The Medicare Annual Wellness Visit is a yearly appointment where a doctor or other provider builds or updates a personalized prevention plan with you. Medicare.gov says plainly that it is a conversation-based visit and not a routine physical exam. Part B covers it once every 12 months, and you pay nothing if the provider accepts assignment.
Is the Annual Wellness Visit the same as a physical?
No, and the difference decides whether a bill surprises you. Medicare has three names that people mix up: the “Welcome to Medicare” visit, the Annual Wellness Visit and the routine physical. Per CMS, a routine physical is an exam done without a link to a specific illness, symptom, complaint or injury, and Original Medicare does not cover it. Medicare.gov also lists routine physical exams among the things Original Medicare does not pay for.
| “Welcome to Medicare” visit | Annual Wellness Visit | Routine physical | |
|---|---|---|---|
| Purpose | One-time preventive check-up: history, screenings, vaccines, family history | Develop or update a personalized prevention plan | Head-to-toe exam with no specific complaint |
| How often | Once, within the first 12 months of Part B | Once every 12 months | Not covered |
| What you pay | $0 if the provider accepts assignment | $0 if the provider accepts assignment | Full cost |
| Physical exam? | No, “isn’t a comprehensive physical exam” | No, “isn’t a routine physical exam” | Yes |
Source: the Medicare.gov pages on the Welcome to Medicare visit and the yearly Wellness visit. Medicare.gov adds that if you have specific health concerns, you should book a separate appointment for them so the wellness visit stays focused on prevention.
How much does the Medicare Annual Wellness Visit cost?
You pay nothing for the visit itself if your provider accepts assignment, meaning the provider agrees to take the Medicare-approved amount as full payment. The Part B deductible does not apply to the visit.
The catch is what gets added on. Medicare.gov says you may owe coinsurance, and the Part B deductible may apply, if the provider performs extra tests or services during the same visit that Medicare does not cover under this preventive benefit. A routine physical exam is the usual example, and you could then owe the full amount for it. Our guide to Medicare Part B costs and enrollment explains the premium, the deductible and the 20% coinsurance.
When you book, say “Medicare Annual Wellness Visit” rather than “annual physical.” Ask whether the office accepts assignment and whether anything else will be done at the same appointment.
Who is eligible, and when can you have it?
You need Medicare Part B, because Part B pays for it. The rule on timing, from Medicare.gov: your first yearly Wellness visit cannot take place within 12 months of your Part B enrollment or your Welcome to Medicare visit. You do not have to have had the Welcome visit first. The Welcome visit itself is available once, in your first 12 months of Part B.
The federal rule at 42 CFR 410.15 says Medicare will not pay if you had another Annual Wellness Visit or the Welcome visit within the past 12 months. The office checks this when it bills, so ask them to confirm the earliest covered date before you book.
What happens at the visit?
It is mostly questions and planning. Medicare lets a physician, physician assistant, nurse practitioner, clinical nurse specialist, or another licensed professional working under a physician’s supervision, do the visit.
Medicare.gov says your provider will:
- take routine measurements such as height, weight and blood pressure
- review your medical and family history
- review your current prescriptions
- offer to talk about advance directives
- give you a written checklist of the screenings, vaccines and other preventive services you need
- perform a cognitive assessment to look for signs of dementia
- screen for risk of substance use disorder, and review any opioid prescription
You also fill out a questionnaire called a Health Risk Assessment. Federal rules say it collects self-reported information, takes no more than 20 minutes and can be completed on your own beforehand or with the provider’s help. It asks about health status, physical function, mood, stress, loneliness, pain, activities of daily living, balance and fall risk, and home safety.
| Part of the visit | What it means in practice |
|---|---|
| Health Risk Assessment | A questionnaire about how you are doing, which can be filled in before the visit |
| List of providers and suppliers | The first visit builds a list of the doctors and suppliers regularly involved in your care; later visits update it |
| Depression review | Part of the first visit under the federal rule; the questionnaire also asks about mood each year |
| Safety review | At the first visit: hearing, daily activities, fall risk and home safety |
| Cognitive assessment | Done by direct observation, taking into account what you and your family report |
| Advance care planning | Optional; your choice whether to talk about it |
| Personalized prevention plan | A written screening schedule and a list of risk factors, with referrals if needed |
Source: 42 CFR 410.15. Exact wording and tools differ by office. If you want fall prevention or home safety on the agenda, say so, and see our guide to fall prevention in NYC apartments.
What is not included?
The visit is for prevention, so several things sit outside it. Medicare.gov says that if the provider adds tests or services that are not covered under this benefit, you may pay for them.
- A routine physical exam. Not covered by Original Medicare.
- Looking into a new problem. A new symptom, a medication change or a flare-up of a chronic condition is a separate service. Medicare.gov’s advice is to book a separate appointment for specific concerns.
- Lab work and other tests. Your provider may “order other tests, if necessary.” Whether a given test is covered, and what you owe, depends on the test. Ask before you agree.
- Vaccines and screenings. The visit produces a checklist of what you are due for. Each service is covered under its own rules. Our guide to senior vaccines covers the shots.
How do you prepare for the visit?
A little preparation makes the visit far more useful, because so much of it depends on what you can tell the provider. The Welcome to Medicare page lists what to bring to that visit, and the NIA’s tips for caregivers add more.
- Ask for the questionnaire early. Ask the office whether the Health Risk Assessment can be sent ahead, so you can complete it calmly at home.
- Write out every medicine. Include name, dose and schedule for prescriptions, over-the-counter drugs, vitamins and supplements, and note who prescribed each one. Our guide to building a medication list has practical tips.
- Write down family history. Note conditions in parents, brothers, sisters and children.
- Gather records. Bring immunization records, insurance cards and names of the other doctors you see.
- Make a question list. Put the most important question first. Note any falls, memory worries, mood changes or trouble with hearing and sight.
- Bring glasses and hearing aids. The NIA suggests making sure they work, and asking the office for an interpreter in advance if you need one.
Some medicines can affect thinking, balance and sleep. Do not stop or change any medicine on your own because of something you read. Raise it with the prescriber at the visit. Our article on medications linked to dementia risk explains what to ask.
Does the visit check for memory problems?
Yes. The cognitive assessment is part of every Annual Wellness Visit. Federal rules describe it as an assessment of cognitive function by direct observation, with due consideration of patient reports and concerns raised by family members, friends or caregivers. So if you have noticed repeated questions, missed bills or wrong turns on familiar streets, say so, in writing if you can.
The wellness visit is a screen, not a diagnosis. If the provider thinks there may be cognitive impairment, Part B covers a separate visit for a fuller review, to establish or confirm a diagnosis and to develop a care plan. For that visit, you pay 20% of the Medicare-approved amount after the Part B deductible. Medicare.gov says you can bring a spouse, friend or caregiver to help listen and answer questions.
Our article on memory loss in older adults explains what is normal and when to see a doctor. If mood is the concern, see depression in older adults. For anyone in crisis, Medicare.gov points to 988, the Suicide and Crisis Lifeline.
What about advance care planning?
The visit offers it, and it is voluntary. Per Medicare.gov, Part B covers advance care planning as part of the Welcome to Medicare and yearly Wellness visits, and you pay nothing if the provider accepts assignment. It is a chance to start talking about a health care proxy and a living will. In New York, see our guide to the living will, health care proxy and MOLST.
Does Medicare Advantage cover the Annual Wellness Visit?
Medicare.gov says Medicare Advantage plans must cover all emergency and urgent care and almost all medically necessary services that Original Medicare covers. The wellness visit is a Part B preventive benefit, so ask the plan how it handles the visit. Check which doctors are in the plan’s network, whether you need a referral and what the plan says you will pay. See our comparison of Medicare Advantage and Original Medicare, and Medicare versus Medicaid if you have both.
Medicare.gov adds that plans may offer extra benefits Original Medicare does not, such as vision, hearing and dental. Your plan’s materials say what applies to you.
How can a family caregiver help?
Many older adults find it helpful when a family member goes with them to appointments. The NIA’s guidance for caregivers covers the basics:
- Get permission first. The person can say aloud that they agree to have you there. To speak with the provider when they are not present, you will need legal permission, such as a HIPAA release form that the office gives you.
- Let the person answer. Include them in the conversation. Do not turn it into a talk between you and the doctor.
- Take notes. Writing down the plan helps everyone, including other family members, remember it.
- Respect privacy. Leave the room when asked.
Getting there can be the hard part. Our guides to senior medical transportation in NYC and medical escort explain the options.
Getting to appointments: advice from our nurse director
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
Most older New Yorkers get to appointments with a relative, a Medicaid ride or a regular taxi. The ride is rarely the hard part. The hard part is the visit: who helps at the front desk, finds the right office, explains the symptoms to the doctor and remembers what was said? That is tough for someone with dementia, limited mobility or limited English.
If your father walks slowly, forgets what the doctor said or gets lost in a big hospital, I would book an escort. Our Medical Escort service sends a trained home health aide (HHA) to the home, goes with the patient to the clinic, sits in on the appointment if the patient agrees, helps with the conversation, writes down the doctor’s instructions and brings the patient home. It is private pay. Check the vehicle type, whether an escort is needed and the return trip ahead of time, and confirm the booking the day before.
We are a licensed home care agency in Brooklyn and Queens, licence #2572L001, New York State Department of Health. If you want help with the home side of things after a visit, call (718) 232-2777 or use our contact page.
Medicare rules change. Everything above was checked on 16 October 2026 against medicare.gov, cms.gov, ecfr.gov and nia.nih.gov. Confirm your own situation with your provider, your plan or 1-800-MEDICARE. This page is general information, not medical or insurance advice.
Frequently asked questions
What is the Medicare Annual Wellness Visit?
It is a yearly, conversation-based visit with a doctor or other provider to create or update a personalized prevention plan. Medicare.gov says it is not a routine physical exam.
Is the Medicare Annual Wellness Visit free?
You pay nothing for it if your provider accepts assignment, and the Part B deductible does not apply. You may owe coinsurance, and the deductible may apply, for extra tests or services that Medicare does not cover under this benefit.
How often can I have a Medicare Annual Wellness Visit?
Once every 12 months. Your first one cannot take place within 12 months of your Part B enrollment or your Welcome to Medicare visit.
What is the difference between the Welcome to Medicare visit and the Annual Wellness Visit?
The Welcome visit is a one-time preventive check-up in your first 12 months of Part B. The Annual Wellness Visit comes after that and repeats yearly. Neither is a physical exam, and both are $0 if the provider accepts assignment.
Does Medicare pay for a routine physical?
No. Original Medicare does not cover routine physical exams, which CMS defines as exams with no link to a specific illness, symptom, complaint or injury. Ask the office how your visit will be billed.
Can a family member go with me to the visit?
Yes. Medicare.gov says you can bring a spouse, friend or caregiver to a cognitive assessment, and the NIA says many older adults find it helpful to have someone with them. Tell the provider you agree to the person being there, and ask the office for a HIPAA release form if they will need to speak with the provider later.
Does Medicare Advantage cover the Annual Wellness Visit?
Medicare Advantage plans must cover almost all medically necessary services that Original Medicare covers. What you pay and which providers you can use depend on the plan, so call the plan before booking.
