Medicare Annual Wellness Visit vs. an annual physical exam | Medicare For Me (2024)

FAQs

Medicare Annual Wellness Visit vs. an annual physical exam | Medicare For Me? ›

While a physical includes a full examination and a wellness evaluation, an Annual Wellness Visits focuses solely on a patient's answers to a health risk assessment. It does not typically include any lab work or tests requiring physical contact.

A annual physical is a more extensive exam with bloodwork and the doctor physically doing exams. The purpose of the annual wellness visit (AWV) under Medicare is to paint a picture of your current state of health and to create a baseline for future care.

The primary purpose of the Medicare Wellness Visit is prevention. It plays a key part in helping to reduce your risk for common preventable health problems such as heart disease, stroke and type 2 diabetes, as well as for injuries from falls or other causes.

At your Medicare annual wellness visit, your health care provider will: Review your blood pressure, heart rate, height, weight and body mass index (BMI). Review your current health problems, as well as your medical, surgical, family and social histories. Review your current medications.

Medicare covers a “Welcome to Medicare” visit and annual “wellness” visits. While both visit types are available to Medicare recipients, recipients aren't required to participate in either visit type to maintain their Medicare Part B coverage.

Wellness checkups are not the same as "physicals."

Unlike a physical exam, a wellness visit focuses on preventing diseases and disabilities. It's less about blood tests or listening to your lungs and more about preparing for a fulfilling life. You can expect questions about your current health status and history.

Annual Wellness Visits should not be used to diagnose new conditions, prescribe new medications, or treat any sort of infection, injury, or discomfort. If a patient is experiencing pain or distressing symptoms, they should schedule a dedicated sick visit with their provider.

The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical.

During a Medicare Wellness Visit, you might be asked to remember three words as part of a cognitive assessment. The three words commonly used are “banana, sunrise, and chair”​​. This test helps doctors check your memory and cognitive function.

Think of the annual physical exam as more of a "hands-on" experience, whereas the annual wellness visit takes a "hands-off" approach to evaluation. It would seem that when the federal government was debating what to cover within traditional Medicare, the decision was to cover the broader look at a beneficiary's health.

Is a breast exam part of a Medicare wellness visit? ›

Medicare covers Pap tests and pelvic exams to check for cervical and vagin*l cancers. As part of the pelvic exam, Medicare also covers a clinical breast exam to check for breast cancer.

Review your medical history and your health risk assessment. Develop or update a list of your current providers and medications. Take your height, weight, blood pressure and other routine measurements. Complete a screening for depression and for any problems with memory or thinking.

During the visit:

Have the patient complete a depression screen Have the patient complete functional assessment (initial and subsequent) Measure BP, height, weight, BMI and/or waist measurement Complete list of risk factors. Update immunization record and order immunizations. Update preventive checklist.

One of the most significant distinctions is that a physical exam is more extensive than a wellness visit. An AWV mainly consists of assessments and does not require a physical exam, but an annual physical does require an AWV.

Since 2011, Medicare has required that physicians assess a patient's cognition during an annual wellness visit if the patient asks them to do so.

While a physical includes a full examination and a wellness evaluation, an Annual Wellness Visits focuses solely on a patient's answers to a health risk assessment. It does not typically include any lab work or tests requiring physical contact.

The decision to pay for annual Medicare wellness exams rather than an annual physical exam does not mean that annual physicals are unimportant. Rather, it would seem that the federal government believes annual wellness visits are more important to a Medicare beneficiary's long-term health.

During this visit, your doctor or other health care provider will: Review your medical and social history related to your health. Give you information about preventive services, including certain screenings, shots or vaccines (like flu, pneumococcal, and other recommended immunizations).