For Professionals: Medicare Basics

Understanding Medicare’s Annual Wellness Visit: Frequently Asked Questions

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Nov 3, 2011

As of January this year, Medicare began covering an Annual Wellness Visit (AWV), a new benefit resulting from the Affordable Care Act. The AWV takes place with one’s primary care provider, is covered once every 12 months after the first year of Medicare coverage, and has no deductibles, coinsurance or copayments.

Among other things, the Annual Wellness Visit includes the provider taking your medical history, a health risk assessment, an evaluation of your physical condition, and a screening for cognitive impairment, including depression. It also includes a personalized prevention plan, where the doctor develops a strategy with you to manage your health, including planning the preventive services and screenings you may need over the next 5 to 10 years. The plan helps you take advantage of Medicare’s preventive services, many with no cost-sharing. Also resulting from ACA, eliminating the cost-sharing for many preventive services covered by Medicare marks a major milestone in Medicare’s efforts to keep beneficiaries healthy rather than just pay for treatment when people are sick. Over 800,000 beneficiaries have used the AWV benefit as of June 2011.

The Annual Wellness Visit is different than the Welcome to Medicare visit. The Welcome to Medicare visit is for beneficiaries new to Medicare (see the FAQ below). Neither the AWV nor the Welcome to Medicare visit is a routine physical exam. Both provide you with an opportunity to talk with your doctor about your health concerns. In addition, while the AWV has no cost-sharing, if your doctor performs other services or orders extra testing not included in the AWV during the same appointment, the doctor may claim for those additional services and you may have a copay.

Key publications from Medicare.gov:

FAQ: Frequently Asked Questions

1. What does the Annual Wellness Visit cost?

You pay nothing out of pocket for this visit. However, you may incur a copayment or deductible expense if additional services are performed or ordered by your doctor.

2. When am I eligible for my Annual Wellness Visit?

After you have had Medicare Part B for more than 12 months. If you've had a "Welcome to Medicare" visit within the last 12 months, you must wait 12 months after your Welcome visit to schedule your Annual Wellness Visit.

3. How often can I have my Annual Wellness Visit?

You may have an Annual Wellness Visit once every 12 months.

4. What is covered during the new Annual Wellness Visit?

Your first Annual Wellness Visit will include:

  • routine measurements such as height, weight, blood pressure and body-mass index;
  • review of medical and family history;
  • establishing a list of current providers, suppliers, and medications;
  • a personal risk assessment (including any mental health conditions);
  • a review of functional ability and level of safety;
  • detection of any cognitive impairment;
  • screening for depression;
  • establishing a schedule for Medicare's screening and preventive services you qualify for over the next 5 to 10 years;
  • other advice or referral services that may help intervene and treat potential health risks;
  • voluntary advanced care planning.

Subsequent Annual Wellness Visits will include:

  • measurement of weight, blood pressure, and other measurements deemed appropriate;
  • an update to medical and family history;
  • an update to the list of providers, suppliers, and medications;
  • a review of the initial personal risk assessment;
  • detection of any cognitive impairment;
  • an updated screening schedule; and,
  • a review and update of your list of referral services to help intervene and treat potential health risks.

6. Is the Annual Wellness Visit the same thing as an annual physical exam?

No. An annual physical is a much more extensive physical examination. In addition to collecting a medical history, it may also include: vital signs check, lung exam, head and neck exam, abdominal exam, neurological exam, dermatological exam, and extremities exam. The Annual Wellness Visit is not meant to replace your annual physical.

7. Will I actually see a doctor during the Annual Wellness Visit?

You will see your primary care provider which could be a physician, nurse practitioner or physician assistant. However, most of your time may be spent with an allied health profession, such as a nurse or medical assistant who will gather most of your medical history so that your physician can determine an appropriate preventive health screening plan.

8. What is the difference between the “Welcome to Medicare” visit and the “Annual Wellness Visit”?

  • Medicare covers a one-time Welcome to Medicare Visit. (See below for what your provider will cover at this visit.)
  • Medicare also covers an Annual Wellness Visit every 12 months. (See above for what your provider will cover during this visit).

9. When am I eligible for my “Welcome to Medicare” visit?

Medicare covers a one-time "Welcome to Medicare” visit within the first 12 months you have Medicare Part B. If you did not receive your Welcome to Medicare visit and have been with Medicare for more than 12 months, you are eligible for your Annual Wellness Visit.

10. What does the “Welcome to Medicare” visit cost?

As of January 2011, you pay nothing out of pocket for this visit.

11. What is covered in the “Welcome to Medicare” visit?

A “Welcome to Medicare” visit includes the following:

  • A thorough review of health, education and counseling about the preventive services covered by Medicare and referrals for other care if needed.
  • Establishing a schedule for Medicare's screening and preventive services you qualify for over the next 5 to 10 years.
  • A review of a medical and social history with attention to risk factors for disease detection.
  • A review of an individual's potential for depression or other mood disorders.
  • A review of the individual's functional ability and level of safety.
  • An examination to include an individual's height, weight, blood pressure, visual acuity screen, measurement of body mass index and other factors as deemed appropriate by the examining physician or qualified non-physician practitioner.
  • End-of-life planning, upon an individual's request.
  • Education, counseling, and referral based on the results of the review and evaluation services described in the previous five components.
  • EKG with interpretation and report.
  • Hearing assessment.

12. Do I have to have my “Welcome to Medicare” visit before my Annual Wellness Visit?

No. You don't have to have a "Welcome to Medicare" visit before getting an Annual Wellness Visit, but if you have the “Welcome to Medicare” visit, you'll have to wait 12 months before you can have your first Annual Wellness Visit.

13. What if I require further tests or screenings?

Medicare covers many screenings for people who are at high risk for certain diseases. During your Annual Wellness Visit, you and your doctor will decide what tests and screenings you need.

14. How do I schedule my Annual Wellness Visit or my “Welcome to Medicare” visit?

To help schedule your Welcome to Medicare visit or determine when you become eligible for your first Medicare Annual Wellness Visit, call your primary care physician.

Note: FAQ section edited from article, “Riverside Believes in Wellness at Any Age – Now so Does Medicare.”

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