A Medicare Annual Wellness Visit vs. an annual physical exam

July 15, 2020
A Medicare Annual Wellness Visit vs. an Annual Physical Exam

Last year, an article ran in the Washington Post (and was republished in Kaiser Health News) about a Medicare beneficiary who scheduled her annual checkup with her primary care doctor. To her, the appointment seemed like a routine physical, and she assumed that Medicare would pay for the visit… until she received a large bill.

Why did this happen? There is a difference between an “annual wellness visit” and an “annual physical exam.” One is focused more on preventing disease and disability, while the other is more focused on checking your current overall health. We’d like to clear up any confusion you might have.

What is a “Welcome to Medicare” preventive visit?

People over 65 who choose standard Medicare coverage (Part B-Medical coverage) when they enroll in Medicare can also opt for a one-time “Welcome to Medicare” preventive visit within the first 12 months. For this visit to be free:

  • Your doctor must accept Medicare
  • Your doctor must not provide additional tests or services during the same visit
  • Additional tests or services not covered under preventive benefits must not be performed

When making your appointment, let your doctor’s office know this is your “Welcome to Medicare” preventive visit. This visit will include a review of your medical history and  counseling of your preventive services. It is not a head-to-toe physical exam.

What is a Medicare Annual Wellness Visit?

If you choose standard Medicare coverage, you can opt to have an Annual Wellness Visit (AWV) with the purpose of creating a personalized prevention plan. In addition, topics such as advance care planning are discussed. When making your appointment, let your doctor’s office know this is your “Annual Wellness Visit.” Like the “Welcome to Medicare” visit, it is not a head-to-toe physical exam. Your AWV is covered if you have been enrolled in standard Medicare coverage (Part B) for more than 12 months and you have not received another AWV in 12 months. Over time, your personalized prevention plan will be updated based on our current health and risk factors.

What is an annual physical exam, and does Medicare Advantage cover this?

An annual physical exam is more extensive than an AWV. It involves a physical exam by a doctor and includes bloodwork and other tests. The annual wellness visit will just include checking routine measurements such as height, weight, and blood pressure. A simple way to remember the difference is that a Medicare wellness exam will include assessments, but won’t include physical tests where the doctor has to physically touch you, unless you have a specific diagnosis or symptom. A Medicare Advantage plan will give you access to both the “Welcome to Medicare” preventive visit and the Medicare AWV. Most of the time, a Medicare Advantage plan will cover annual physicals free of charge.

Aspire Health Plan now pays the doctor so they do not charge the patient a co-pay when the scope of the visit goes outside the AWV. No matter what, we’d like to emphasize the importance of scheduling and attending your AWV every year. It’s a good idea to see your primary care doctor annually. And as an added perk for Aspire Health Plan members, this helps you earn Aspire Rewards.


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