Annual Physical vs. Wellness Visit for Medicare

Annual Physical vs. Wellness Visit: What’s the Difference for Medicare Beneficiaries?

If you're a Medicare beneficiary, you may have heard the terms "annual physical" and "annual wellness visit" used interchangeably—but here’s the thing: they're not the same. Understanding the difference can help you avoid confusion at your doctor's office and ensure you’re using your Medicare benefits wisely.

In this article, we’ll break down what each visit includes, what Medicare covers, and how you can prepare for each one to make the most of your health care experience.

The Basics: Two Very Different Appointments

Annual Physical Exam
An annual physical is a comprehensive, head-to-toe examination typically performed by your primary care provider to check your overall physical health. It’s a common practice in traditional health insurance plans and often includes:

• A hands-on physical exam
   
• Blood tests or other lab work
   
• Screenings (like EKGs or urinalysis)
   
• Updating vaccines
   
• Review of ongoing medical issues
   
• Listening to your heart, lungs, and checking reflexes
   

Think of the annual physical as a full body checkup, focused on identifying or treating current issues.

Annual Wellness Visit (AWV)
The Medicare Annual Wellness Visit, introduced through the Affordable Care Act, is a preventive visit that focuses more on planning and prevention than diagnosing new health conditions and/or addressing current ones. It includes:

• A review of your medical and family history
   
• Discussion of your current health providers and prescriptions
   
• Height, weight, blood pressure, and BMI measurements
   
• Cognitive function screening
   
• Personalized health advice and screening schedule
   
• Creating (or updating) your Personalized Prevention Plan
   

The goal of the Annual Wellness Visit is to create a roadmap for your future health, helping you stay well and independent as long as possible.

What Does Medicare Cover?

This is one of the most important distinctions for beneficiaries to understand.

Covered by Medicare (one of these per year):

Welcome to Medicare Visit:
Within the first 12 months of being enrolled in Medicare Part B, you’re eligible for a one-time “Welcome to Medicare” preventive visit—a more comprehensive introduction that also comes at no cost.

Annual Wellness Visit:
Medicare Part B covers an annual wellness visit every 12 months at no cost to you, as long as it’s been 12 months or longer since your Welcome Visit. Your provider must accept Medicare for this to be covered, and it’s important to note that it will not be covered if additional tests or services are performed during the same visit.

Not Covered by Medicare:

Annual Physical Exam:
Medicare does not cover a traditional physical exam. If you schedule this thinking it’s the same as the AWV, you may end up with unexpected out-of-pocket costs, especially if lab work or screenings are performed that aren’t preventive in nature.

Why the Confusion?

Many people grew up hearing they should get a “yearly physical,” and naturally assume that’s what Medicare offers. But Medicare takes a preventive care approach with the Annual Wellness Visit.

Because the two visits often happen in the same setting (your doctor’s office), it’s easy to mix them up—especially if your provider uses terms like “annual exam” loosely. That’s why it’s important to clarify what you’re scheduling and make sure it aligns with what Medicare covers.

When Should You Get an AWV?

You’re eligible for your first Annual Wellness Visit 12 months after your initial Welcome Visit (or after you’ve been enrolled in Medicare Part B for 12 months, if you choose to skip the Welcome Visit). After that, you can go back for an Annual Wellness Visit once every year.

Your provider may ask you to fill out a health risk assessment questionnaire, which helps them understand your lifestyle, health concerns, and risks. This allows them to build a personalized prevention plan that might include:

• Recommended screenings (like mammograms, colonoscopies, etc.)
   
• Fall prevention strategies
   
• Cognitive assessments
   
• Referrals for services like nutrition counseling or mental health
   
  

Tips for a Successful Wellness Visit

Want to get the most out of your AWV? Here’s how:

• Bring your medical history – including hospitalizations, chronic conditions, and family history
• List all your current medications – including over-the-counter supplements
• Note any recent changes in your health – fatigue, mood, memory, mobility
• Write down questions in advance – this is a great opportunity to talk through any concerns
• Bring your completed health risk assessment if provided in advance by your provider

Does Medicare Cover More than One Visit in the Same Year?

No, Medicare Part B will only cover one of these visits per year. There are a few scenarios in which you may need to have two different visits discussed above in the same 12-month period, but in all cases, only one of them will be covered:

• Annual physical + Annual Wellness Visit → Only the AWV is covered by Medicare
• Annual physical + Welcome to Medicare Visit → Only the Welcome Visit is covered by Medicare
• Welcome to Medicare Visit + Annual Wellness Visit → Only one of these (whichever occurs first) is covered by Medicare

If you schedule a physical in conjunction with your AWV, or if your doctor includes extra services not considered part of preventive care, you may have to pay out of pocket. To avoid surprises, ask your provider:

“Is this visit being billed as an Annual Wellness Visit under Medicare Part B?”

Bottom Line: Know Before You Go

Understanding the difference between an annual physical and a Medicare-covered wellness visit can help you:

• Avoid unexpected costs
   
• Make informed decisions
   
• Take full advantage of your preventive benefits
   

Medicare is focused on prevention. The Annual Wellness Visit is your yearly opportunity to check in with your doctor, set health goals, and stay on top of screenings—all at no cost to you.

If you’re still unsure which appointment is right for you, talk to your provider—or reach out to a licensed Medicare agent who can guide you based on your plan and needs.

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