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Medicare Annual Wellness Exam: What You Need to Know

The Medicare annual wellness exam is a free health benefit that includes a personalized prevention plan. Taking advantage of this important benefit can help beneficiaries take proactive steps to stay healthy.

If you have Medicare Part B insurance, you may have heard about the Medicare annual wellness exam, which is a free benefit. However, you may still have questions about the purpose of the exam and how it can help you. For instance, it’s important to know that the annual wellness exam is covered in full by Medicare, but it’s not the same as a routine physical exam, which isn’t covered by Medicare.

This article answers some of the most common questions about the Medicare Annual Wellness Visit (AWV) so that you can make the most of this important yearly health checkup.

What is the purpose of the Medicare annual wellness exam?

The purpose of the Medicare annual wellness exam is to develop or update your personalized prevention plan and perform a health risk assessment.

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It’s an opportunity for you and your primary care doctor to touch base about preventable health diseases and keep you on the right track toward living a healthy and active lifestyle.

What’s included in the Medicare annual wellness exam?

First, your primary care doctor will ask you to fill out a questionnaire called a Health Risk Assessment that evaluates your health status, frailty and physical functioning.

It also assesses other aspects of your health, such as:

  • Psychosocial risks (e.g., depression/life satisfaction, stress, anger, loneliness/social isolation, pain, and fatigue)
  • Behavioral risks (e.g.,  tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety and home safety)
  • Activities of daily living (e.g., dressing, feeding, toileting, bathing, grooming, physical ambulation including balance and your risk of falls)

After reviewing this assessment, your primary care doctor will likely provide a variety of other services and talk to you about preventable health diseases.

In particular, they will:

  • Review your medical and family history
  • Develop or update a list of your current providers and prescriptions
  • Take routine measurements such as height, weight and blood pressure
  • Assess for any cognitive impairment
  • Talk to you about screenings, vaccinations and other preventive services.

They may also provide advance care planning, which refers to planning for care you would receive if you became unable to speak for yourself.

When am I eligible for the Medicare annual wellness exam?

You’re eligible as soon as you’ve had Medicare Part B for 12 months. At that point, you can get a yearly wellness exam once every 12 months thereafter.

Does Medicare require a wellness exam?

Medicare does not require a wellness exam; however, it’s still important to take advantage of this important benefit. That’s because the wellness exam gives you an opportunity to get personalized health advice.

You can talk about any healthcare concerns you may have, ask questions about your medications, talk about changes to your diet or exercise routine and more.

Is the Medicare wellness exam free?

Yes, the Medicare annual wellness exam is a Medicare-covered service as long as your primary care doctor accepts Medicare. It won’t cost you anything unless your doctor performs additional tests or services during the same exam. If they do, you may owe a coinsurance or copayment depending on the service provided.

What’s the difference between a Medicare annual wellness exam and the Initial Preventive Physical Exam?

The Initial Preventive Physical Exam (sometimes referred to as the “Welcome to Medicare” exam) is a one-time exam also focused on preventable health diseases that occurs within the first 12 months of your Medicare Part B coverage.

Many of the services you receive during the Welcome to Medicare visit are the same as ones you get during the annual wellness exam (e.g., medical history review, personalized prevention plan and social health history review), and like the wellness exam, there is no cost to you if your doctor accepts Medicare.

What’s the difference between a Medicare annual wellness exam and a routine physical exam?

A routine physical exam is an exam that is not related to a specific illness, symptom, complaint or injury.

A routine physical exam is not a Medicare-covered service, meaning you will typically owe 100% of the amount due.

What can I do to prepare for the Medicare annual wellness exam?

There are several ways you can prepare for this exam. For example, you can write down all medications (and doses) you take or put them in a bag to bring with you to the appointment. This includes prescriptions, non-prescriptions, vitamins, supplements and herbal medications. Also write down your family medical history so you don’t forget anything.

Likewise, you can compile a list of all the healthcare providers you see, including their full names, addresses and phone numbers.

Another helpful way to prepare is to jot down any health-related questions or concerns in advance. You can hand the paper directly to your physician, or you can read the questions aloud. Bring a notebook with you to write down important information and advice.

If your appointment is via telehealth, be sure you know the steps to log onto the telehealth platform, and have your computer or mobile device fully charged and ready to go.

Make an appointment with your doctor today for your Medicare Annual Wellness Visit, or call a licensed insurance agent to learn about additional preventive care benefits that may be available in some Medicare Advantage (Medicare Part C) plans.

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Lisa

About the author

Lisa Eramo is an independent health care writer whose work appears in the Journal of the American Health Information Management Association, Healthcare Financial Management Association, For The Record Magazine, Medical Economics, Medscape and more.

Lisa studied creative writing at Hamilton College and obtained a master’s degree in journalism from Northeastern University. She is a member of the American Health Information Management Association, American Academy of Professional Coders, Society of Professional Journalists, Association of Health Care Journalists and the American Society of Journalists and Authors.

Lisa currently resides in Cranston, Rhode Island with her wife and two-year-old twin boys.

 

Website: LisaEramo.com

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