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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Discussion:

  • […] contacted about scheduling a free Health at Home visit, which should be a few months apart from the Annual Wellness Visit. During this visit, you receive a comprehensive health and wellness assessment performed by a […]

  • […] you review your advance care documents periodically – at least annually around the time of your Medicare Annual Wellness Visit (AWV). Your health status could change, and you want to make sure that your documents reflect your […]

  • May 26, 2021 at 1:15 pm, Charlene Huff says:

    Is it normal to have an annual clip paid by Medicare, then have an AWV? Isn’t that double dipping. I mean, I don’t see the difference.

    • May 26, 2021 at 9:21 pm, Aspire Health Plan says:

      Hi Charlene,

      A annual physical is a more extensive exam with bloodwork and the doctor physically doing exams. The purpose of the annual wellness visit (AWV) under Medicare is to paint a picture of your current state of health and to create a baseline for future care. The Medicare Wellness exam includes the assessments, but none of the “physical” tests where the doctor has to physically touch you.

    • July 19, 2021 at 4:31 pm, Susan says:

      I agree,I see 3 doctors in less than year,medicare should concentrate on paying medical Bill’s instead of making more appointments for the same things

  • November 17, 2021 at 11:14 pm, Marva Layman says:

    Wellness check is a waste of time for patient’s and doctor’s office alot of questions are ask and alot of paper work which patient can tell or write down anything a visit that should be eliminated and go back to physical exam

  • April 2, 2022 at 5:55 pm, David says:

    The wellness exam is a waste of everyone’s time and valuable resources. I compare it to having a physical exam on Zoom. Let’s get back to sensible medicine.

  • May 31, 2022 at 3:35 pm, Carolyn Brooks says:

    An In-Home Wellness Exam, demanded by a Medicare provider seems to be in direct conflict of HIPPA Laws. This seems both invasive and paternalistic. I do not have a quarrel with visiting my PCP for an annual “Wellness Exam”. I have an annual check-up. But I strongly resent my Medicare provider invading my home with their own practitioner to perform a physical exam and collect information. What happened to doctor patient confidentiality? An Annual Wellness Exam is not mandatory. The bullying by Medicare Providers to have an in-home wellness visit is wrong in every sense! Many seniors may be unaware that they have the right to refuse an in-home visit if they so wish.

    • June 1, 2022 at 4:21 pm, Aspire Health Plan says:

      Hi Carolyn,

      Although many of our plan members take advantage of the convenience of our in-home Annual Wellness Visits, these visits are in no way mandatory. Our network of providers offer a variety of options, for the convenience of our members – in office, video visits, and in-home Annual Wellness Visits.

  • July 13, 2022 at 5:19 pm, Deleta E Robinson says:

    O understsnd the AWV as required by Medicare.
    I remain perplexed as to their noncoverage of annual physical exam where blood is likely drawn etc. Who should pay for this OV?

    • July 13, 2022 at 10:58 pm, Aspire Health Plan says:

      Hi Deleta! Thank you for checking out our blog. While Original Medicare does not cover an annual physical exam, a Medicare Advantage plan might! (Coverage varies by plan.) If you are enrolled in one, check with your plan directly and find out. Aspire Health Medicare Advantage plans cover an annual physical exam, and our service area is Monterey County, California. Give us a call at (866) 798-1530 if you have any questions.

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