Medicare Annual Wellness Exam: What’s Covered?

If you’ve ever booked a “Medicare annual wellness exam” expecting a full-on, head-to-toe physicalonly to discover it’s more like a strategy session for
your future healthwelcome to the club. The Medicare Annual Wellness Visit (AWV) is real, valuable, and (usually) $0. It’s also famously misunderstood.
Think of it as a yearly reset button for prevention: your risks, your screenings, your safety, your goals, and your next best steps.

In this guide, we’ll break down exactly what’s covered, what’s not, how to prep so you get the most out of it, and how to avoid the “Wait… why am I being
billed?” surprise. Then, at the end, you’ll find a longer “real-world experiences” sectionbecause sometimes the best way to understand Medicare is to hear
how the visit plays out in real life.

What the Medicare Annual Wellness Visit really is (and isn’t)

The Annual Wellness Visit is a Medicare Part B preventive benefit designed to create (or update) a personalized prevention plan. You can generally get it once
every 12 months if you’ve had Part B for more than 12 months. It’s not the same thing as a routine physical, and it’s not meant to diagnose or treat new
problems in the moment. It’s more “Let’s keep you well” than “Let’s figure out why your knee is making that noise.”

Also important: Medicare has a separate “Welcome to Medicare” preventive visit (often called the IPPE) that’s available within your first 12 months of Part B.
Some people do the Welcome visit first, then move on to the Annual Wellness Visit in later years. Others skip the Welcome visit and start with the AWV when
eligible. Different benefit, different timing, similar theme: prevention.

What’s covered in a Medicare Annual Wellness Visit

The exact flow can vary a bit by clinic, but Medicare outlines required elements for the initial AWV and the subsequent AWVs. Here’s what you can reasonably
expect to be included.

1) A Health Risk Assessment (HRA)

This is typically a questionnaire you fill out before (or during) the visit. It collects self-reported information about your health status, lifestyle habits,
mood, stress, daily functioning, fall risk, and more. If it feels like “a lot of questions,” that’s because it’s trying to catch risks earlybefore they become
a medical emergency at 2 a.m.

2) Review of your medical and family history

Your provider reviews your past medical and surgical history, hospital stays, allergies, injuries, treatments, and important family history (especially things
that may increase your risk for certain conditions). If you can’t remember the name of that surgery from 2009, don’t worrymany people can’t. Do your best,
and bring any records you have.

3) Medication review (including supplements) and your care team list

Expect a review of your current prescriptions, over-the-counter medications, vitamins, and supplements. You’ll also go over a list of the providers and
suppliers you regularly see (including behavioral health, if applicable). This part may feel “administrative,” but it’s one of the best ways to reduce
medication errors and duplicated tests.

4) Routine measurements (vitals and basic body measurements)

You’ll usually have routine measurements taken, like weight and blood pressure. At the first AWV, you may also see height and BMI recorded (or waist
circumference, when appropriate). These numbers aren’t here to judge you. They’re here to spot trends, flag risk, and guide prevention.

5) Cognitive impairment check

Medicare includes a check for cognitive impairment as part of the AWV. This can be based on direct observation, a brief screening tool, and/or input from you
or someone close to you. It’s not a “gotcha” test. It’s an early-warning systembecause earlier recognition can lead to better support and planning.

6) Review of depression risk and other psychosocial risks

Your provider may ask about mood, stress, social isolation, or other psychosocial factors. The goal is to identify risk factors and connect you with resources
or next stepsnot to turn your wellness visit into a therapy session you didn’t ask for. (Though if you do want to talk about mental health concerns, your
provider can guide you on the best visit type and next steps.)

7) Functional ability and safety screening

This is the part that surprises many peoplein a good way. Medicare expects providers to review, at minimum, items like:

• Ability to perform activities of daily living (ADLs)
• Fall risk
• Hearing impairment
• Home and community safety (including driving, when appropriate)

Translation: “Are you steady on your feet? Safe at home? Hearing well enough to avoid hazards? Getting around okay?” These questions can prevent serious
injuries and preserve independence.

8) A written screening schedule (your prevention checklist)

One of the biggest “wins” of an AWV is leaving with a clear screening scheduleoften a checklist covering the next 5–10 years. It’s typically based on your
age, risk factors, screening history, and nationally recognized preventive recommendations, plus what Medicare covers. This is where you find out what you’re
due for (and what can wait).

9) A list of your risk factors and conditionsplus a prevention plan

Medicare expects providers to identify your risk factors and conditions and recommend interventions. That might include lifestyle changes, community programs,
preventive counseling, and referrals. Common topics include nutrition, physical activity, tobacco cessation, fall prevention, and social engagement. In plain
English: the visit should end with a plan you can actually use.

10) Advance care planning (optional, but often very helpful)

Advance care planning can be offered during the AWV if you want it. This is a conversation about your preferences for future medical decisions if you ever
can’t speak for yourselfoften involving advance directives and identifying a decision-maker. It’s not about being “dramatic.” It’s about being prepared.
(Also: having this discussion can be a gift to your family, who would otherwise be stuck guessing.)

11) Additional elements you may see (depending on your situation)

Medicare guidance also includes reviewing current opioid prescriptions (if you have them), screening for potential substance use disorders, and an optional
Social Determinants of Health (SDOH) risk assessmentbasically, a structured look at how things like housing, food access, transportation, and social needs
affect health. Not every clinic does every optional element every year, but you may see them increasingly included as practices modernize.

What’s NOT covered (the part that prevents surprise bills)

Here’s the big headline: the Annual Wellness Visit is not a comprehensive physical exam. Medicare does not require a hands-on head-to-toe exam as part of the
AWV. And clinical lab tests (like routine blood work) are not automatically included as part of the AWV benefit itself.

Also not included under the AWV benefit: diagnosis and treatment of new symptoms. If you use the visit to discuss a specific medical problemsay,
“My chest feels tight when I climb stairs” or “My hip pain is waking me up”your provider may (appropriately!) perform a separate evaluation and management
service during the same appointment. That can change what you owe.

So what might trigger costs?

• Additional services performed the same day: If your provider orders or performs services that aren’t covered under the AWV preventive
  benefit, you may owe coinsurance, and your Part B deductible may apply.
• A “routine physical” request: Many people ask for “a physical,” but Medicare generally covers the wellness visit instead. If you receive
  services Medicare doesn’t cover as preventive, you may be billed.
• Lab work tied to a medical issue: Tests ordered for diagnosis or management of a condition may be billed differently than preventive
  screening services.

None of this means you should stay silent about symptoms. It means you should be clear about the goal of the appointment. If you need both an AWV and a
problem-focused visit, ask the office how they handle scheduling and billing so you’re not blindsided.

How much does the Annual Wellness Visit cost?

In many cases, you pay nothing for the AWV if your doctor or other health care provider accepts Medicare assignment and the visit stays within the wellness
benefit. The Part B deductible typically doesn’t apply to the AWV itself. But if additional tests or services are performed during the same visit that Medicare
doesn’t cover under the wellness benefit, costs may apply (coinsurance and/or deductible).

If you’re in a Medicare Advantage plan, the plan must cover at least what Original Medicare covers, but cost-sharing rules and network requirements can vary.
The best approach: confirm with your plan and your provider’s office before the appointment, especially if you’re combining visits or expecting tests.

How to prepare: a simple AWV checklist

The fastest way to upgrade your wellness visit from “fine” to “actually useful” is to show up prepared. Here’s what to bring and do:

• A current medication list (or bring the bottles), including supplements and over-the-counter meds
• Your providers list (specialists, pharmacies, therapists, clinics you visit)
• Family history notes (major conditions in parents/siblings/children if known)
• Recent screenings you’ve had (colonoscopy date, mammogram date, vaccinations, etc.)
• Any assistive devices you use (cane, walker, hearing aids) so the visit reflects real life
• Questions you actually care about (more on this below)
• Advance directive documents if you already have them (optional, but helpful)

Questions worth asking during your AWV

• What screenings am I due for this yearand which ones can wait?
• What are my top 3 health risks right now?
• What’s one change that would have the biggest payoff for me?
• Am I at higher fall risk, and what can I do at home to reduce it?
• Are my vaccines up to date for my age and conditions?
• Do any of my medications raise fall risk, dizziness, or confusion?
• What community or counseling programs would you recommend?

What the appointment usually looks like (minute-by-minute vibe)

While every practice is different, the typical Annual Wellness Visit often feels like a structured conversation plus screeningless “exam table drama” and more
“planning meeting with your body as the agenda.”

1. Check-in and questionnaires: You may complete (or review) the Health Risk Assessment.
2. Measurements: Blood pressure and weight are common; sometimes additional routine measures.
3. History and medication review: This is where you correct outdated lists and clarify what you actually take.
4. Risk review: Lifestyle, fall risk, hearing, home safety, mood, cognitiondepending on the clinic’s workflow.
5. Prevention plan: You and your provider review recommended screenings, prevention steps, and referrals.
6. Wrap-up: You should leave with a written plan or checklist (paper or patient portal).

Pro tip: If your goal is “I want labs, a full physical exam, and to talk about my shoulder pain,” say that up front when you schedule. The office can guide
you on the right appointment types so your expectations match the billing reality.

Can the Annual Wellness Visit be done by telehealth?

Some offices can complete parts of the wellness visit through telehealth (especially questionnaires, history review, and counseling). Medicare’s telehealth
rules have also been in flux in recent years. As of early 2026, Medicare telehealth coverage has expanded through January 30, 2026, allowing many beneficiaries
to receive telehealth services from home; starting January 31, 2026, many non-behavioral telehealth services generally revert to rural-location rules (with
exceptions). Because eligibility can depend on your situation, your provider type, and your coverage (Original Medicare vs. Medicare Advantage), it’s best to
ask the office: “Can my AWV be done by telehealth, and will it be billed as the no-cost wellness benefit?”

How to avoid surprise costs (without skipping important care)

1) Use the right words when you schedule

Say “Annual Wellness Visit” if that’s what you want. If you say “annual physical,” the office may schedule something else (or you may expect services that
aren’t part of the AWV). Clear language prevents mismatched expectations.

2) Ask what happens if you bring up symptoms

It’s completely reasonable to ask: “If we talk about a medical problem during this visit, will I be billed for a separate office visit?” Many clinics will
explain their process and let you choose whether to address it now or schedule separately.

3) Confirm assignment (and network, if applicable)

For Original Medicare, the “you pay nothing” rule hinges on the provider accepting assignment and the visit staying within the wellness benefit. For Medicare
Advantage, network rules can matter. A quick verification before the appointment can save headaches later.

4) Treat the AWV like a prevention strategy session

The AWV shines when you focus on prevention: screenings, fall prevention, medication safety, lifestyle changes, cognitive health, and long-term planning.
You can still address symptomsjust understand that it may turn into a combined visit with different billing.

Why the AWV is worth doing every year

When done well, the Annual Wellness Visit can be one of the highest “return on time” appointments you’ll have all year. It helps catch risks before they
become crises, ensures you’re on track for preventive screenings, and creates a plan you can actually follow. It’s also a rare medical visit where the main
goal is to keep you out of the doctor’s office later. (Yes, the irony is noted.)

Real-world experiences: what people say the Annual Wellness Visit feels like

Because the Annual Wellness Visit is more conversation than stethoscope, people’s experiences tend to fall into a few familiar patterns. Here are common
“this is what happened” scenariosshared as composite examples (not real individuals), but based on how clinics typically run the visit and what patients
commonly report.

Experience #1: “I thought I was getting a physical… but it was still useful.”

A lot of first-timers walk in expecting a classic physical: heart and lungs, reflex hammer, the whole medical greatest-hits album. Instead, the visit starts
with forms and questions. At first, that can feel anticlimacticlike showing up for a concert and getting a budgeting workshop.

Then the value starts to show. People often say the medication review is the surprise MVP. It’s where they realize an old medication is still listed even
though they stopped it months ago, or that two different doctors prescribed similar meds that may overlap. Others find out they’re overdue for a screening they
assumed was already handled. The takeaway many people share: “It wasn’t what I expected, but I left with a clearer plan.”

Experience #2: “The fall-risk questions felt randomuntil they weren’t.”

The safety and functional screening can feel oddly personal. Questions like “Have you fallen in the past year?” or “Do you feel steady when walking?” can
sound simple, but they often lead to practical changes. Some people realize they’ve been quietly avoiding stairs or rushing to the bathroom at night in dim
lightingtwo classic setups for a fall.

In these stories, the best visits don’t just ask questionsthey offer next steps: a referral to physical therapy for balance, advice on supportive footwear,
or home safety suggestions like better lighting and removing trip hazards. People often say they didn’t think a “wellness visit” would talk about throw rugs,
but they appreciate it later when they feel safer and more confident moving around.

Experience #3: “I mentioned one symptom and suddenly it wasn’t ‘free.’”

This is the scenario behind many frustrated conversations. Someone comes in for the no-cost wellness visit and casually mentions a new problemmaybe shortness
of breath, new swelling, or worsening pain. The clinician does the right thing medically by digging in, ordering tests, or adjusting treatment. Then a bill
appears because part of the appointment became a problem-focused evaluation.

The lesson people often share (after the fact): the AWV is a great time to raise concerns, but it helps to ask in the moment: “Is this something that changes
the billing today?” Many clinics will explain what’s happening and give options, such as scheduling a follow-up visit dedicated to the symptom. That way, you
still get your prevention planwithout feeling blindsided.

Experience #4: “Advance care planning was awkward… and then it was a relief.”

Advance care planning can make people uneasy because it forces us to think about worst-case situations. But many who choose to have the conversation describe
it as unexpectedly empowering. Instead of leaving decisions to chance (or leaving loved ones to guess), they clarify who should speak for them and what matters
mostcomfort, independence, aggressive treatment, or something in between.

People often say the hardest part is starting. Once it becomes a normal conversation“If you couldn’t communicate, who would you trust to decide for you?”it
feels less scary and more like good planning. A common reflection: “I didn’t love talking about it, but I’m glad we did.”

Experience #5: “The best AWV is the one that ends with a plan I can follow.”

The most positive experiences tend to share one feature: clarity. The patient leaves knowing what screenings are due, what risks matter most, and what one or
two changes are worth focusing on next. It might be a walking plan, a nutrition referral, a hearing test, or a fall-prevention program. Not 27 new goalsjust
a realistic next step.

In other words, a great Annual Wellness Visit doesn’t just tell you what’s wrong with the world. It gives you a simple map for what to do nextand that’s a
pretty solid trade for an hour of your time.