Medicare does cover Annual Wellness Visits conducted via telehealth. The policy shift began in March 2020, when Medicare started reimbursing for AWVs delivered through video and audio technology as part of the emergency telehealth expansion during the pandemic.1The Journal of the American Board of Family Medicine. National Trends of Telehealth Use in Medicare Annual Wellness Visits That said, the story is more nuanced than a simple “yes.” How well a telehealth AWV works compared to an in-person one depends on what your provider needs to assess, your comfort with the technology, and whether you have someone nearby to help if needed.
How the Telehealth AWV Policy Came About
Before 2020, Medicare required Annual Wellness Visits to be conducted face to face. The AWV is not the same as a standard physical exam. It is a preventive visit focused on reviewing your health history, updating a personalized prevention plan, screening for cognitive changes, and making sure you are up to date on vaccines and cancer screenings. Medicare covers one AWV per year at no cost to the beneficiary, with no copay or deductible.
When COVID-19 made in-person visits risky for older adults, the Centers for Medicare and Medicaid Services (CMS) expanded telehealth coverage broadly, and AWVs were included. Providers could now bill Medicare for these visits conducted over video. The change was originally temporary, tied to the public health emergency, but Congress has since extended telehealth flexibilities multiple times. As of this writing, Medicare continues to reimburse for telehealth AWVs, though the specific rules around audio-only visits versus video visits have shifted over time and may change again when current extensions expire.
What a Telehealth AWV Actually Looks Like
The core components of an AWV remain the same whether you are sitting in a clinic exam room or on your couch with a tablet. Your provider will review your medical and family history, go over your current medications, update your list of providers, and work through a health risk assessment. That assessment covers things like fall risk, mood, alcohol use, and your ability to carry out daily activities. The visit should also produce or update a personalized prevention plan that maps out which screenings, vaccines, and lifestyle changes are recommended for you over the coming year.2PubMed Central. A Virtual Practice-Tailored Medicare Annual Wellness Visit Intervention: Increasing Use and Preventive Health Care
Much of this translates naturally to a video call. Reviewing your medication list, discussing your health concerns, and filling out questionnaires can all be done remotely. Some practices send the health risk assessment to patients electronically before the visit, which actually streamlines things. You fill it out at your own pace, and then the provider reviews it with you during the appointment rather than rushing through paperwork together.
Where the telehealth format runs into trouble is anything that requires the provider to physically observe or examine you. Checking your blood pressure, listening to your heart, assessing your gait and balance, or performing a visual skin check are all harder or impossible through a screen. This does not necessarily disqualify the visit, but it means some elements may need a follow-up in-person appointment or may simply be deferred.
The Cognitive Screening Challenge
One of the most important parts of the AWV is the cognitive assessment. Medicare requires providers to detect any signs of cognitive impairment during the visit. This is often the only routine touchpoint where early memory problems or confusion might get flagged, and it matters because catching cognitive decline early opens the door to planning, support services, and in some cases treatment. Telehealth has been recognized as a tool that could actually broaden access to this kind of screening, especially for people who have difficulty getting to a clinic.3Innovation in Aging. The Evaluation of Telehealth’s Impact on Medicare Annual Wellness Visits and Dementia Diagnosis
In practice, though, providers report real difficulties performing cognitive and mobility assessments over video. Managing patients who have hearing or visual impairments is particularly hard without a caregiver or family member present to help navigate the technology and relay instructions.4PubMed. Primary Care Providers’ Perspectives on Telehealth Medicare Annual Wellness Visits for Older Adults in a Midwestern Health System Standard cognitive screening tools like the Mini-Cog or clock-drawing test were designed for in-person administration, and they do not always translate cleanly to a video format. A patient holding a piece of paper up to a webcam is not the same as a provider watching them draw in real time.
Researchers have been exploring alternatives. One approach involves having patients complete an online cognitive screening test at home before their visit. A recent feasibility study found that about 79% of older adults were able to complete a self-administered online cognitive test at home, and most participants actually said they preferred it to in-clinic testing. However, performance on the at-home test only moderately correlated with the standard in-clinic cognitive assessment, and the completion rate fell slightly below what researchers had hoped, suggesting some people need extra support to get through it.5medRxiv. Feasibility of at-home online cognitive screening prior to primary care wellness visits for older adults This kind of pre-visit testing is promising but not yet standard practice.
Virtual AWVs Lead to Fewer Preventive Tests
Here is a finding that should give anyone considering a telehealth AWV some pause. A large study comparing virtual and in-person annual visits found that high-value preventive tests were about 14% less likely to be ordered at virtual visits and about 13% less likely to be completed afterward, compared to in-person visits where roughly 55% of patients had such tests ordered.6JAMA Network Open. Test Ordering and Completion During Virtual vs In-Person Annual Visits These are not obscure tests. “High-value” in this context means things like cancer screenings, diabetes blood work, and cholesterol panels that evidence supports for preventive care.
There is a silver lining buried in the same data: low-value tests, the kind of unnecessary testing that drives up costs without improving outcomes, were also about 19% less likely to be ordered at virtual visits.6JAMA Network Open. Test Ordering and Completion During Virtual vs In-Person Annual Visits So virtual visits cut both helpful and unhelpful testing. The net effect, though, is that if your AWV is the visit where your provider is supposed to flag that you are overdue for a colonoscopy or need a lipid panel, doing it virtually increases the odds that those orders fall through the cracks. Some of the gap in test completion likely reflects a second step the patient needs to take: after a virtual visit, you still have to go somewhere in person to get blood drawn or undergo an imaging study, and that extra step creates friction that an in-person visit avoids.
Who Actually Uses Telehealth AWVs
Despite being available since 2020, telehealth AWVs remain uncommon. Research on Medicare fee-for-service beneficiaries found that telehealth is rarely used to deliver the AWV benefit, even after the policy change expanded eligibility.7PubMed Central. Demographic differences in annual wellness visit completion after expanded medicare telehealth coverage Most people who get an AWV still do it in person. This is not entirely surprising. The AWV is already an underused benefit, with only a fraction of eligible Medicare beneficiaries completing one in any given year, so layering a new delivery format on top of an already low-uptake service was unlikely to produce dramatic shifts overnight.
The people who stand to benefit most from a telehealth option are those who face barriers getting to a clinic: people in rural areas, those with mobility limitations, and beneficiaries who lack reliable transportation. Telehealth could, in theory, help close gaps in preventive care access by removing geographic and logistical obstacles.8PubMed Central. Demographic differences in annual wellness visit completion after expanded medicare telehealth coverage – Section: BACKGROUND In practice, the digital divide introduces its own barriers that cut along familiar lines.
The Digital Divide and Equity Concerns
Telehealth requires, at minimum, a phone, and ideally a smartphone, tablet, or computer with a camera and a reliable internet connection. These requirements are not evenly distributed. A study of over 100,000 telehealth patients found that nearly half received care through audio-only phone visits rather than video. The likelihood of using video dropped significantly with age, with each additional decade of life reducing the probability of a video visit by about 7 percentage points. Living in a zip code with low broadband access, needing a language interpreter, and being on Medicaid as a primary insurance were all independently associated with lower video visit use.9Journal of General Internal Medicine. Predictors of Audio-Only Versus Video Telehealth Visits During the COVID-19 Pandemic
This matters for AWVs specifically because the visit’s value depends partly on what the provider can observe. An audio-only phone call is better than skipping the visit entirely, but it strips away any visual assessment. Your provider cannot watch you walk, notice a suspicious skin lesion, or gauge your affect and engagement during a cognitive screen over the phone. Racial and ethnic disparities in AWV completion also persist even after telehealth became an option, suggesting that simply making a virtual version available does not automatically reach the populations who were already underserved.7PubMed Central. Demographic differences in annual wellness visit completion after expanded medicare telehealth coverage
How to Get the Most Out of a Telehealth AWV
If you are going to do your AWV via telehealth, some preparation can close the gap between a virtual visit and an in-person one. Providers who have successfully implemented telehealth AWVs consistently point to pre-visit coordination as the single most important factor. Staff support before the appointment, including technical troubleshooting, sending forms in advance, and confirming the patient can connect, makes a meaningful difference in how smoothly the visit goes.4PubMed. Primary Care Providers’ Perspectives on Telehealth Medicare Annual Wellness Visits for Older Adults in a Midwestern Health System
From the patient side, a few practical steps help:
- Have your medications visible: Gather all your pill bottles and supplements before the visit so you can show them to the camera or read the labels. Medication reconciliation is a key AWV component, and an accurate list matters more than you might think.
- Take your vitals ahead of time: If you have a home blood pressure cuff or a bathroom scale, record your readings the morning of your visit. Many pharmacies also offer free blood pressure checks. Having these numbers ready partially compensates for the provider not being able to check them in the office.
- Bring a family member or caregiver: This is especially valuable if you have hearing or vision difficulties, or if cognitive screening is part of your visit. A second person can help relay instructions, manage the technology, and provide their own observations about any changes they have noticed in your health or memory.
- Use video if at all possible: A video visit gives your provider far more information than an audio-only call. If your internet is unreliable, try connecting from a location with better service, or ask your provider’s office whether they can help you set up the technology.
- Ask about follow-up orders: Given that preventive test orders are more likely to slip through the cracks after a virtual visit, specifically ask your provider whether you are due for any screenings or lab work before you hang up. Write down what needs to be done and where to go.
When an In-Person Visit Is the Better Choice
A telehealth AWV is a legitimate option, but it is not always the best one. If you have new or worsening symptoms, if your provider needs to do a physical examination for any reason, or if you have been putting off in-person care, the AWV can serve as the appointment that gets you back into the office. For people with significant hearing loss, limited vision, or difficulty using technology, an in-person visit may simply produce a more thorough assessment.
There is also a psychological dimension. For some older adults, the AWV is one of the few regular touchpoints they have with the healthcare system. The social contact of an office visit, the routine of getting out of the house, and the structure of interacting with a care team in person all carry value that a screen cannot fully replicate. If you are someone who tends to minimize symptoms or forget to bring things up, the physical environment of a doctor’s office can serve as a prompt in ways a video call from your living room does not.
Medicare Advantage and the AWV
Most of the telehealth AWV research focuses on traditional (fee-for-service) Medicare, but a large share of Medicare beneficiaries are enrolled in Medicare Advantage plans. These private plans are required to cover everything original Medicare covers, including the AWV, but they have their own rules around telehealth delivery. Some Medicare Advantage plans have been more aggressive about encouraging virtual AWVs, and some have offered additional telehealth benefits beyond what original Medicare provides.
One wrinkle worth knowing: in some practices, providers have replaced traditional annual physical exams with AWVs for their Medicare Advantage patients, since the AWV is a distinct Medicare benefit with its own billing code.2PubMed Central. A Virtual Practice-Tailored Medicare Annual Wellness Visit Intervention: Increasing Use and Preventive Health Care If you are on a Medicare Advantage plan and your provider offers a telehealth wellness visit, it is worth confirming whether the visit is being billed as an AWV or as a standard office visit, because the cost-sharing and covered services differ. AWVs carry no out-of-pocket cost; a regular office visit billed through telehealth may carry a copay depending on your plan.
Telehealth Primary Care and Downstream Health Effects
A broader question lurks behind the AWV-specific discussion: does getting your primary care through telehealth change your health outcomes? The AWV is just one visit in a larger pattern of care, and some evidence suggests that telehealth primary care is not merely a pale substitute for in-person visits. One study of Medicare beneficiaries found that patients who used telehealth only for their primary care had significantly fewer emergency department visits and hospitalizations compared to their own baseline rates before the telehealth period. Patients who used in-person care only also had fewer ED visits, but their hospitalization rates did not drop. Interestingly, patients who used both telehealth and in-person care actually had more hospitalizations, though this group may have been sicker to begin with and seeking care through every available channel.10BMC Health Services Research. Use telehealth as needed: telehealth substitutes in-person primary care and associates with the changes in unplanned events and follow-up visits
These findings do not prove that telehealth causes better outcomes. People who successfully manage video visits may be healthier, more engaged, or more tech-savvy to begin with. But the data at least pushes back against the worry that telehealth primary care is dramatically inferior. For AWVs specifically, the visit is heavily oriented toward conversation, planning, and screening rather than hands-on examination, which makes it one of the better candidates for virtual delivery within the primary care toolkit.
The Policy Landscape Keeps Shifting
One complication for anyone trying to plan ahead is that Medicare telehealth policy is not settled. The broad telehealth flexibilities introduced during the pandemic have been extended repeatedly, but they are temporary extensions rather than permanent law. Congress has debated making many of these changes permanent, and CMS has proposed rules that would codify some telehealth access, but the exact scope of what will be covered, whether audio-only visits will remain reimbursable, and whether geographic restrictions will return are all subject to legislative action that could change year to year.
For now, the practical advice is straightforward: if you want a telehealth AWV, call your provider’s office and ask whether they offer it and whether they can bill it under your current Medicare coverage. Most practices that adopted telehealth AWVs during the pandemic have kept them as an option, and the billing infrastructure is well established at this point. If you are due for your annual wellness visit and a trip to the clinic feels like a barrier, a virtual visit is a real and covered option that can keep your preventive care on track, even if it works best when you go in knowing what it can and cannot do.