Medicare has covered Annual Wellness Visits via telehealth since March 2020, when the program began reimbursing for virtual AWVs in response to the COVID-19 pandemic.1The Journal of the American Board of Family Medicine. National Trends of Telehealth Use in Medicare Annual Wellness Visits The shift was initially an emergency measure, but it opened a door that hasn’t fully closed. Whether telehealth AWVs remain permanently available depends on evolving federal policy, and the visit itself looks somewhat different through a screen than it does in a clinic exam room.
What the Annual Wellness Visit Actually Is
The Medicare AWV is not a head-to-toe physical exam. It’s a preventive planning visit designed to update your health risk profile, review medications, screen for depression and cognitive decline, check whether you’re current on vaccines and cancer screenings, and discuss advance care planning. Medicare covers one AWV per year at no cost to the beneficiary, with no copay or deductible. There are two versions: an Initial Preventive Physical Examination (sometimes called the “Welcome to Medicare” visit) during your first 12 months of Part B enrollment, and the subsequent AWV available every year after that. The IPPE includes a few hands-on elements like blood pressure, weight, and a visual acuity check. The subsequent AWV is more of a structured conversation with questionnaires and screening tools.
This distinction matters for telehealth. Because the subsequent AWV is mostly discussion and screening, it translates reasonably well to a video or phone call. The IPPE, with its physical measurement requirements, is harder to replicate remotely. When COVID-19 hit and roughly 80 percent of primary care visits shifted to telehealth in March 2020, practices found the AWV’s required blood pressure and weight measurements to be a real obstacle.2PubMed Central. Achieving Large-Scale Quality Improvement in Primary Care Annual Wellness Visits and Hierarchical Condition Coding – Section: Impact of COVID-19 Many ended up deferring those elements until in-person visits resumed months later.
How a Telehealth AWV Works in Practice
A telehealth AWV follows the same checklist as an in-person one, but providers adapt their approach. The visit typically involves updating your health history, reviewing your current medications, running through depression and alcohol-use screening questionnaires, discussing whether you’re up to date on recommended preventive services like colonoscopies or mammograms, and having a conversation about advance care planning. Providers who have done these visits regularly describe them as flexible, convenient, and often shorter than their in-person counterparts.3PubMed. Primary Care Providers’ Perspectives on Telehealth Medicare Annual Wellness Visits for Older Adults in a Midwestern Health System
One unexpected advantage providers have reported is the ability to observe a patient’s home environment during a video visit. Seeing cluttered walkways, poor lighting, or how a person moves through their living space can reveal fall risks and functional limitations that would never come up in a clinic setting. That kind of environmental context is genuinely useful for the AWV’s goal of building a personalized prevention plan.
Pre-visit coordination has turned out to be essential to making telehealth AWVs run smoothly. Staff often call patients beforehand to walk them through the technology, confirm which screenings are due, and help them fill out questionnaires electronically. In practices that invested in this kind of preparation, providers reported that the actual visit itself was more focused and efficient.3PubMed. Primary Care Providers’ Perspectives on Telehealth Medicare Annual Wellness Visits for Older Adults in a Midwestern Health System
Where the Virtual Format Falls Short
Telehealth AWVs have real limitations, and providers are candid about them. The biggest challenges cluster around three areas: cognitive screening, mobility assessment, and managing patients who have sensory impairments.
Cognitive screening is one of the AWV’s signature components. Medicare expects providers to assess for signs of cognitive decline at every wellness visit. In person, this might involve watching how someone performs a clock-drawing test, follows multi-step instructions, or navigates brief standardized assessments. Over video, some of these tasks become awkward or unreliable. A Cochrane review of telehealth assessments for dementia found that remote evaluations can detect dementia with sensitivity and specificity both ranging from 0.80 to 1.00, but the researchers rated this as very low-certainty evidence due to inconsistency between studies and risk of bias.4Cochrane Database of Systematic Reviews. Telehealth assessment for the diagnosis of dementia and mild cognitive impairment For milder cognitive impairment, the picture was worse: only one study with 100 participants provided data, showing a sensitivity of just 0.71 and specificity of 0.73. In practical terms, that means a telehealth cognitive screen may miss roughly three out of ten people with mild cognitive impairment.
Telephone-based cognitive tools like the Telephone Interview for Cognitive Status show a meaningful relationship with healthcare utilization patterns in older adults, suggesting they capture something real about cognitive function.5PubMed Central. Feasibility of Telephone-Based Cognitive Assessments and Healthcare Utilization in US Medicare-Enrolled Older Adults Following Emergency Department Discharge But “something real” and “good enough to replace an in-person assessment” are not the same thing. Providers have specifically flagged cognitive assessment as one of the hardest parts of the AWV to do remotely.
Mobility and fall-risk assessments pose a similar problem. Watching a patient stand up from a chair, walk across a room, and turn around is a standard part of evaluating an older adult’s stability. Through a webcam, the viewing angle is limited, and providers can’t be confident they’re seeing the full picture. Patients who have hearing impairments or significant vision loss also struggle with telehealth visits, particularly when they don’t have a caregiver present to help facilitate the technology and communication.3PubMed. Primary Care Providers’ Perspectives on Telehealth Medicare Annual Wellness Visits for Older Adults in a Midwestern Health System
Impact on Preventive Care
Despite the limitations, the evidence on telehealth AWVs’ effect on preventive care is encouraging. A study of three small community-based practices that implemented a virtual AWV intervention using electronic health record tools and practice redesign saw AWV utilization jump from 7 percent at baseline to 54 percent within eight months.6PubMed Central. A Virtual Practice-Tailored Medicare Annual Wellness Visit Intervention: Increasing Use and Preventive Health Care That’s a dramatic shift. Along with it, depression screening rose from about 52 percent to 68 percent, alcohol misuse screening climbed from roughly 43 percent to 60 percent, and advance care planning conversations more than doubled, going from about 8 percent to nearly 19 percent.
At the individual patient level, the same study found that fulfillment of all eligible preventive services went from about 48 percent to 54 percent. That may sound modest, but across a Medicare population, even a few percentage points of improvement in preventive service completion translates to a large number of people getting screenings and vaccinations they would otherwise have missed.7PubMed Central. A Virtual Practice-Tailored Medicare Annual Wellness Visit Intervention: Increasing Use and Preventive Health Care – Section: Results Patients who completed an AWV were more likely to be up to date on their recommended services than those who didn’t, regardless of whether the visit happened in person or virtually.
A separate evaluation of pharmacist-led telehealth AWVs found similar benefits for preventive care and quality metric satisfaction, with the added finding that a post-visit follow-up protocol further improved outcomes.8PubMed. Evaluation of Pharmacist-led Telehealth Medicare Annual Wellness Visits to Satisfy Quality Metrics and USPSTF Recommendations After Implementation of a Post-Visit Follow-Up Protocol The pharmacist-led model is worth noting because it suggests that telehealth AWVs can work well even when delivered by non-physician providers within a team-based care structure.
Who Gets Left Behind
Telehealth AWVs were supposed to expand access, and in some ways they have. But the access gains haven’t been evenly distributed. A large study of Medicare beneficiaries found that after telehealth coverage expanded, American Indian and Alaska Native beneficiaries had substantially lower odds of completing an AWV at all compared to White beneficiaries. Black and Hispanic beneficiaries also had lower completion odds.9PubMed Central. Demographic differences in annual wellness visit completion after expanded medicare telehealth coverage These disparities persisted even after controlling for individual and county-level factors like income and rurality.
There’s an interesting wrinkle in that data: among people who did complete an AWV, Black beneficiaries were actually more likely than White beneficiaries to use telehealth for the visit.9PubMed Central. Demographic differences in annual wellness visit completion after expanded medicare telehealth coverage That suggests the problem isn’t that telehealth is unappealing to minority beneficiaries. Rather, the barriers seem to operate at an earlier stage, preventing people from getting an AWV in the first place, whether virtual or in person. Structural factors like provider availability, trust in the healthcare system, and awareness that the AWV exists and is free likely play a larger role than the telehealth modality itself.
Providers working in underserved communities have pointed to limited internet access, lack of devices, and the absence of community-based tech support as concrete obstacles to telehealth.3PubMed. Primary Care Providers’ Perspectives on Telehealth Medicare Annual Wellness Visits for Older Adults in a Midwestern Health System For a 78-year-old Medicare beneficiary without reliable broadband, a video wellness visit isn’t more convenient; it’s impossible.
The Audio-Only Question
Not all telehealth is video. A substantial share of telehealth visits during the pandemic were audio-only, meaning a regular phone call. Across one large health system, about 45 percent of patients who had a telehealth visit used phone only.10PubMed Central. Predictors of Audio-Only Versus Video Telehealth Visits During the COVID-19 Pandemic This wasn’t random: older patients, those who needed an interpreter, those on Medicaid, African American patients, and people in areas with low broadband access were all significantly less likely to use video.
For the AWV specifically, audio-only visits raise questions. The visit’s cognitive screening component is harder over the phone because the provider can’t see the patient at all. Environmental observations, one of telehealth’s genuine advantages, disappear entirely. And the sense of personal connection that helps build the provider-patient relationship can feel thinner over the phone than over video. At the same time, phone-based AWVs may be the only realistic telehealth option for the patients who stand to benefit most from not having to travel to a clinic.
Medicare’s policies on audio-only reimbursement for AWVs have shifted over time, with pandemic-era flexibilities sometimes extending and sometimes tightening. If you’re considering a phone-based AWV, it’s worth confirming with your provider’s billing office that the visit will be covered under current rules, since these policies can change from one calendar year to the next.
What to Expect If You Schedule One
If you schedule a telehealth AWV, here’s what will make it go well. Before the visit, your provider’s office will likely send you questionnaires to fill out covering your health history, current medications, mood, and functional abilities. Complete these ahead of time. If you have a blood pressure cuff or scale at home, take readings and have them ready, since your provider may ask for them even though they can’t measure directly. Have your medication bottles nearby so you can review them together.
During the visit, expect to go through your screening results, discuss any changes in your health over the past year, review which preventive services you’re due for, and talk about your goals and preferences for future care, including advance care planning. Your provider may ask you to perform a simple cognitive screening task, like remembering a list of words or counting backward. They might ask you to stand and walk if the video angle allows it.
Afterward, you should receive a personalized prevention plan that lists your upcoming screenings, vaccinations, and any referrals. One important caveat: a telehealth AWV doesn’t include a hands-on physical exam. If your provider identifies something during the visit that needs a physical evaluation, they’ll schedule a separate in-person appointment. The AWV and a physical exam are different services under Medicare, and many beneficiaries don’t realize they can have both in the same year.
Reimbursement Parity and the Future of Virtual AWVs
One of the practical factors that determines whether telehealth AWVs survive long-term is reimbursement. Providers in studies have emphasized the importance of maintaining payment parity between telehealth and in-person AWVs.3PubMed. Primary Care Providers’ Perspectives on Telehealth Medicare Annual Wellness Visits for Older Adults in a Midwestern Health System If Medicare pays less for a virtual AWV, practices will stop offering them, particularly smaller and rural practices that operate on thin margins. The pandemic-era telehealth flexibilities were extended multiple times by Congress, and various legislative proposals have sought to make some of them permanent.
The evidence that virtual AWV programs dramatically increase utilization is hard to ignore. Going from 7 percent AWV completion to 54 percent in under a year, as one intervention demonstrated, represents a massive improvement in preventive care delivery.6PubMed Central. A Virtual Practice-Tailored Medicare Annual Wellness Visit Intervention: Increasing Use and Preventive Health Care AWV completion rates nationally have been stubbornly low for years, and anything that moves the needle that far is going to attract attention from policymakers and health systems alike. The challenge is preserving the access benefits of telehealth while honestly reckoning with what a screen or phone can’t replace.
Pharmacist-Led and Team-Based Models
One development worth watching is the expansion of who conducts telehealth AWVs. Medicare allows AWVs to be performed by physicians, nurse practitioners, physician assistants, and certain other qualified health professionals. In some health systems, pharmacists have begun leading telehealth AWVs as part of interprofessional teams, handling medication reviews, screening questionnaires, and preventive care coordination. Evaluations of these pharmacist-led models have found that they improve quality metric satisfaction and preventive care delivery, particularly when paired with structured follow-up after the visit.8PubMed. Evaluation of Pharmacist-led Telehealth Medicare Annual Wellness Visits to Satisfy Quality Metrics and USPSTF Recommendations After Implementation of a Post-Visit Follow-Up Protocol
This matters because one of the biggest barriers to AWV adoption has always been workflow. In a busy primary care practice, carving out 30 to 40 minutes for a wellness visit that doesn’t address acute complaints can feel like a luxury. Distributing the AWV’s components across a team, with a pharmacist conducting the bulk of the visit remotely and a physician reviewing the results afterward, may be a more sustainable model. The telehealth format makes this kind of task-sharing logistically easier because it doesn’t require physical exam room time. For Medicare beneficiaries, the key takeaway is that your AWV might be conducted by someone other than your usual doctor, and that’s not necessarily a downside if the care team is well-coordinated.