What is the Medicare Wellness Visit? 

When it comes to living a healthy lifestyle, eating right and getting plenty of exercise are the keys to staying fit and feeling good. If you’re over the age of 65, seeing your doctor for a wellness visit can also contribute to a longer and more active life. If you’re eligible for Medicare due to age or a qualifying disability, you will have coverage for an annual wellness visit with your primary doctor. 

What is a wellness visit?

When you’re sick or hurt, you probably call your doctor to make an appointment. It can be important to schedule annual wellness visits even if you’re relatively healthy. Building a rapport with your physician and making a preventive care plan can lead to early detection and treatment of many conditions. 

During a wellness visit, you have a chance to talk with your doctor about anything that’s been bothering you medically. A wellness visit typically does not include a physical exam or diagnostic testing, but instead, it is a chance to talk about preventative strategies you can use to live better and stay healthy. 

What is measured during a wellness visit?

Although a wellness visit is not as intensive as a visit for an annual physical exam with your doctor, there are some things that are measured and recorded during these visits. In general, your vital signs will be taken and your weight and height will be recorded. You may also be asked about any medications you are taking as well as your family history of medical concerns.

What is the Medicare wellness visit?

Medicare recipients will be happy to know that they can take advantage of an annual wellness visit. Medicare benefits provide coverage for an annual wellness visit at no cost. This visit can be a great opportunity to check in with your doctor and talk about any medical concerns or lifestyle changes that you want to address.

In most cases, doctor visits are covered by the outpatient benefit of Medicare coverage under Part B. Original Medicare Part B coverage is used to help cover the cost of things like office visits, surgery and clinical diagnostic testing. When using Part B coverage, Medicare recipients generally pay 20% of the cost while Medicare coverage picks up the remaining 80%.

In the case of the annual Medicare wellness visit, the cost of the visit is covered completely by Medicare. On top of that, you don’t need to have met your deductible in order to take advantage of this wellness visit. You do, however, need to carry Medicare Part B coverage and be current on your monthly premium.

Services and screenings related to your wellness visit

One thing to note is that you may face a coinsurance charge if additional services are performed during your annual wellness visit through Medicare insurance. The visit itself is covered completely, but if you bring up a medical concern and your doctor decides that testing or treatment is needed, these additional services will usually fall under billing through Medicare Part B. As such, Medicare recipients need to be aware of the services they receive during an annual wellness visit to avoid surprise bills.

Does Medicare cover an annual physical?

Medicare benefits usually do not cover an annual physical, but Part B supplies coverage for doctor visits. Medicare recipients will usually pay 20% of the cost of the visit. If you are prescribed any medications during a physical, Medicare Part D may supply coverage as long as your medications are available for purchase from a retail pharmacy and are intended for self-administration at home.

Does Medicare Advantage offer a wellness visit?

Seniors who have Medicare coverage through a Medicare Advantage plan can also receive access to a covered wellness visit once per year. Medicare Advantage plans must provide access to the same coverage as Original Medicare, but many MA plans offer additional benefits.  

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