Medicare Coverage Questions

We receive many Medicare coverage questions, and we hope this information is helpful to you. There are two types of wellness visits covered by Medicare at 100 percent, as long as they are obtained during the correct time-frame:

  • “Welcome to Medicare” visit
  • Annual wellness visit

When scheduling an appointment, it is important to let your clinic provider know your appointment is a Medicare wellness visit. Reviewing this information carefully ensures you receive the services you desire at your appointment.

What does a Medicare wellness visit cost?

All Medicare beneficiaries who have Part B receive the “Welcome to Medicare” and annual wellness visit at no cost. However, if your doctor or healthcare provider addresses any problems or performs additional tests or services, Medicare no longer considers your appointment a wellness visit. You may be responsible for the balance after insurance payment. Medicare does not cover regular physicals, so you would be charged the full cost of the visit.

Medicare coverage of preventive services:

Welcome to Medicare visit

You can get this introductory visit only within the first 12 months you have Medicare Part B. This visit is covered one time. You don’t need to have this visit to be covered for yearly “wellness” visits. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including certain screenings, shots, and referrals for other care, if needed.

  • Height, weight, and blood pressure measurements
  • A calculation of your body mass index
  • A simple vision test
  • A review of your potential risk for depression and your level of safety
  • An offer to talk with you about creating an advance directives
  • A written plan that lists age-appropriate screenings, shots and other preventive services, along with coverage details for these services

Annual wellness visits

If you’ve had Part B for longer than 12 months, you can get this visit to develop or update a personalized prevention help plan to prevent disease and disability based on your current health and risk factors. This visit is covered once every 12 months (11 full months must have passed since the last visit). Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit.

  • A review of your medical and family history
  • Developing or updating a list of current providers and prescriptions
  • Height, weight, blood pressure, and other routine measurements
  • Detection of any cognitive impairment
  • Personalized health advice
  • A list of risk factors and treatment options for you
  • A screening schedule (like a checklist) for appropriate preventive services, along with coverage details for these services

This quick guide is to help you understand the services Medicare covers, and doesn’t cover, during an Annual Wellness Visit. We’ll check your height, weight and blood pressure, but a Medicare Wellness Visit is not a physical exam. It is a conversation with your care team designed to help you prevent illnesses and injuries.

What’s Covered

A Medicare Annual Wellness Visit is a conversation including:

  • A health risk assessment.
  • Past family and social history.
  • Noting what other care providers you see, like an eye doctor, dentist or chiropractor.
  • Assessment of cognitive function.
  • Recommendations for health screening and immunizations.
  • Care planning in case of an emergency. This includes a discussion of your healthcare directive.
  • Social determinants of health risk assessment (nonmedical factors that may affect your health).
  • Health education and counseling resources.
  • Current opioid or other prescription pain medications you may be taking and assessment of risks.

What’s Not Covered

The services below are not covered by Medicare during an Annual Wellness Visit:

  • A physical exam.
  • Discussion or diagnosis of a new health problem, illness, injury.
  • Discussion or management of existing health problems.
  • Medication management including refills.