and any risk factors you may have.

This appointment with your doctor is not the kind of full-body physical that you may have had in the past. Instead, it’s more of a review with your doctor so that he can go over a written checklist and design a prevention plan for you.

Here are some of the covered items that your Medicare doctor is likely to review with you during your first Medicare Annual Wellness Visit:

  • Routine measurements
  • Height, weight, and blood pressure check
  • Health risk assessment consisting of questions about your healthcare status, needs, and risks
  • Review of medical history and family medical history
  • Check your list of current medications
  • Assessment of your functional ability and mobility – i.e., are you able to handle your tasks of daily living like eating, transferring, bathing, and dressing
  • Screenings for hearing impairments, dementia, and depression

Your physician is also likely to update your list of preferred providers and give health advice that would enable you to reduce your risk factors. They may promote education or even counseling related to losing weight, eating right, increasing exercise, preventing falls, and ways to stop smoking.

Lastly, your doctor may also schedule you for other appropriate preventive care services, like diabetes screenings and/or mammograms.

How often does Medicare pay for a wellness visit?

You’ll be eligible for a wellness visit every year. After your first one, the subsequent wellness appointments will cover things that your doctor established as a baseline during your initial appointment.

Is the Medicare Annual Wellness Visit Mandatory?

 By Danielle Kunkle Roberts

Key Points

  • While the Medicare Annual Wellness Visit is not mandatory, it is a 100% covered preventive service.
  • The Annual Wellness Visit differs from the typical annual physicals you were used to with group coverage.
  • If you’ve had Medicare Part B for more than 12 months, you qualify for an Annual Wellness visit once each year.
Is the Medicare Annual Wellness Visit Mandatory?
The goal of the Medicare Annual Wellness Visit is to develop or update a personalized prevention plan.

Medicare offers several preventive care services at no cost to beneficiaries. These exams and screenings can help you stay healthy and prevent illnesses. The most common preventive care service is the Medicare Annual wellness visit.

The Medicare Annual Wellness Visit is not mandatory. It is a medical visit that you can take advantage of voluntarily and free of charge. The wellness visit is intended to keep you in touch with your Medicare doctor and ensure that your doctor can help you with preventive care planning.

Let’s take a look at what this particular appointment includes and also review some of Medicare’s other preventive care services.

What is included in the Medicare Annual Wellness Visit?

The Annual Wellness Visit is an appointment with your primary care provider, during which they will update your prevention plan. The purpose of the appointment, after all, is to help you prevent sickness based on your health status and any risk factors you may have.

This appointment with your doctor is not the kind of full-body physical that you may have had in the past. Instead, it’s more of a review with your doctor so that he can go over a written checklist and design a prevention plan for you.

Here are some of the covered items that your Medicare doctor is likely to review with you during your first Medicare Annual Wellness Visit:

  • Routine measurements
  • Height, weight, and blood pressure check
  • Health risk assessment consisting of questions about your healthcare status, needs, and risks
  • Review of medical history and family medical history
  • Check your list of current medications
  • Assessment of your functional ability and mobility – i.e., are you able to handle your tasks of daily living like eating, transferring, bathing, and dressing
  • Screenings for hearing impairments, dementia, and depression

Your physician is also likely to update your list of preferred providers and give health advice that would enable you to reduce your risk factors. They may promote education or even counseling related to losing weight, eating right, increasing exercise, preventing falls, and ways to stop smoking.

Lastly, your doctor may also schedule you for other appropriate preventive care services, like diabetes screenings and/or mammograms.

How often does Medicare pay for a wellness visit?

You’ll be eligible for a wellness visit every year. After your first one, the subsequent wellness appointments will cover things that your doctor established as a baseline during your initial appointment.

If you've had Part B for more than 12 months, you can get a yearly wellness visit every 12 months to develop or update a personalized prevention plan
If you’ve had Part B for more than 12 months, you can get a wellness visit each year.

Medicare Part B pays for 100% of the Annual Wellness visit whenever you are seeing a participating Medicare provider. Be aware that seeing a non-participating provider may result in excess charges that you will owe.

Sometimes your doctor may diagnose something new or need to treat a new or existing health condition during the wellness visit. This becomes diagnostic care, and Medicare can bill you for that care. Medicare Part B would pay 80% of the cost of that care after you have first satisfied your Part B deductible.

If you have enrolled in a Medigap plan, that plan may pay for some or all of the remaining 20%, depending on which Medigap plan you enrolled in. Medicare supplement plans F and G are two of the most popular supplements across the United States. Both of these plans will pay the 20% coinsurance for you.

Is a wellness visit the same as a physical?

Not exactly. An annual physical is typically a more comprehensive and extensive examination. For example, when you have had an annual physical in the past, you may have submitted blood and urine for lab testing. Your doctor may also have performed head, neck, lung, and abdominal exams, as well as testing your reflexes and neurological responses.

Medicare does not cover this kind of annual physical, so your doctor will generally not cover these during your Annual Wellness Visit. If he does, then it may be billed as diagnostic.

While the visit may not be as comprehensive as a full physical, we are lucky to have the wellness visit today. For more than 40 years, Medicare did not cover any wellness visit beyond the Welcome to Medicare initial exam.

This means that for decades Medicare beneficiaries were paying for wellness visits entirely out of their own pockets, just like they did for prescriptions before Part D was rolled out in 2006.

Who is eligible for the Annual Wellness Visit?

Medicare beneficiaries who have had Part B for at least 12 months qualify for the wellness visit. If you have never had the initial Welcome to Medicare exam or any wellness visit in the last 12 months, you can also qualify.

If you only have Medicare Part A, you are not eligible until you add Part B.

Who can perform the Annual Wellness Visit?

Any doctor or practitioner recognized by Medicare can perform the wellness visit. This would include nurse practitioners, physician assistants, clinical nurse specialists, and other health professionals who are working under the supervision of a Medicare physician.

Do Medicare Advantage plans cover the wellness visit?

All Medicare Advantage plans must cover the same medical services as Original Medicare Parts A and B, so yes, they will offer an annual wellness visit at no cost to you. Some Medicare Advantage plans also offer more comprehensive physical exams. Check your plan’s Summary of Benefits to find out what the plan offers and whether there are any costs to you for a physical if one is offered.

What to Bring to your Wellness Visit

Before your appointment, your doctor’s office may send you a form with a list of questions. This is a health risk assessment that will give your doctor relevant information about you. Filling it out will help your doctor gain a more thorough understanding of your current state of health.

It’s always a good idea to prepare for the visit ahead of time so that you will be prepared to discuss your health and your medical and family history with your physician. Plan to bring a complete list of medications that you take as well as any vitamins, minerals, supplements, and over-the-counter medications.

Be sure you write down the dosage and frequency at which you take these medications and whether you take the brand name or the generic version of the medication.

You might also make a list of your top 3 – 5 medical concerns or questions so that you can discuss them with your doctor. For example, if you have a family history of dementia, you may have questions for your doctor about how to watch for signs of this disease. Or, if you have a chronic illness, you might want to discuss with your doctor the best ways to manage your condition.

It is okay to bring a friend or family member with you to your wellness visit to help you take notes.

Pro Tips from Boomer Benefits

We commonly see billing errors happen regarding the annual wellness visit. When you call your doctor’s office to schedule this appointment, make sure to specify that you want this scheduled as an Annual Wellness Visit. Often, we see that the doctor’s office staff will incorrectly code this appointment as a normal office visit.

You don’t want this to happen because then the appointment won’t be covered at 100%. Instead, it will be subject to Medicare Part B’s deductible and coinsurance, resulting in out-of-pocket charges that you will be responsible for paying.

Remember that if you have enrolled in either your Medicare supplement or a Medicare Advantage plan through Boomer Benefits, then our Client Service Team handles any billing issues for you free of charge.

So be sure to call us if you get an unexpected bill so that we can conference in your doctor’s office and figure out what happened. We can then work with you, your doctor’s office, and Medicare itself to straighten out the billing and get your visit covered as it was supposed to be.

Get Someone on Your Side

It can often be scary to face Medicare alone. You may not know who to turn to with these questions. That’s where we come in. Give our team a call and see if we can help you with setting up your supplemental coverage so that you can gain access to our free Client Service Team help.

Key Takeaways

  • An Annual Wellness Visit is less comprehensive than a physical.
  • You are eligible for an Annual Wellness Visit once every 12 months.
  • Medicare Advantage plans must cover the same services as Part A and B, so an annual wellness visit is also covered at no cost to you.

https://boomerbenefits.com/medicare-annual-wellness-visit/

Share:

View the Latest Posts:

Before Your Next Appointment: 5 Medicare Questions That Can Help Prevent Costly Surprises

You schedule an appointment, hand over your insurance card, and assume your coverage will take care of the rest. Then a bill arrives—or the pharmacy tells you that your new prescription needs approval. Understanding your Medicare coverage before you use it can help you prepare for expenses, address paperwork, and ask better questions. Whether you are new to Medicare or have had coverage for years, these five questions are worth keeping handy. 1. Can I Use This Doctor With My Coverage? “Do you take Medicare?” is a starting point, but the next question depends on how you receive your benefits. With Original Medicare, you can generally use doctors and hospitals that accept Medicare throughout the United States. Ask whether the provider accepts assignment, meaning they agree to accept the Medicare-approved amount as full payment for covered services. With Medicare Advantage, you may need to use your plan’s network for non-emergency

7 Medicare Enrollment Mistakes to Avoid When Turning 65

Turning 65 is an exciting milestone—but it also brings important Medicare decisions. With multiple enrollment periods, coverage options, and deadlines to understand, even a small mistake could lead to delayed coverage, unexpected expenses, or lifelong penalties. Here are seven common Medicare enrollment mistakes and how you may be able to avoid them. 1. Assuming Medicare Enrollment Is Always Automatic Some people are automatically enrolled in Medicare Parts A and B, while others must enroll themselves. If you are already receiving Social Security or Railroad Retirement Board benefits before turning 65, enrollment may happen automatically. If you are not receiving these benefits, you will generally need to sign up for Medicare. Do not assume your coverage will begin automatically. Confirm your enrollment status before your 65th birthday. 2. Missing Your Initial Enrollment Period Your Medicare Initial Enrollment Period is a seven-month window that generally includes: The three months before your 65th

Original Medicare vs. Medicare Advantage: What Should You Choose at 65?

As your 65th birthday approaches, you will have several important Medicare decisions to make. One of the biggest is choosing how you want to receive your Medicare benefits. Should you select Original Medicare, or would a Medicare Advantage plan better fit your needs? Both options can provide valuable healthcare coverage, but they work very differently. The right choice depends on your doctors, prescriptions, budget, travel plans, and personal preferences—not simply on which option has the lowest advertised premium. Here is what you should understand before making your decision. First, What Is Original Medicare? Original Medicare is the traditional federal Medicare program. It includes: Medicare Part A, which generally helps cover inpatient hospital care, skilled nursing facility care, hospice care, and certain home healthcare services. Medicare Part B, which generally helps cover doctor visits, outpatient care, preventive services, medical equipment, and other medically necessary services. With Original Medicare, you can generally

Medicare Wellness Visits Explained: What Is Covered—and What Is Not

When you become eligible for Medicare, you may hear several similar-sounding terms: the “Welcome to Medicare” visit, the Annual Wellness Visit, and a routine physical exam. Although these appointments can all play a role in managing your health, they are not the same—and Medicare may cover them differently. Understanding the distinction before scheduling an appointment can help you ask the right questions, make better use of your benefits, and avoid unexpected costs. The “Welcome to Medicare” Preventive Visit The “Welcome to Medicare” preventive visit is a one-time appointment available during the first 12 months that you have Medicare Part B. This visit is designed to establish a baseline for your health and create a preventive-care plan. Your provider may review your medical and social history, discuss screenings and vaccines, check basic measurements, perform a simple vision test, assess certain health risks, and provide a written checklist of recommended preventive services.