The Medicare Wellness Visit (MWV) is a preventive health service designed to help beneficiaries and their healthcare providers plan for future health needs. This appointment focuses on proactive care rather than addressing current illnesses or injuries. The MWV is a voluntary benefit available to all eligible individuals with Medicare Part B coverage.
Voluntary Status and Scheduling Rules
The Medicare Wellness Visit is a voluntary benefit under Medicare Part B, and there is no penalty for opting not to schedule it. Part B covers services deemed medically necessary or preventive. Eligibility depends on how long you have been enrolled in Part B and the type of visit requested.
Medicare offers two distinct types of wellness visits, each with specific timing rules. The “Welcome to Medicare” Preventive Visit is a one-time benefit available only within the first 12 months after Part B coverage begins. This initial visit establishes a health baseline separate from the yearly wellness appointments that follow.
After the first 12 months of Part B enrollment, you become eligible for the Annual Wellness Visit (AWV). You can receive one AWV every 12 months, meaning at least 11 full months must pass between each appointment. When scheduling, specify that you are requesting a “Medicare Annual Wellness Visit” to ensure the correct service is billed.
Components of the Wellness Visit
The primary goal of the Medicare Wellness Visit is to create or update a personalized prevention plan. This appointment focuses on assessment and planning, not on a hands-on physical examination or treatment of existing problems. The visit begins with the completion of a Health Risk Assessment (HRA), a questionnaire detailing your health status, lifestyle, and potential injury risks.
During the visit, your provider reviews your medical and family history, along with a complete list of current medications, including prescriptions, vitamins, and supplements. Routine measurements are taken, such as height, weight, Body Mass Index (BMI), and blood pressure. A cognitive function screening is also performed to check for signs of memory trouble or potential impairment.
The provider performs a functional assessment, looking at safety factors like the risk of falling and the ability to perform daily activities. Based on the information gathered, a personalized schedule of appropriate preventive services is developed. This plan includes recommended cancer screenings or immunizations for the next five to ten years.
Coverage and Potential Costs
The Medicare Wellness Visit is covered 100% by Medicare Part B, provided the healthcare professional accepts Medicare assignment. If the visit is strictly limited to the preventive and assessment components, you will have no out-of-pocket costs. The Part B deductible does not apply to the MWV.
Potential costs can arise if the visit goes beyond its preventive scope. If the provider addresses a new symptom, treats an existing condition, or performs diagnostic services (like blood work or an EKG) during the same appointment, those services are billed separately. These diagnostic or treatment services are subject to the standard Medicare Part B deductible and 20% coinsurance. To avoid unexpected bills, schedule a separate appointment if you need to discuss a specific illness or new medical complaint.
Wellness Visit Versus a Comprehensive Physical Exam
The Medicare Wellness Visit is often confused with a traditional annual physical exam, but they differ fundamentally in scope and coverage. The AWV focuses on risk assessment and planning, relying on interviews and non-hands-on measurements. It does not include a head-to-toe physical examination.
In contrast, a comprehensive physical exam is a hands-on checkup that includes listening to the heart and lungs, palpation, and checking reflexes. Medicare Part B generally does not cover a routine, comprehensive annual physical exam. If a traditional physical is performed, you may be responsible for the full cost, as it is considered a non-covered service unless tied to a specific diagnosis.