Does Medicare Cover an Annual Wellness Visit?

You can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit is a conversation-based visit with your doctor or other health care provider to create a prevention plan. It isn’t a routine physical exam. If you have specific concerns about your health, you should schedule a separate appointment to discuss those, so your "Wellness" visit stays focused on prevention.

Your health care provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering the questions can help you and your doctor develop or update a personalized prevention plan to help you stay healthy and get the most out of your visit.

During this visit, your provider will:

• Take routine measurements (like height, weight, and blood pressure).
• Give you health advice.
• Review your medical and family history.
• Review your current prescriptions.
• Offer to talk with you about creating advance directives. Advance directives are legal documents that record your wishes about future medical treatment, in case you’re ever unable to make decisions about your care.
• Give you a written plan (like a checklist) letting you know what screenings, vaccines, and other preventive services you need.
• Give you an optional “ Physical activity and nutrition risk assessment ” to help your provider understand your physical activity and nutritional habits and their impact on your health.

Your provider will also:

• Perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium.
• Evaluate your potential risk factors for substance use disorder and refer you for treatment, if needed. If you use opioid medication, your provider will review your pain treatment, share information on non-opioid treatment options, and may refer you to a specialist, if appropriate.
• Order other tests, if necessary, depending on your general health and medical history.

Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “ Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.

You pay nothing if your provider accepts assignment.

The Part B deductible doesn’t apply.

However, you may have to pay coinsurance, and the Part B deductible may apply if your provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit.

If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Once every 12 months.