More Than Just a Physical
A Medicare wellness checkup is a preventive visit covered by Medicare Part B that helps you and your doctor create a personalized plan to keep you healthy. It’s not a head-to-toe physical exam—instead, it focuses on preventing illness based on your current health and risk factors.
Key Things to Know About Medicare Wellness Checkups:
- Two types of visits: The “Welcome to Medicare” visit (one-time, within the first 12 months of Part B) and the Annual Wellness Visit (yearly, after 12 months of Part B).
- What’s covered: A Health Risk Assessment, medication review, screening schedule, cognitive and depression screening, and advance care planning.
- Cost to you: $0 copay and no deductible when you use a participating provider.
- Not a physical: It doesn’t include a full exam, lab work, or treatment of existing conditions.
- Frequency: Once every 12 months for the Annual Wellness Visit.
Many people confuse these visits with a routine physical exam. The key difference is that wellness visits are forward-looking, helping you and your doctor spot potential health problems before they become serious. You’ll fill out a questionnaire, discuss your health history, and create a plan for future screenings. The visit also covers things you might not expect, like checking for memory problems and discussing social needs. If you haven’t scheduled your wellness visit, you’re missing out on a valuable, free benefit designed to keep you healthy.
“Welcome to Medicare” vs. Annual Wellness Visit (AWV): Know Your First Steps
Understanding the two types of Medicare preventive visits is key to using your benefits. The “Welcome to Medicare” visit, or Initial Preventive Physical Exam (IPPE), is a one-time check-up, while the Annual Wellness Visit (AWV) is a yearly appointment. Both focus on creating and updating a personalized prevention plan to keep you healthy.
| Feature | Initial Preventive Physical Exam (IPPE) / “Welcome to Medicare” Visit | Annual Wellness Visit (AWV) |
|---|---|---|
| Eligibility | New Medicare patients within the first 12 months of starting Medicare Part B coverage. | After you’ve had Part B for more than 12 months. |
| Purpose | To get a baseline of your health and create an initial prevention plan. | To update your personalized prevention plan and assess your health risks annually. |
| What’s Included | Review of medical/social history, height, weight, BMI, simple vision test, depression screening, and discussion about advance directives. | Health Risk Assessment (HRA), update of medical/family history, list of current providers and prescriptions, height, weight, BMI, blood pressure, detection of cognitive impairment, and creating a screening schedule. |
| Cost | $0 (no copay or deductible) if the doctor accepts assignment. | $0 (no copay or coinsurance) if your doctor accepts assignment. |
The “Welcome to Medicare” visit is a one-time benefit, and you must use it within the first 12 months of your Part B enrollment. If you miss this window, you can still get your first Annual Wellness Visit. The AWV is then available every 12 months. It’s a great way to stay on top of your health and work with your doctor to create a plan that’s right for you.
What to Expect During Your Medicare Wellness Checkup
The Medicare wellness checkup is a unique opportunity to focus on your long-term health and preventive care. It’s designed to be a conversation and a planning session, not just a quick check-up. Here’s what it covers:
The Health Risk Assessment (HRA): Your Health Story
At the heart of your Medicare wellness checkup is the Health Risk Assessment (HRA). This questionnaire helps your doctor understand your health by covering:
- Your self-assessed health status
- Psychosocial risks like depression and stress
- Behavioral risks like diet, exercise, and tobacco use
- Your ability to perform daily activities
This information is crucial for creating a personalized prevention plan. For more details, CMS provides Details on the HRA from CMS.
Creating Your Personalized Prevention Plan
Based on your HRA, your doctor will create or update a personalized prevention plan. This roadmap to better health includes:
- A 5-10 year screening schedule based on your risk factors and guidelines from the U.S. Preventive Services Task Force (USPSTF).
- A list of your specific risk factors and health goals.
- Referrals for health education or counseling if needed.
This plan empowers you to take an active role in your health. To learn more about what services Medicare covers, check out our article on What does Medicare actually cover in 2025?.
Discussing Advance Care Planning
Your wellness visit is also a time to discuss Advance Care Planning (ACP). This optional conversation allows you to make your future healthcare wishes known. You can discuss creating an advance directive, such as a living will or a health care power of attorney, to ensure your preferences are respected if you can’t communicate them yourself. This proactive step provides peace of mind for you and your family. For more details, see our article on Understanding the Difference Between Preventative and Diagnostic Medical Procedures.
A Deeper Look: Assessing Cognitive, Mental, and Social Health
The Medicare wellness checkup goes beyond physical measurements, delving into crucial aspects of your overall well-being that are often overlooked in standard appointments. This includes a careful look at your cognitive function, mental health, substance use, and even the social factors that impact your health.
Cognitive and Mental Health Screening
During your Medicare wellness checkup, your doctor will look for signs of cognitive impairment, such as issues with memory or decision-making. This is a proactive step to detect conditions like dementia or Alzheimer’s disease early. If your doctor suspects a problem, Medicare covers a separate, more thorough cognitive assessment. For more information, the National Institute on Aging provides excellent Resources for Alzheimer’s and Related Dementias.
Your wellness visit also includes a yearly depression screening. Your doctor will review potential risk factors for depression using standardized screening tools. Mental health is just as important as physical health, and these screenings help ensure you get the support you need.
Addressing Substance Use and Opioid Management
A vital part of your Medicare wellness checkup involves discussing substance use and opioid management. Your doctor will assess potential risk factors for substance use disorder, including opioid use, especially if you have current prescriptions. They will review your pain management plan and discuss non-opioid options.
This conversation also covers alcohol and tobacco use. Medicare covers counseling for both alcohol misuse and smoking cessation. If any substance use disorder is identified, your doctor will provide referrals for treatment. These discussions are confidential and aimed at ensuring safe medication practices and a healthy lifestyle. For more insights into Medicare benefits, consider attending our Medicare Educational Webinar JS.
Social Determinants of Health (SDOH) Risk Assessment
An optional but important part of your Medicare wellness checkup is the Social Determinants of Health (SDOH) Risk Assessment. This helps your doctor understand how non-medical factors affect your well-being. You may be asked about:
- Food insecurity
- Housing stability
- Transportation needs
- Social isolation
If any risks are identified, your doctor can connect you with community resources and support services. Medicare covers this assessment, emphasizing a holistic approach to your health. For more on preventive services, visit our Preventative Services page.
Preparing for and Following Up on Your Visit
To get the most out of your Medicare wellness checkup, it’s important to prepare beforehand and follow up afterward. This ensures the visit is as productive as possible.
How to Prepare for Your Visit
A little preparation can make your Medicare wellness checkup much more effective.
- Schedule it correctly: When you call, specify that you’re booking a “Medicare Yearly Wellness Visit” to ensure it’s coded correctly and free of charge.
- Gather your information: Bring a list of all medications (including over-the-counter and supplements), your family health history, and a list of your other doctors.
- List your questions: Write down any health concerns or questions you have so you don’t forget them.
- Complete paperwork: If your provider sends a Health Risk Assessment (HRA) form, fill it out beforehand to save time.
- Bring a companion: Consider taking a family member or friend to help take notes and remember details.
- Separate other issues: The wellness visit is for prevention. If you have a specific health problem, schedule a separate appointment to address it.
For more tips, check out our Medicare Guide.
What to Do After Your Visit
The visit doesn’t end when you leave the office. Following up is key to making your prevention plan work.
- Review your plan: Understand the recommendations and goals you discussed with your doctor.
- Schedule screenings: Proactively book any recommended tests, like mammograms or colonoscopies.
- Follow through on referrals: If your doctor referred you to a specialist or a community program, make those appointments.
- Make lifestyle changes: Start working on any new health goals, such as diet or exercise adjustments.
- Monitor your health: Pay attention to any new symptoms and contact your doctor if you have concerns.
By actively participating, you turn your wellness visit into an ongoing commitment to your health.
Costs and Coverage: What You Need to Know
One of the best features of the Medicare wellness checkup is that it’s free for most beneficiaries. Understanding the coverage details can help you avoid unexpected costs.
Understanding the Costs of a Medicare Wellness Checkup
If you have Original Medicare and your doctor accepts assignment, your Annual Wellness Visit (AWV) and your one-time “Welcome to Medicare” visit are covered with no copay and no deductible.
However, it’s important to know that if your doctor performs additional tests or services during the same visit to diagnose or treat a new or existing problem, those services are considered diagnostic. Diagnostic care is subject to your standard Medicare Part B deductible and 20% coinsurance. The wellness visit itself remains free. Also, a routine physical exam is not covered by Medicare. For a comprehensive look at Medicare, visit our main Medicare page.
How Medicare Advantage Plans Cover the Visit
Medicare Advantage (Part C) plans are required to cover Annual Wellness Visits at no cost, just like Original Medicare. However, you will likely need to use a doctor within your plan’s network to ensure full coverage. Always check your plan’s specific rules for preventive services and in-network providers. To stay informed about all your Medicare options and benefits, consider joining our next Attend a Workshop Webinar.
Conclusion: Take Control of Your Health with Medicare
The Medicare wellness checkup is a powerful, no-cost tool for proactive health management. It allows you and your doctor to create a personalized prevention plan, focusing on early detection and addressing your unique health needs, from physical and cognitive health to social well-being.
Navigating Medicare can be complex, but We Can Help You, Inc. is here to simplify it. Our mission is to help you make informed decisions for a healthy and secure retirement. Understanding and using benefits like the Medicare wellness checkup is a key part of that.
Don’t let this valuable benefit go unused. Schedule your Medicare wellness checkup today and take a vital step toward a healthier future. For more information on preventive care, explore our article, Understanding Medicare’s Preventative Services: A Crucial Component of Health Care.
