Medicare Annual Wellness Visits: Answers to your top questions

Reviewed by: Amber Wieser, MBA, BSN, RN

If you have Medicare, be sure to schedule your Annual Wellness Visit every year through your primary care provider’s office. Medicare Annual Wellness Visits are an essential part of maintaining good health as you age.

Contrary to popular belief, these visits are not physical exams, nor are they just routine check-ups. Medicare Annual Wellness Visits are preventive care visits to help you and your Primary Care team make a plan for how to stay well.

In this article, we’ll answer frequently asked questions about Medicare Annual Wellness Visits, providing you with information to make the most of these yearly appointments.

What is a Medicare Annual Wellness Visit?

A Medicare Annual Wellness Visit is a yearly appointment that focuses on preventive care. At Emplify Health by Gundersen, the appointment is scheduled with a registered nurse (RN) from your primary care provider’s office after you’ve had Medicare Part B coverage for 12 months or longer.

Unlike a traditional annual check-up, which might include a physical exam, the annual wellness visit is more about planning and prevention. We will not listen to your heart and lungs or check other parts of your body. During the visit, you and your nurse will discuss your health history, review your current health status and develop/update a personalized prevention plan. This includes making sure you are up to date on recommended immunizations and health screenings, like colorectal cancer screenings and mammograms. If the nurse refers you for screenings or services outside the appointment, they will help you schedule those services at the time of your appointment.

Why are these visits important?

The goal of a Medicare Annual Wellness Visit is to create and complete a personalized plan. The plan will help you prevent disease and disability based on your current health and risk factors. By focusing on prevention, these visits can help catch potential health issues early and improve your overall quality of life. 

In addition, these RN-led visits allow your primary care provider more time to focus on your chronic health conditions and medical needs at a separate, focused, Disease Management Visit.

Who is eligible for a Medicare Annual Wellness Visit?

During the initial 12 months of Medicare Part B coverage, beneficiaries are offered a “Welcome to Medicare” preventive visit. This in-clinic visit closely resembles the Medicare Annual Wellness Visit and serves to assist in establishing an individualized preventive care plan with your provider.

Following the first year of Medicare Part B coverage, you'll be eligible for an Annual Wellness Visit each year through your primary care provider’s office. This visit is completed with a nurse in the clinic or virtually, by phone or video.

What does the Annual Wellness Visit include?

During your Medicare Annual Wellness Visit, an Emplify Health by Gundersen registered nurse will complete a health risk assessment and review your personalized prevention plan. Your nurse will:

• Update your medical and family history
• Review your current providers and medications
• Measure your height, weight, blood pressure and pulse (if you choose the in-clinic option)
• Evaluate your risk factors for preventable diseases
• Discuss and help schedule preventive screenings or tests that you may need
• Screen for physical, mental health​ and memory concerns
• Discuss advanced care planning services available if you choose to create or update your advance directive

Where does the visit take place?

After your first 12 months of Part B coverage, Medicare Annual Wellness Visits can take place in the clinic of your choice or from the comfort of your home. You have the option to schedule with a nurse via phone, video visit or in-person at the clinic.

How is a Medicare Annual Wellness Visit different than a routine physical exam or a Disease Management Visit?

A Medicare Annual Wellness Visit focuses on preventive care and planning, whereas a routine physical exam is a more hands-on exam of your body with no relationship to treatment or diagnosis of an illness or symptom. A routine physical exam is not covered by Medicare.

The Annual Wellness Visit, by contrast, is a time for conversation and planning to prevent or stop the progression of a chronic illness. It is an opportunity to discuss your health goals and create a roadmap to achieve them.

During a Disease Management Visit, your provider may perform a focused physical exam related to your new or existing health conditions, such as diabetes or joint pain. They will also review and update your medications, labs or other tests.

Compare Medicare visits and costs

How can you prepare for your Medicare Annual Wellness Visit?

Preparation is key to making the most of your Annual Wellness Visit. Here are some steps you can take:

• If you have MyChart, you will be asked to complete questionnaires before arriving for your appointment. If you cannot access the questionnaires before your appointment, plan to complete them during your visit.
• Bring a list of all your medications. Include prescription drugs, over-the-counter medications, vitamins and supplements.
• Review your health history. Be ready to discuss your past medical history, family history and any changes in your health since your last visit.
• Make a list of your healthcare providers. Include all doctors, specialists, therapists and other healthcare professionals you see.
• Think about your health goals. Consider what you want to achieve in terms of your health and any concerns you have.

Does Medicare cover the cost of Annual Wellness Visits?

Yes. Medicare Part B covers the cost of Annual Wellness Visits at 100% when you see an in-network provider. You will not have to pay anything out of pocket for the visit itself.

If you have a new or existing health concern, you will need a separate Disease Management Appointment with your primary care provider. You or your insurance carrier will be responsible for the cost of that visit.

What should you discuss during your Annual Wellness Visit?

Take this opportunity to discuss the following:

• Lifestyle changes: Discuss any lifestyle changes you’re considering, such as diet or exercise.
• Mental health: Don’t hesitate to bring up any concerns about your mental health, such as stress, anxiety or depression.
• Preventive screenings: Ask about preventive screenings and vaccines you may need.

While an Annual Wellness Visit can help identify chronic conditions and develop prevention plans, this is not a Disease Management Visit.

“We are always striving to improve the health, well-being and quality of life of those we serve. The Medicare Annual Wellness Visit is a time we can do just that! We can address every patient’s unique preventive care and health maintenance needs,” says Amber Wieser, MBA, BSN, RN, Primary Care Shared Services, Bellin and Gundersen Health System.

Your Annual Wellness Visit is a time to focus on you and your health, so make sure you cover all the topics that are important to you.

How can an Annual Wellness Visit improve your health?

By focusing on prevention, Annual Wellness Visits can help identify potential health issues early, when they are most treatable. They also empower you to take an active role in your healthcare, ensuring that you have the support and resources you need to maintain and improve your health.

Schedule today

To schedule a Medicare Annual Wellness Visit, call your primary care provider’s office. Mention the “Medicare Annual Wellness Visit” to your Gundersen scheduler. Reminder: You are eligible for a Medicare Annual Wellness Visit if you have had Medicare Part B for more than 12 months. The Medicare Annual Wellness Visit cannot be scheduled during the same year as your “Welcome to Medicare Visit.”

To schedule a “Welcome to Medicare Visit” with your provider, call your primary care provider’s office. Mention the “Welcome to Medicare Visit” to your Gundersen scheduler. Reminder: You are eligible for a Welcome to Medicare Visit with your provider if you have had Medicare Part B for less than 12 months.

For more information, talk to your primary care provider or contact Medicare at (800) MEDICARE or visit medicare.gov.