The Medicare Annual Wellness Visit (AWV) is a preventive benefit designed to create a personalized health strategy for beneficiaries. It is not a traditional physical exam, but rather a planning session focused on risk assessment and prevention. The primary purpose of this yearly visit is to help patients and their providers develop a comprehensive plan to stay healthy and detect future health issues early. Understanding the specific timing rules set by Medicare is important to ensure the service is fully covered.
The Timing Rules for Initial Medicare Visits
Medicare sets distinct timing requirements for the initial visits a beneficiary can receive. The first preventive service is the “Welcome to Medicare” Preventive Visit, also known as the Initial Preventive Physical Examination (IPPE). This one-time benefit must be utilized within the first twelve months of a beneficiary’s enrollment in Medicare Part B coverage.
The IPPE includes reviewing health history, measuring vitals, and providing education on other preventive services. The first Annual Wellness Visit (AWV) cannot occur until twelve full months have elapsed since the Part B coverage became effective. If the beneficiary had the IPPE, the first AWV must be scheduled after twelve full months have passed since the month the IPPE was completed.
Understanding the 12-Month Requirement for Recurring Wellness Visits
The “12-month” rule for subsequent Annual Wellness Visits is precise and refers to a full year of time that must pass between services. Medicare defines this interval as twelve full months after the month the previous AWV was performed. For example, if a beneficiary had an Annual Wellness Visit on any day in January 2024, they are not eligible for the next AWV until February 1, 2025.
Scheduling a recurring AWV even one day too early will result in Medicare denying the claim for the service. If the timing rule is not followed, the beneficiary may be held responsible for the entire cost of the visit. This strict adherence to the 12-month interval is what distinguishes the fully covered AWV from a standard, medically necessary office visit.
What to Expect During a Wellness Visit
The AWV is a structured appointment that focuses on a future-oriented prevention strategy rather than treating current ailments. It begins with the completion of a Health Risk Assessment (HRA), a questionnaire about the patient’s health status, injury risks, and behavioral factors like diet and physical activity. The provider will then review the patient’s medical and family history, along with current medications, to update the health profile.
The visit also includes routine measurements such as height, weight, body mass index, and blood pressure. The functional ability assessment checks for potential fall risks and the ability to perform daily activities. The provider will develop a personalized prevention plan, which includes a checklist for all appropriate preventive services, such as vaccinations, mammograms, and colonoscopies, that the patient may need in the coming year.
Costs Associated with Wellness Visits
The Annual Wellness Visit is covered at 100% by Medicare Part B, provided the provider accepts assignment and the strict timing rules are met. The beneficiary is not responsible for any copayment, coinsurance, or deductible for the AWV service. This financial benefit encourages beneficiaries to engage in preventive health planning without facing out-of-pocket costs.
However, unexpected expenses can arise if the healthcare provider addresses a new or existing medical problem, performs a full physical examination, or orders additional diagnostic tests during the same visit. Those specific services are treated as separate, medically necessary care. For these additional services, the standard Medicare Part B deductible and 20% coinsurance may apply. To avoid surprise billing, beneficiaries should confirm with their provider that only the components of the fully covered AWV will be performed, or sign an Advance Beneficiary Notice (ABN) if additional services are anticipated.