Annual Medicare wellness visits: What you should know and why you shouldn’t skip them

Have you had your annual Medicare wellness visit?

Whether you’re new to Medicare or you haven’t readily used this benefit, here’s why it’s important.

Medicare wellness visits are intended to help you stay healthy as you get older, says James Sims, DNP ANP-BC, a practitioner at PeaceHealth’s clinic for older adults in Eugene, Oregon.

“Sometimes this is the only visit that patients make to the office during the year,” he says. “These visits give us an opportunity to find out if you’re up to date on health screenings. They’re also a time to talk about other things that can help you maintain your health.”

Annual Medicare wellness visits are a special type of appointment.

Medicare has precise guidelines about the type of care and topics allowed during your annual visit. This is to make sure you and your PCP have time to focus on areas that will help you stay well.

What annual visits are

Annual Medicare wellness visits:

• Start at age 66 (or the year after you start using Medicare). When you become eligible for Medicare at age 65, you’ll have a “Welcome to Medicare” visit which can be performed any time after your 65th birthday but before you turn 66. The next year, you’ll have an annual visit.
• Are yearly appointments with your primary care provider. 
• Are recommended every year.
• Focus on prevention, health goals and advance care planning. 

What annual visits are not

Annual Medicare wellness visits are not:

• A regular physical exam or a visit to talk about an acute issue such as illness or injury. 
• Designed to diagnose or treat specific health conditions.

Preparing for your annual visit

After your annual Medicare wellness visit is scheduled, you will get a questionnaire. If you use My PeaceHealth, you can sign in and complete it online. Otherwise, you’ll get a paper copy in the mail. Fill it out ahead of time and bring it to your visit.

Before your appointment, review tips on making the most of your appointment. It’s often helpful to write down your thoughts ahead of your visit.

You might also spend a little extra time on your advance care directive. If you have one, bring a copy. If you don’t, PeaceHealth offers helpful resources on advance care planning. 

What to expect at your annual visit

• The visit will take 30-60 minutes.
• You won’t have to change into a gown since the visit does not include a physical exam.
• You and your PCP will talk about your health history, questionnaire responses and risks for certain conditions. Discussion might include topics like:
  • Screenings such as mammograms or colonoscopies.
  • Immunizations to prevent things like pneumonia or shingles.
  • Walking, balance, falls or driving.
  • Muscle tone and bone strength.
  • Memory, hearing and vision.

After your wellness visit

Based on discussions from your visit, your PCP might recommend screenings, shots or tests. These would likely mean setting up a follow-up appointment. It depends on the recommendation.

Your PCP may also provide guidelines or tips on how to achieve any health goals discussed during your visit.

Costs that are covered 

For the annual wellness visit, you won’t have a copay.

Costs are covered for:

• One wellness visit each year.
  • Under traditional Medicare, this visit can happen once every 366 days.
  • On a Medicare Advantage plan, this visit can happen any time each calendar year.
• A discussion with your provider about topics related preventive care and advance directives.

Costs that are not covered

Care that is not covered by the annual wellness visit includes:

• A physical exam.
• Discussion of a new health concern.
• Discussion of a current chronic disease.
• Advice about current or new medications.
• Prescription refills
• Tests or screenings. 

If you need care that is not covered by the annual wellness visit, you can: 

• Make a separate appointment to discuss your concerns.
• Ask your clinic if your provider can combine a regular exam with your annual visit.

In either case, you would be responsible for any copays that apply for the regular exam. It’s best to check with your provider and Medicare to understand how to get the most from your benefits.

It’s your benefit. Use it!

“Most routine office visits are brief. We don’t always get to talk about preventive care and other critical topics,” says Sims. “That’s why annual Medicare wellness visits are so important and why you don’t want to skip yours.”

If you haven’t scheduled your annual wellness visit, call your clinic to schedule this visit today. 

If you have an upcoming appointment to discuss other concerns, ask if the annual wellness visit can be combined with the existing appointment.