The acronym AWV stands for Annual Wellness Visit, a preventive benefit provided to Medicare beneficiaries. This service focuses on planning for future wellness and identifying health risks to promote better long-term health. The AWV is a fully covered service under Medicare Part B, highlighting its role in the federal government’s commitment to preventative healthcare.
Defining the Annual Wellness Visit
The Annual Wellness Visit is intended to develop or update a personalized prevention plan for the Medicare beneficiary. This is a dedicated planning session, not a visit to treat an acute illness or manage a chronic condition. The primary goal is to assess current health status, identify potential risk factors, and create a roadmap for reducing the risk of disease or disability.
The benefit was authorized by the Social Security Act to promote health maintenance among the Medicare population. Providers use the visit to review health history, evaluate lifestyle, and establish a baseline for overall well-being. By focusing on individualized prevention, the AWV encourages the use of appropriate screening services and health education programs.
Determining Eligibility and Frequency
Accessing the AWV requires meeting specific administrative criteria related to Medicare enrollment. A beneficiary must be enrolled in Medicare Part B for longer than 12 months to be eligible for the first AWV.
A beneficiary is not eligible for the AWV if they have received the Initial Preventive Physical Examination (IPPE), often called the “Welcome to Medicare” physical, within the preceding 12 months. The IPPE is a one-time benefit for new enrollees, and the AWV becomes available afterward. Subsequent visits are covered once every 12 months, meaning a full 11 months must have passed since the last Annual Wellness Visit.
This annual frequency allows the personalized prevention plan to be reviewed and updated as the patient’s health and risk profile changes. Medicare covers the AWV at no cost to the beneficiary, provided the healthcare provider accepts assignment. Medicare Advantage plans are also required to cover this benefit without cost-sharing when the patient uses an in-network provider.
Components of the AWV
The Annual Wellness Visit centers on a structured set of assessments designed to build a detailed health profile for the personalized plan. A primary component is the Health Risk Assessment (HRA), which is a self-reported or provider-administered questionnaire covering demographics, health status, psychosocial risks, and behavioral risks.
The provider must complete several key tasks during the visit:
- Establish or update a comprehensive list of all current healthcare providers and suppliers.
- Review all medications, including prescription drugs, over-the-counter items, and supplements.
- Take routine physical measurements, such as height, weight, and blood pressure, to calculate the Body Mass Index (BMI).
- Screen for cognitive impairment to detect early signs of conditions like dementia.
- Review functional ability and safety, assessing activities of daily living and potential fall risks.
Based on this gathered information, the provider develops a written personalized health advice and screening schedule for the coming year.
Distinguishing the AWV from a Physical Exam
The Annual Wellness Visit is a planning and risk assessment session, distinctly different from a traditional, hands-on physical examination. The AWV focuses on information gathering and future planning, making it a “hands-off” assessment. The primary goal is creating or updating the prevention plan, not diagnosing or treating new conditions.
A traditional annual physical exam is a comprehensive, head-to-toe examination involving hands-on procedures like palpation, listening to the heart and lungs, and checking reflexes. Physical exams often include laboratory tests, blood work, or X-rays, which are explicitly not covered as part of the AWV. If a hands-on physical exam or lab work is performed during an AWV, it may be billed separately, and the patient could incur a cost, such as a co-payment or deductible.