medicare well visit :: Article CreatorExpert OpinionFor Older Adults, Not All Annual Check-ups Are Alike
by Jeffrey Millstein, For The Inquirer
Published Dec. 21, 2024, 6:00 a.M. ET
A reader recently lamented to me that she went to her doctor's office for her annual exam and left very frustrated. She was interviewed extensively by a nurse, then asked another battery of questions by her doctor, but was never physically examined.
"What kind of check-up is that?" she said.
It was not the first time I've heard frustration over what should be included in an annual check-up.
If you are in the Medicare age group and have recently called your primary care office to schedule an annual visit, you may have been surprised to learn there are different types of annual check-ups which have different health-care goals.
» READ MORE: Your primary care doctor can help you with mental health challenges, too
Many people see their primary-care clinician multiple times throughout the year for a wide range of medical needs: chronic disease management, sickness, review and discussion of test results.
You may want to designate one of these as your annual visit — a time to review your "problem" list, what medications you are taking, as well as recommended health screenings or vaccines, and make plans for future care. These visits may also be important to qualify for insurance discounts. For other people, an annual visit may be the only touch point with a primary-care clinician each year.
It is important to understand the differences to schedule correctly and avoid frustration when you arrive for your appointment:
Annual visits are generally more comprehensive than a sick visit or routine follow up and should be given a longer time slot in the clinician's schedule. Be clear when requesting an annual visit to help assure that you are given the time you need to talk to your provider and cover a full examination.
A Medicare annual wellness visit, or AWV, is a co-pay free visit type created by the Centers for Medicare and Medicaid Services (CMS) to help encourage older people and their clinicians to address preventive care and other matters that can get missed when responding to an acute medical concern, such as chronic pain assessment, screening for depression and dementia, fall risk, food and housing security, or ability to care for yourself independently. While the AWV covers important medical and social issues, it does not include a physical examination and may be performed by your primary clinician or nurse. It can even be done via Zoom or another virtual platform.
» READ MORE: Having difficulty getting a primary care appointment? Try these ideas.
If you want to be sure to be examined or if you have pressing concerns to address, the AWV may not be the type of medical appointment you need. Some clinicians are willing to address problem issues and perform physical exams at the same time as your AWV, but confirm that in advance. This will help you to set and manage expectations.
Primary care practices are increasingly focusing on wellness and care quality, which is a change for the better. This also means there are more options when you call for a visit, or schedule online. Be sure the visit type that you schedule aligns with your goals for that visit. And don't be shy about asking for help.
Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.
Does Medicare Cover Annual Physicals?
Annual physicals are routine checkups to monitor your overall health. While other health insurance plans commonly cover them, Medicare does not.
However, Medicare does offer a similar service called an annual wellness visit, and a one-time Welcome to Medicare exam. They both focus on preventive care and keeping track of your health, but they're not the same as a full physical.
Key Takeaways
Medicare will not pay the cost of an annual physical and may not pay the full cost of associated diagnostic tests. Medicare pays for a Welcome to Medicare exam you receive in the first 12 months after you enroll. After that, it covers an annual wellness exam. The Welcome to Medicare visit and the annual wellness visits focus on preventive care to keep you healthy and avoid disease. Medicare covers many preventive services, such as flu shots and diabetes screenings. Medicare Advantage private health insurance plans could include annual physicals as an extra benefit. What Is a Welcome to Medicare Visit? You are eligible for an initial preventive physical exam, also called a Welcome to Medicare visit, when you enroll in Part B for the first time. You can have the exam anytime during your first 12 months with Medicare. The exam is free and you will not be charged a deductible, coinsurance, or copay. A Welcome to Medicare visit is not a physical exam. Its purpose is to keep you healthy and avoid preventable diseases in the future. Your doctor will gather information about your physical and mental health, evaluate your risks for various diseases, and explain what you can do to maintain or improve your health. Here are examples of information your doctor will collect: Your height, weight, and blood pressure Your medical history, including previous surgeries, hospitalizations, major illnesses or injuries, allergies, and medications Your lifestyle habits, including your diet, exercise, and use of alcohol, tobacco, or illegal drugs Your mental health, including any history of depression or other mental disorders Your family medical history Your ability to perform daily tasks safely, whether you have hearing or vision problems, and your risk of falling At the end of your exam, your doctor may provide education or counseling about your health. They may also recommend screening tests like a mammogram or routine lab tests, or refer you to a specialist. The cost of health screenings and other medical services you receive after your welcome visit isn't included in your exam. How much you'll pay out of pocket depends on the types of tests your doctor orders and whether you've purchased additional insurance to go with traditional Medicare. Tip While traditional Medicare doesn't cover annual physical exams, some Medicare Advantage plans do. What Is an Annual Wellness Visit? If you've had Medicare Part B for more than 12 months you're eligible for an annual wellness visit. Your doctor may send you a health risk questionnaire to fill out before your appointment date. They will use that data to evaluate your risks of physical diseases, psychological problems like depression, and behavioral issues like excessive alcohol or tobacco use. During your visit, your doctor will perform many of the same tasks they completed during your Welcome to Medicare visit, such as measuring your height, weight, and blood pressure, and getting a current list of medications. Your doctor will ask for an update on your recent medical history, including any procedures, illnesses, or injuries you've experienced, and medical providers you've seen in the last 12 months. They will assess your physical and cognitive health, and create a schedule for preventive tests, such as a glaucoma screening or a bone density measurement. Tip Your first annual wellness visit must occur at least 12 months after your Welcome to Medicare exam. All subsequent visits must be at least 12 months apart. If you missed the Welcome to Medicare exam, you can still take the annual wellness visits. What Is an Annual Physical Exam? A routine physical exam includes many of the elements of a wellness exam, including a review of your medical history, an assessment of your risks for preventable diseases, and measurements of your height, weight, and blood pressure. The main difference is that a physical exam is intended to diagnose disease while a wellness exam focuses on risk assessment, prevention, and health education. Your doctor performs a physical checkup to identify and solve potential problems, such as anemia or a leaky heart valve. Accordingly, an annual physical may include services not provided during a wellness visit, like a head and neck exam, reflex checks, and the collection of urine and blood samples for lab testing. Why Medicare Does Not Cover the Annual Physical Exam Medicare doesn't cover routine physical exams because its rules, set by Title XVIII of the Social Security Act, focus on medically necessary services rather than general checkups. Medicare focuses on maintaining good health by preventing disease. Routine checkups involve physical tests to diagnose diseases. How Much Does an Annual Physical Cost? The average cost of an annual check-up without insurance is approximately $200, including some routine tests like blood and urine tests. Because costs vary by state and type of facility, you should check costs in advance. When a provider gives you a price, ask what services are included. For instance, does the price include routine blood and urine tests? Does it include an electrocardiogram? If your doctor recommends tests that aren't included in the cost of your exam, you may have to pay for them out of pocket. Does Medicare Cover Annual Physicals for Seniors? No. Annual physicals aren't covered by traditional Medicare because they are excluded by the federal law that governs Medicare. All Medicare plans cover a Welcome to Medicare exam during your first 12 months with Medicare and in subsequent years, an annual wellness exam. Unlike a routine physical, which is performed to diagnose disease, an annual wellness visit focuses on screening, prevention, and education. What Does Medicare Cost? How much you'll pay for Medicare depends on where you live and the type of coverage you buy. In 2025, the standard monthly premium for Medicare Part B is $185. You'll pay an additional monthly premium of $17 (on average) for a Medicare Advantage plan or $64 to $400 (or more) for a Medigap plan. If you have traditional Medicare and want prescription drug coverage, you'll pay an average monthly premium of $40 for a Part D plan. Besides your monthly premiums, you may also have some out-of-pocket expenses for copays, coinsurance, or deductibles. Out-of-pocket costs can vary widely from one plan to another. When Did Medicare Stop Paying for Annual Physicals? Medicare has never paid for annual physicals because Title XVIII of the Social Security Act (which authorized Medicare) excludes coverage for routine or annual physical checkups. It also excludes physical exams performed without a specific symptom, patient complaint, or requirement by a third party (such as an insurer). Medicare pays for annual wellness visits, which focus on preventive screening rather than physical tests to diagnose disease. What Preventive Care Services are Covered by Medicare? Medicare Part B covers many types of preventive services that can help you stay healthy by detecting problems early when treatments are most effective. Preventive services include vaccinations, exams, lab tests, screenings, and health monitoring. Your doctor will help you determine which preventive services you need. The out-of-pocket expenses depend on your insurance plan, but some services may be free. Here are examples of preventive services Medicare covers. Bone mass measurements Depression screenings Diabetes screenings Mammograms Prostate cancer screenings Flu vaccines COVID-19 vaccines Annual wellness visits The Bottom Line Medicare doesn't cover annual physical exams, but it does a Welcome to Medicare exam and annual wellness exams. The Welcome to Medicare visit and annual wellness visits are free, but (depending on your plan) you may have to pay all or part of the cost of diagnostic tests your doctor orders. Medicare enrollees who want an annual physical must either cover the cost out of pocket or enroll in a Medicare Advantage plan that includes this benefit.
Here's What Your Annual Wellness Visit (AWV) Has To Do With Your Brain
An AWV is a key part of keeping your body and mind healthy. Here's what to expect during your appointment — and key questions to ask while you're there.
Are you 65 or older? If you've been using your Original Medicare or Medicare Advantage plan for longer than 12 months, you have access to a no-cost benefit that you might not be aware of. It's called an annual wellness visit, or AWV for short, and it's one of the best tools for staying on top of your physical and cognitive health.
These yearly check-ins with your doctor provide you with ample time to talk with them about your overall health. And they give your doctor time to set you on a path to living healthier, from the tip of your toe to the top of your head (including your brain!).
Here are three things to expect during your AWV — and what to ask your doctor to make sure your brain health is part of the conversation.
#1: You'll complete a health risk assessment.Maybe you have some concerns about your health — or you're just looking for some friendly advice from your primary care doctor. During your AWV, your doctor will start out by asking you to fill out a questionnaire. The questions you answer will help them determine if you're at early risk of any physical or mental health issues — and your answers can help guide you and your doctor toward a prevention plan to help you stay healthy. Your assessment may include:
A review of your medical and family history
A review of your current conditions and prescriptions
Check-ins on your physical health, like your height, weight, and blood pressure
Check-ins on your brain health, including a cognitive assessment
Personalized health advice
A list of risk factors and treatment options
A checklist of preventive services
#2. You'll get your cognitive health tested.When your doctor checks your blood pressure and weight, they're doing it to make sure that if you're showing early signs of, say, heart disease or diabetes, you'll have an action plan in place to help lower your risk.
The same is true of your brain health. Your doctor may have you take a short questionnaire or assessment to check your memory and spatial awareness. They're trying to detect early signs that can help you take action to lower your risk of brain health issues like Alzheimer's disease and other forms of dementia. And if you're bringing your spouse or a family member to your appointment, the doctor may also ask them to fill out a questionnaire to capture their impressions of your memory and other cognitive skills.
If your doctor thinks you may have early signs of cognitive health issues, Medicare covers a separate visit for a more thorough review to check for conditions such as dementia, depression, anxiety, or delirium (that's a state in which you may have episodes of confusion). Many of these conditions can be temporary, if you get the right help — so it's better to find out about them early.
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#3. You'll get to ask plenty of questionsWhen you go in for your AWV, your doctor will ask you a lot of questions, sure. But remember that this is your visit, so nothing's off the table. Come prepared with as many questions as you want to ask too. Here are some topics you might want to cover during your visit:
Am I at risk for Alzheimer's disease or dementia? Research shows that many factors can contribute to a person's individual risk for Alzheimer's disease and dementia. Some risk factors you're born with — like your family history (maybe you have a parent or sibling with Alzheimer's).
But other risk factors — like how much exercise you get, what you eat, how well you sleep, and even how much you're in touch with family and friends — can all contribute to your risk. Making improvements on those parts of your life can help lower your risk. Discuss your concerns with doctor, who can help you devise a prevention plan, which could include things such as a:
Another prevention option? Improving your brain health with BrainHQ. You may have no-cost access to BrainHQ's brain training program through your Medicare Advantage plan. Check your eligibility today.
What can I do to boost my mood? Changes in mood can be an important indicator of mental health concerns. Let your doctor know if you've been feeling down or overly anxious lately. They can connect you with a mental health professional who can help. They may also encourage you to try to stay active, physically and socially, both of which can help regulate your mood.
How can I better control my blood pressure? Regular screenings for high blood pressure can help determine whether you're at risk of health issues such as heart disease and stroke. A stroke, for example, can cause serious brain damage. If your blood pressure isn't under control, your doctor may suggest lifestyle changes to help lower it.
Any tips on how I can stop smoking? Lighting up may be as bad for your brain as it is for your heart and lungs. If you smoke or vape tobacco products, ask your doctor to connect you with resources to help you quit.
What can you do to sharpen your brain after your AWV? If that cognitive assessment — or any of the advice your doctor gave you about Alzheimer's and dementia prevention — has you concerned about your brain, it's never too late to start sharpening its function. You can do that by using the science-backed brain-training exercises at BrainHQ, which were designed by top scientists. Even if your brain is going strong at your AWV, training with BrainHQ can help you maintain your brain health for the long run.
Effective brain training can:
Rewire your brain
Sharpen your cognitive function, so you can think faster, focus better, and remember more
Make you happier, healthier, and more in control of whatever challenges life throws at you
If you have a Medicare Advantage plan, there's a chance they offer BrainHQ at no additional cost to you. Check your eligibility today.
And if you're on Original Medicare, don't worry. You can still sign up to get monthly or yearly access to BrainHQ.
See our sources:Annual wellness visits: Medicare.GovHigh blood pressure: American Heart AssociationTobacco: National Cancer InstituteAlzheimer's and dementia: Alzheimer's Association
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