What happens at a Medicare annual wellness visit?

What happens at a Medicare annual wellness visit?

The yearly “Wellness” visit is a conversation-based visit with your doctor or other health care provider to develop or update a personalized plan to help prevent disease or disability, based on your current health and risk factors. During the visit, your provider will:

• Take routine measurements, like height, weight and blood pressure.
• Give you health advice.
• Review your medical and family history.
• Review your current prescriptions.
• Offer to talk with you about creating advance directives, the legal documents that record your wishes about future medical treatment in case you're ever unable to make decisions about your care.
• Give you a written plan, like a checklist, letting you know what screenings, vaccines and other preventive services you need.
• Give you an optional physical activity and nutrition risk assessment, to help your provider understand your physical activity and nutritional habits and their impact on your health.
• Perform a cognitive assessment to look for signs of dementia, including Alzheimer's disease.
• Evaluate your potential risk factors for substance use disorder and refer you for treatment, if needed. If you use opioid medication, your provider will review your pain treatment, share information on non-opioid treatment options, and may refer you to a specialist, if appropriate.
• Order other tests, if necessary, depending on your general health and medical history.

What is the Health Risk Assessment?

The Health Risk Assessment is a questionnaire your provider will ask you to fill out as part of the yearly “Wellness” visit, and your answers help you and your doctor develop or update your personalized prevention plan. You or your provider can update it before or during the visit. CMS tells providers that, at a minimum, the Health Risk Assessment collects:

• Demographic data.
• A self-assessment of your health status.
• Psychosocial risks, including but not limited to depression, life satisfaction, stress, anger, loneliness or social isolation, pain and fatigue.
• Behavioral risks, including but not limited to tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety (like seat belt use) and home safety.
• Activities of daily living, including but not limited to dressing, feeding, toileting, grooming, physical ambulation (including balance or fall risks) and bathing.
• Instrumental activities of daily living, including but not limited to using the phone, food preparation, housekeeping, laundry, transportation, shopping, managing medications and handling finances.

What else does the provider check at the first Wellness visit?

CMS's guidance for providers adds more to the first yearly “Wellness” visit: a list of the providers and suppliers who regularly give you medical care, a review of your potential risk factors for depression, and a review of your functional ability and level of safety, including your ability to do daily activities, fall risk, hearing impairment, and home and community safety (including driving, when appropriate). Your provider also sets up a written screening schedule, based on a checklist for the next 5 to 10 years, U.S. Preventive Services Task Force and Advisory Committee on Immunization Practices recommendations, and your Health Risk Assessment, health status and screening history, and can refer you to health education or counseling programs on topics like fall prevention, nutrition, physical activity, tobacco-use cessation, social engagement, weight loss and cognition.

At later Wellness visits, your provider updates the Health Risk Assessment, your history, your providers list, your screening schedule and your list of risk factors, and measures your weight (or waist circumference) and blood pressure. If your provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function. See what Medicare covers for dementia care.

When can I get a Medicare Wellness visit?

Medicare Part B covers the yearly “Wellness” visit once every 12 months. Your first one can't take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit, and you don't need to have had a “Welcome to Medicare” visit to qualify for a yearly “Wellness” visit.

The “Welcome to Medicare” preventive visit is a separate, one-time check-up that Part B covers within the first 12 months you have Part B. It's a chance to review your medical history, get up to date on important screenings and vaccines, and talk with your provider about your family history and how to stay healthy.

What do I pay for a Medicare Wellness visit?

You pay nothing for the yearly “Wellness” visit if your provider accepts assignment, and the Part B deductible doesn't apply. However, you may have to pay coinsurance, and the Part B deductible ($283 in 2026) may apply, if your provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit. If Medicare doesn't cover the additional tests or services, like a routine physical exam, you may have to pay the full amount.

Two optional parts of the visit cost nothing when they're part of your yearly “Wellness” visit: advance care planning, if your provider accepts assignment, and the physical activity and nutrition risk assessment. If you get advance care planning as part of other medical treatment, the Part B deductible and coinsurance apply, and if you get the risk assessment as part of another office or behavioral health visit, you pay 20% of the Medicare-approved amount after the Part B deductible. See Medicare and advance care planning.

Is the Wellness visit the same as an annual physical?

No. Medicare.gov says the yearly “Wellness” visit isn't a routine physical exam, and Original Medicare doesn't cover routine physical exams. If you have specific concerns about your health, Medicare.gov suggests you schedule a separate appointment to discuss them, so your Wellness visit stays focused on prevention. See whether Medicare covers an annual physical.

Medicare Advantage Plans must cover all medically necessary services that Original Medicare covers, and plans may also offer extra benefits that Original Medicare doesn't cover. A plan may have different rules and out-of-pocket costs and may require you to use doctors in its network, so check with the plan before you schedule a visit.