Medicare Annual Wellness Visit
Medicare Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to develop or update your personalized prevention plan. The AWV helps you prevent disease and disability based on your current health and risk factors. Does Medicare pay for your annual wellness visit?
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Your Annual Wellness Visit
Medicare will pay for your Annual Wellness Visit (AWV) when the following conditions are true:
- Your “Welcome to Medicare” initial visit is within the first 12 month
- It has been 12 months or longer since your last AWV
- During these 12 months, you have had Medicare Part B
If you qualify, Medicare Part B covers your AWV at 100% of the Medicare-approved cost. Moreover, there is no deductible. So you do not pay the $203 Part B deductible in 2021.
When you meet these conditions, Medicare covers the cost for your AWV. Discover more Medicare Part B preventive services.
However, if your AWV uncovers the need to investigate or treat a new or existing problem, Medicare may bill you for any diagnostic care.
Your First Annual Wellness Visit
Your first AWV maybe your Welcome to Medicare Visit if it occurs within the first 12 months of enrolling in Medicare Part B. During your initial visit, your primary care physician will cover the following:
Health Risk Assessment – you fill out the form shown on the right. The health assessment includes the following:
- General Health, Tobacco and Alcohol Use
- Physical Activity
- Functional Status Assessment
- Pain Assessment
Provider Consultation – reviews your Health Risk Assessment and addresses the following:
- Psychosocial risks
- Behavioral risks
- Activities of Daily Living
- Establish a list of current providers and suppliers
- Establish your medical/social and family history
- Physical Exam includes your height, weight, body mass index (BMI), blood pressure, visual acuity, and other factors based on your assessment
- Establish or detect any cognitive impairment you may have
Personalized Prevention Plan – a list of risk factors and conditions for which primary, secondary, and tertiary interventions are recommended. Furthermore, you will be furnished personalized health advice and referrals, as appropriate, to health education or preventive counseling services or programs such as:
What does an Annual Wellness Visit include?
During your AWV, you can update your medical/family history. Based on these updates, your primary care doctor may revise your personalized prevention plan. Furthermore, you can update your list of health providers and suppliers.
Your Annual Wellness Visit includes the following: (Medicare.gov)
- Check your weight (or waist circumference), blood pressure, and other routine measurements
- Assessment of any cognitive impairment such as signs of Alzheimer’s disease or dementia
- Receive personalized health advice and referrals to health education, preventive counseling, and programs
- A screening schedule for preventive services, such as diabetes and vaccines
How to Make An Annual Wellness Appointment
The Washington Post published an article about a lady on Medicare named Beverly Dune. She “called her primary care doctor’s office to schedule an annual checkup, she assumed her Medicare coverage would pick up most of the tab. The appointment seemed like a routine physical, and she was pleased that the doctor spent a lot of time with her. Until she got the bill: $400.”
When you call your doctor to make an appointment, it is essential to use the words “annual wellness visit.” Otherwise, if you use the words “Annual Physical,” the visit may cost you $400! A physical exam is more comprehensive than a wellness visit.
For example, a physical is a full-body examination where the doctor exams your head, neck, lungs, abs, reflexes, and neurological responses. Furthermore, physicals usually include blood and urine lab testing.
Therefore, make sure you use the words “annual wellness visit” when you schedule your doctor’s appointment. Otherwise, Medicare won’t cover it. Discover what else Medicare does not cover.
Last Updated on June 25, 2021 by Brian Kondas