Routine medical care is important when you’re sick or suffering from an ailment, but what about when you’re feeling fine? The truth is, scheduling an annual doctor’s visit to assess your health, often referred to as a wellness visit, is just as important to do when you’re feeling fine as it is when you’re feeling under the weather.
These visits provide your physician the chance to discuss any healthcare concerns you may have, and they also give you the opportunity to ask questions about any medications or supplements you’re taking or about changes to your diet or exercise routine.
Understanding Medicare Wellness Visits
“Welcome to Medicare” Preventive Visit
This one-time appointment is available within the first 12 months of enrolling in Medicare Part B. It serves as an introduction to Medicare’s preventive services and includes:
- Review of Medical and Family History: Discuss your health history to identify potential risk factors.
- Baseline Measurements: Record vital statistics such as height, weight, blood pressure, and body mass index (BMI).
- Preventive Services Counseling: Guidance on screenings, vaccinations, and other preventive measures appropriate for you.
- Advance Care Planning: Voluntary discussion about future care preferences and planning.
For more details, visit the official Medicare page on the “Welcome to Medicare” preventive visit.
Annual Wellness Visit
After your first year with Medicare Part B, you’re eligible for an Annual Wellness Visit once every 12 months. This visit focuses on creating or updating a personalized prevention plan and includes:
- Health Risk Assessment: A questionnaire to evaluate your health status and risk factors.
- Routine Measurements: Updating vital statistics like height, weight, and blood pressure.
- Review of Medical and Family History: Updating any changes in your health history.
- Screening Schedule: A checklist for appropriate preventive services and screenings.
- Personalized Health Advice: Recommendations for health management and preventive measures.
- Cognitive Assessment: Evaluation for signs of cognitive impairments.
- Advance Care Planning: Optional discussion about future care preferences.
Refer to Medicare’s guide on Yearly “Wellness” visits for comprehensive information.
The Difference Between a Physical and a Wellness Visit
A common misconception is that a Medicare Wellness Visit is the same as an annual physical exam. However, there are key differences:
- Medicare Wellness Visit: Focuses on preventive care, personalized health planning, and assessing potential risks.
- Physical Exam: A hands-on examination that includes diagnostic tests, lab work, and evaluation of existing conditions.
Medicare does not cover a routine annual physical exam, but it does cover the Annual Wellness Visit. If you require a full physical exam, you may have to pay out-of-pocket unless you have additional coverage.
Medicare Advantage and the Annual Wellness Visit
If you have a Medicare Advantage (Part C) plan, your Annual Wellness Visit is still covered. Medicare Advantage plans must provide the same preventive services as Original Medicare, including the Welcome to Medicare visit and Annual Wellness Visit, at no additional cost.
Differences Between Medicare Advantage and Original Medicare
- Network Restrictions: Unlike Original Medicare, Medicare Advantage plans often require you to visit in-network doctors for covered preventive services.
- Additional Benefits: Many Medicare Advantage plans offer extra wellness perks, such as gym memberships (SilverSneakers), vision, dental, and hearing benefits, or even virtual check-ups.
- Integrated Care: Some plans provide care coordination services to help manage chronic conditions alongside your wellness visit.
If you’re enrolled in a Medicare Advantage plan, check with your provider to confirm in-network doctors and any additional wellness services included in your plan.
For more details on Medicare Advantage plans, visit our Medicare Advantage Plan Finder.
Frequently Asked Questions (FAQ)
1. Is a Medicare Wellness Visit the same as a physical exam?
No, a Medicare Wellness Visit is different from a physical exam. It focuses on preventive care and does not include hands-on examinations or diagnostic tests.
2. How much does a Medicare Wellness Visit cost?
The Annual Wellness Visit is covered by Medicare Part B at no cost if provided by a participating doctor. However, if additional tests or services are performed, you may have to pay a 20% coinsurance fee.
3. Can I get a Medicare Wellness Visit every year?
Yes, after your first year with Medicare Part B, you can get a Medicare Annual Wellness Visit once every 12 months.
4. Do Medicare Advantage plans cover wellness visits?
Yes, Medicare Advantage (Part C) plans cover wellness visits, but you may need to see an in-network provider to receive the service at no cost.
Need Help Understanding Medicare Costs?
You can find and compare Medicare Advantage plans, Medicare Part D plans, and Medicare Supplements using our plan finder tools:
- Medicare Advantage Plan Finder
- Medicare Special Needs Plan Finder
- Medicare Part D Plan Finder
- Medicare Supplement Plan Finder