A Medicare Wellness Visit is a preventative service designed to create or update a personalized health plan, not a hands-on physical examination. This service is covered under Medicare Part B, but access is subject to time restrictions set by the Centers for Medicare & Medicaid Services (CMS). Understanding these timing rules is important for beneficiaries to ensure they receive the benefit without incurring unexpected out-of-pocket costs. The rules determine when a beneficiary can receive the initial visit and the precise date they become eligible for subsequent annual visits.
The Required Initial Visit
Before accessing yearly Medicare Wellness Visits, a beneficiary must first complete the one-time “Welcome to Medicare” Preventive Visit, officially known as the Initial Preventive Physical Examination (IPPE). This visit is available only within the first 12 months of enrollment in Medicare Part B. The IPPE establishes a baseline of health and is distinct from the annual visits that follow.
During this initial visit, the provider reviews the beneficiary’s medical and social history, measures height, weight, and blood pressure, and performs a basic vision test. The provider also initiates a personalized health advice and screening schedule. Completion of the IPPE is a prerequisite that sets the eligibility for all future yearly wellness services. If a beneficiary does not complete the IPPE within the first 12 months of Part B enrollment, they must wait to receive their first Annual Wellness Visit.
Understanding the Annual Timing Requirement
Federal regulations require that Medicare Wellness Visits be 12 months apart. To be covered, each Annual Wellness Visit (AWV) must occur 12 full months after the month the previous AWV was performed, or 12 full months after the month the initial IPPE was completed. This is often referred to as the 12-month rule or the 365-day rule.
CMS enforces this 12-month period to prevent beneficiaries from accessing the service too frequently. For example, if a beneficiary had their AWV on October 15, 2024, they become eligible for their next visit on October 1, 2025—the first day of the 13th month following the previous visit. Scheduling the appointment even one day earlier than the eligibility date will result in the service being denied coverage by Medicare.
This rule is the most common reason a beneficiary receives a bill for a service they expected to be fully covered. The AWV is covered at 100% under Part B, with no co-pay or deductible, but only if the timing requirement is met. Beneficiaries must confirm the exact eligibility date with their provider or Medicare before scheduling to avoid financial responsibility for an improperly timed visit.
Components of the Wellness Visit
The Medicare Annual Wellness Visit is a structured, preventive planning session designed to manage health risks. A required component is the completion of a Health Risk Assessment (HRA), a self-reported questionnaire about lifestyle, health status, and injury risks. The provider also establishes or updates a comprehensive list of all current healthcare providers and medications, including over-the-counter supplements.
The visit includes standard measurements, such as height, weight, blood pressure, and a calculation of Body Mass Index (BMI). A cognitive assessment is also required to screen for any signs of cognitive impairment. Functional ability and level of safety are assessed, including a review of hearing and potential fall risk.
The provider establishes a personalized prevention plan, which may include a schedule for appropriate screenings and recommended health education for the next five to ten years. The AWV does not involve a head-to-toe physical exam, blood work, or treatment for specific illnesses. If the provider addresses a new or existing health problem during the visit, that portion of the service is billed separately and may incur a co-pay or deductible.