Is the Medicare Annual Wellness Visit Mandatory?

If you’re new to Medicare, you may have heard of a free service covered under Medicare Part B called the Annual Wellness Visit. This routine exam is a no-cost option for Medicare participants that may help them stay on top of preventive care and overall wellness.

The Medicare Annual Wellness Visit is not required, but it is recommended.

What is the Medicare Annual Wellness Visit?

Medicare Part B covers two distinct types of wellness visits. New Medicare enrollees may visit their doctor for a free “Welcome to Medicare” wellness visit once within the first 12 months after signing up for Medicare Part B. The assessments and measurements taken during this initial visit are typically used as a baseline for future visits.

After you have been covered by Medicare Part B for 12 months, you are also entitled to a free Annual Wellness Visit. You do not have to pay for this visit, nor does your deductible apply, unless your doctor performs tests outside of what’s covered by the preventive exam.

The purpose of this visit is to create a “personalized prevention plan” to help keep you healthy and reduce your risk for disease or disability. Typically, this visit includes:

· Routine measurements for height, weight and blood pressure

· Discussions about your medical and family history

· Documentation of your current medications

· Screenings for depression

· An establishment of your health risk factors

· A new or updated written schedule for preventive care screenings

· Personalized wellness advice

During this visit, your doctor might also screen your hearing, as well as conduct a cognitive impairment assessment to check for signs of Alzheimer’s disease or dementia.

A Medicare Annual Wellness Visit is not the same as a traditional “physical” exam. The wellness visit does not usually include diagnostics like blood work, urine testing or comprehensive examinations of areas on your body like your lungs or abdomen.

In order to have Medicare Part B cover 100 percent of your Annual Wellness Visit, you’ll need to see a participating Medicare healthcare provider. Additionally, if your doctor diagnoses or needs to treat a health condition during this exam, those services are unlikely to be covered as part of the free visit. In this case, you’ll be billed through your typical Medicare Part B coverage, which is subject to the deductible and coinsurance.

If you have a Medicare Advantage plan instead of Original Medicare, you are still entitled to a free Annual Wellness Visit. However, you may also be entitled to physical examinations or other types of care based on the benefits of your plan.

Are you required to go to the Medicare Annual Wellness Visit?

The Medicare Annual Wellness Visit is not mandatory. While you may take advantage of these visits for free once per year, it’s not a requirement to keep your Medicare benefits. There is no penalty if you choose not to go.

But going is generally a good idea. Medicare covers these visits as a service to encourage you to seek routine preventive care and stay on top of your overall health and wellness. A free visit with your primary healthcare provider can help you monitor your health and identify potential medical problems more easily.

If you want more preventive care benefits beyond what’s covered by the Medicare Annual Wellness Visit, a Medicare Supplement or Medicare Advantage plan may help you take greater control over your health. Learn more by contacting PlanEnroll. We represent a wide range of plans from leading insurance companies — and we can help you find the right coverage for your needs. Our licensed insurance agents are ready to assist you.

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