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Medicare Wellness Visits
As part of your Medicare coverage, you are entitled to a Medicare Wellness Visit once a year. The goal of a wellness visit is to reduce your risk of illness or injury. Medicare Wellness Visits are not a physical exam.
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Overview
The visit is not a traditional head-to-toe physical. If your provider needs to evaluate and treat a medical problem during one of these wellness visits, they may need to charge for this separately. The cost of the tests would be applied to your deductible. To learn more, visit Preventative & Wellness Visits.
Medicare Visit Types
There are two types of of visits: Welcome to Medicare Visit, and Medicare Annual Wellness Visits.
Welcome to Medicare Visit
The only other preventative visit that is fully covered by Medicare (besides the Medicare Annual Wellness Visit) is a one-time Welcome to Medicare Visit. It is available within the first 12 months that you have Medicare Part B and covers similar criteria as the Medicare Annual Wellness Visit.
You are not required to have a Welcome to Medicare Visit. However, you won’t be eligible for a Medicare Annual Wellness Visit until you've been enrolled in Medicare for at least 12 months.
If you do have a Welcome Visit, you'll be eligible for your first Medicare Annual Wellness Visit 12 months after your Welcome Visit.
The Welcome Visit is a preventative, 40-minute visit with a provider, if you have a new health problem you need addressed or are seeking a medication refill, these services will not be covered as part of the visit and separate charges will apply.
Medicare Annual Wellness Visit
At your Medicare Annual Wellness Visit, you and your care team will discuss your health and make a plan to address risk factors or illnesses you may have. The care team will also recommend checkups, vaccinations, and screenings you’ll need.
Discuss Your Health
The care team will talk with you about your health and will:
- Review your past medical history:
- Illness
- Hospitalizations
- Surgeries
- Allergies
- Injuries and treatment
- Current medicines and supplements, including vitamins and calcium
- Review your family history to see what diseases run in your family.
- Review your social history:
- Alcohol, tobacco and drug use
- Eating habits and physical activity
- Take your height, weight, blood pressure, and vitals.
- Calculate your body mass index (BMI).
- Look at your problem-solving and thinking skills.
- Talk about your risk of depression. He or she will ask you about present or past depression or mood disorder.
- Ask you about your safety and how well you function at home:
- Hearing
- Activities of daily living such as cooking meals and bathing
- Risk of falling
Make a Care Plan
The care team will also:
- Make a list of your health care team members. Your list will include all providers and suppliers involved in your regular care.
- Set up a care plan that includes:
- Risk factors and illness you have
- Treatment options and their benefits and risks
- Personalized health advice and services you need
- Your health care directive, if you have one
- Recommend check-ups and vaccinations you need:
- Vaccinations for pneumonia, influenza, and hepatitis B
- Mammograms
- Colorectal cancer screening
- Diabetes screening tests
- Personal coaching to help you manage your diabetes
- Bone mass test
- Glaucoma screening
- Blood tests for heart disease (these are covered separately under Part B)
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Does Medicare pay for a routine yearly physical?
No, Medicare does not pay for routine physical examinations. If you have secondary coverage, please call the customer service number located on the back of your card to determine covered services.
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What preventive medical visits does Medicare cover?
Medicare pays for two wellness visits: a one-time Welcome to Medicare Visit and an Annual Wellness Visit.
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What should I know about the Medicare Annual Wellness Visit?
If you’ve had Medicare Part B for longer than 12 months (and have not had a Welcome to Medicare Visit in the last 12 months), you can get this yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. The visit includes the following:
- Review of medical and family history
- A list of current providers and prescriptions
- Height, weight, blood pressure and other routine measurements
- A screening schedule for appropriate preventive services
- A list of risk factors and treatment options for you
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What should I bring to the Medicare Annual Wellness Visit??
Plan to bring the following items:
- Your medical and immunization records (if you’re seeing a new doctor – call your former doctor to get copies of these)
- Your family health history – to help your doctor determine if you’re at risk for certain diseases
- A list of prescription and over-the-counter drugs that you currently take, how often you take them and why
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How does the Medicare Annual Wellness Visit different from a yearly physical?
An annual physical is a much more extensive examination than the Medicare Annual Wellness Visit. In addition to collecting a medical history, a physical exam may also include a vital signs check, lung exam, head, and neck exam, abdominal exam, neurological exam, dermatological exam, and extremities exam.
If your provider needs to evaluate and treat a medical problem during a Medicare Annual Wellness Visit, he or she would need to charge for laboratory tests separately, and the cost of the tests would be applied to your deductible.
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Do I need to have a Welcome to Medicare Visit before an Annual Wellness Visit?
No.
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Is there a deductible or copay for the Medicare Annual Wellness Visit?
No, there is no deductible or copay for the Medicare Annual Wellness Visit.
But keep in mind that the visit could cost you some money out-of-pocket if you need to have a medical condition evaluated or treated in a way that goes beyond the purpose of a wellness visit. Which is why you should schedule a separate appointment with your primary care provider to address new health issues or get medications refilled.
Under Medicare rules, additional time or treatment during the Wellness Visit would be billed as an office visit, with Medicare paying 80% of the allowed charges and the rest being applied to your deductible or copay.
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Will I have out-of-pocket costs for preventive tests such as mammograms or colonoscopies?
Medicare determines which preventive – or screening– tests are covered and when they should take place, and no copay or deductible is required for these.
A screening test is given to those who have no symptoms of a condition, such as measuring cholesterol levels in people who have no symptoms of cardiovascular disease. A diagnostic test is used to confirm a suspected condition once initial testing has revealed its possibility. Sometimes a screening test becomes diagnostic if potential abnormalities are found and more testing must be performed.
It’s a good idea to become familiar with Medicare’s rules about screening tests. Your Guide to Medicare’s Preventive Services explains in detail which are covered and how often. This guide is available online at: https://www.medicare.gov/coverage/preventive-screening-services.
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Does Medicare cover other kinds of doctor exams?
Yes. If you experience physical symptoms or complaints after a Medicare Annual Wellness Visit, you can schedule a problem-oriented visit or “sick visit” with your doctor. The fees for the exam and related medical tests will be submitted to Medicare and applied to your deductible and copay.
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Preventative & Wellness Visits
Preventative care helps detect or prevent serious diseases and medical problems before they can become major at Essentia Health for Preventative & Wellness Visits.