The Medicare Annual Wellness Visit (AWV) is a preventive service designed to create a personalized plan to prevent disease and disability. The most direct answer to whether this service is free for people with Medicare is yes, for most beneficiaries, provided certain rules are followed. This visit is not a traditional physical examination, but rather a planning session focused on risk assessment and health education. Understanding the differences between the AWV and other medical services is key to ensuring the visit remains at no cost.
Medicare Coverage for Annual Wellness Visits
The Annual Wellness Visit is covered under Medicare Part B as a preventive service. The Social Security Act includes provisions for “personalized prevention plan services,” the formal name for the AWV, to be provided with no cost-sharing. This means that if the service is billed correctly as an AWV, the Part B deductible and coinsurance are waived.
Eligibility for this free annual service depends on the timing of your Medicare enrollment. New beneficiaries are first eligible for the “Welcome to Medicare” Preventive Visit, which must occur within the first 12 months of having Medicare Part B. Subsequent Annual Wellness Visits are covered once every 12 months. A full 12 months must pass after the initial “Welcome to Medicare” visit or the last AWV before the next one is covered.
For the visit to remain free, the services provided must strictly adhere to the defined scope of the Annual Wellness Visit. This ensures the preventive nature of the service is maintained.
Differentiating the AWV from a Routine Physical Exam
The Annual Wellness Visit is fundamentally different from a routine physical exam, a distinction that often causes confusion and unexpected bills. The purpose of the AWV is to develop or update a personalized prevention plan based on your current health and risk factors. This visit primarily involves assessments and planning, not a hands-on physical check-up.
During an AWV, the healthcare provider will typically review your medical and family history and take routine measurements like height, weight, and blood pressure. The visit includes a Health Risk Assessment questionnaire, a cognitive assessment, and the creation of a screening schedule for appropriate preventive services. The service focuses on identifying risk factors, not diagnosing symptoms.
Conversely, a routine physical exam involves a comprehensive, hands-on physical assessment, often with the intent to find or diagnose specific problems. Medicare Part B generally does not cover routine physical exams, which are typically billed as a separate service that may require the patient to pay coinsurance and meet their deductible. The AWV is distinct because it is a structured, question-based assessment to plan future care, rather than a diagnostic examination of the body.
Potential Costs: When the Visit Is No Longer Free
Despite the AWV being a covered benefit with no cost-sharing, a bill can still arise if the visit includes services that exceed the defined preventive scope. This commonly occurs when the encounter transitions from a preventive planning session to a diagnostic or treatment visit. If a significant new or existing health problem is addressed during the AWV, the provider must bill for an additional, separate service.
This separate billing is necessary when the provider performs services “incident to” the AWV, such as treating a specific symptom or managing a chronic condition. For example, if a patient mentions a persistent cough or asks for a prescription refill, the provider must bill for that medically necessary service separately. This diagnostic service then falls under standard Medicare Part B rules, which typically require the patient to pay a coinsurance and are subject to the Part B deductible.
Costs can also be incurred when the provider orders or performs services not part of the AWV scope, such as blood work, X-rays, or an EKG. These diagnostic tests are not included in the free preventive visit and are billed separately, resulting in out-of-pocket expenses.
To avoid surprise billing, beneficiaries should explicitly ask their provider to keep the AWV and any diagnostic or treatment services separate, often referred to as “unbundling” the services. It is advisable to confirm with the provider’s office before the appointment that the visit will be billed strictly as an Annual Wellness Visit. If you have an existing or new health issue you need addressed, discuss with the provider whether they can schedule that as a separate, medically necessary visit, or bill it in addition to the AWV with a clear understanding of the potential costs.