Are you one of the approximately 60 million Americans enrolled in Medicare, a federal health insurance program available to individuals over the age of 65, as well as certain younger people with disabilities? If so, did you know that Medicare generally covers annual wellness visits? It’s true! Below, we explain what these visits are, who can perform them, what you should bring to them, and whether they’re required.

What Is a Medicare Annual Wellness Visit?

Medicare is divided into three parts: Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug coverage). Once you’ve had Medicare Part B for longer than 12 months, you qualify for a yearly wellness visit (note that this is different than a “Welcome to Medicare” visit, which you can attend during your first year of coverage).

As long as the provider you choose accepts assignment—meaning that they agree to be paid by Medicare, accept the amount approved by Medicare, and not bill you for any more than the Medicare deductible and coinsurance—then you won’t have to pay anything for your annual wellness visit. The Part B deductible also generally doesn’t apply. Keep in mind, however, that the Part B deductible may apply and you may need to pay coinsurance if your provider performs additional tests or services not covered by Medicare during your visit (for example, a physical examination).

What Is Covered in a Medicare Annual Wellness Visit?

The goal of a Medicare annual wellness visit is to evaluate your current health and risk factors, then develop a personalized prevention plan to help you avoid disease and disability (or update an existing plan, if you already have one in place). Prior to meeting with your provider of choice, you’ll likely need to fill out a health risk assessment form, which may include questions about your:

• Demographics
• Activity level
• Tobacco and alcohol use
• Diet
• Motor vehicle safety
• Home safety
• Daily activities
• Fall risk
• Sun exposure
• Medication use
• Personal and family medical histories
• Mental wellness
• Cognitive abilities

The questionnaire will probably also ask you to describe any symptoms that you’ve recently been experiencing.

After reviewing your completed health risk assessment form and speaking with you about your answers, your provider may also measure your height and weight, take a blood pressure reading, and perform a cognitive assessment. Based on all of the information gathered during your Medicare annual wellness visit, your provider will offer you personalized advice about your risk factors and the treatment options available to you. They will also provide you with helpful information about advance care planning and create a schedule of screenings and other preventive services recommended for your specific needs.

What Is Not Covered in a Medicare Annual Wellness Visit?

As was noted above, a Medicare annual wellness visit doesn’t include a physical exam. So, what is the difference between the two? Physicals tend to be more comprehensive than Medicare annual wellness visits. For example, during a physical, a provider might:

• Examine your eyes, ears, nose, throat, abdomen, and extremities
• Listen to your heart and lungs
• Perform pelvic and rectal exams
• Conduct neurological tests
• Check your reflexes and motor function
• Order blood and urine lab tests

Services like these are generally not included with free Medicare annual wellness visits.

Who Can Perform a Medicare Annual Wellness Visit?

Not just anyone can administer a Medicare annual wellness visit. Medicare will only cover this type of visit if it’s performed by:

• A physician (either a doctor of medicine or a doctor of osteopathic medicine)
• A physician assistant
• A nurse practitioner
• A clinical nurse specialist
• A licensed medical professional (e.g., a registered dietitian, nutrition professional, or health educator) working under the direct supervision of a physician

What to Bring to Your Medicare Annual Wellness Visit

As previously mentioned, many providers ask their patients to fill out a health risk assessment form prior to their visit. In addition to this questionnaire, you should also bring:

• A list of the medications you’re currently taking (including prescription drugs, over-the-counter drugs, vitamins, and supplements)
• A list of the medical providers you’ve seen during the last six months
• A pen/pencil and a notebook (you may also want to jot down any questions you have for your provider beforehand)

While you’re certainly welcome to attend your Medicare annual wellness visit on your own, many patients bring along a friend or family member to these appointments. A loved one can remind you to ask certain questions during the visit and help you remember what the provider said later on.

Does Medicare Require Annual Wellness Visits?

You already know that Medicare offers free annual wellness visits, but are these visits mandatory? No, they’re not. So, don’t worry—skipping your annual wellness visit won’t affect your Medicare coverage.

With that said, if you qualify for this benefit, it’s a smart idea to take advantage of it. Attending a Medicare annual wellness visit is an easy and cost-efficient way to improve your overall health and well-being. After your visit, you’ll have a much better understanding of where your health currently lies, and you’ll also know what you can do to proactively address any existing concerns and minimize your risk of developing additional issues moving forward.

Where to Get Your Medicare Annual Wellness Visit in Tampa Bay

If you’re interested in attending a Medicare annual wellness visit, you can turn to the family medicine team at Florida Medical Clinic, a trusted practice that’s been serving this community since 1993. All of the physicians on our team participate in Medicare and certain Medicare Advantage programs. We have numerous offices throughout the Tampa Bay region, including one at 13417 US-301 in Dade City. Click here to request an appointment with Dr. Burke at this location.

About Dr. Melissa M. Burke, MD

After receiving undergraduate and graduate degrees from Rutgers University, Dr. Burke went on to earn her medical degree at the Cooper Medical School of Rowan University. She completed her residency training through Hunterdon Health’s Family Medicine Residency program, and she has earned board certification from the American Board of Family Medicine. When Dr. Burke is not treating patients, she enjoys spending time with her husband and their dogs, traveling, and going to the beach.