You have Medicare, so you should be covered for your yearly checkup — right? The answer is yes, but “yearly checkup” means something very specific under Medicare, and it is not always what patients expect. Many people are surprised to find that certain services they assumed were included actually come with a bill. Understanding the difference between a Medicare Annual Wellness Visit and an Annual Physical Exam can save you both confusion and unexpected costs.
What Is the Medicare Annual Wellness Visit?
The Medicare Annual Wellness Visit (AWV) is a preventive benefit covered at no cost to you under Medicare Part B — meaning no copay, no deductible — as long as your doctor accepts Medicare assignment. It is available once every 12 months after your first year of having Medicare Part B.
It is important to understand what the AWV actually is. It is not a physical exam in the traditional sense. It is a health planning visit designed to:
- Update your medical and family history
- Review your current medications and supplements
- Check your height, weight, and blood pressure
- Assess your risk for depression and cognitive decline
- Discuss advance care planning
- Create or update a personalized prevention plan
The AWV focuses on prevention and coordination — it is a conversation about your health future, not a hands-on examination.
What Is an Annual Physical Exam?
An annual physical exam is what most people picture when they think of a yearly checkup. It includes a full head-to-toe physical examination — the doctor listens to your heart and lungs, examines your abdomen, checks your reflexes, and performs other clinical assessments based on your age and health status.
Here is the catch: Original Medicare (Parts A and B) generally does not cover routine physical exams. This means that if you go to your doctor expecting a traditional physical and your visit is billed as a “routine physical,” you may receive a bill for all or part of it.
Key Differences at a Glance
Coverage: AWV is fully covered by Medicare Part B. Routine physical exams are generally not covered by Original Medicare.
Hands-on exam: AWV does not include a physical examination. A physical exam includes hands-on clinical assessment.
Purpose: AWV focuses on prevention planning, screening recommendations, and care coordination. A physical exam evaluates current health and addresses clinical concerns.
Billing: AWV is billed under a specific wellness code. Physical exams are billed differently and may generate cost-sharing.
What About the “Welcome to Medicare” Visit?
When you first enroll in Medicare Part B, you are also entitled to a one-time “Welcome to Medicare” Preventive Visit within the first 12 months of enrollment. This is separate from the AWV and covers a review of your health status, risk factors, and screening referrals.
Can You Have Both in the Same Year?
In some cases, yes — but it depends on how the visit is documented and billed. If a health concern comes up during your AWV that requires clinical evaluation, your doctor may address it at the same visit, but a portion of the visit may be billed separately (and may generate cost-sharing for you). This is a common source of confusion and unexpected charges.
Dr. Iram Qureshi, DO, at Express Internal Medicine in Plano, TX, takes time to explain the difference to Medicare patients before their visit so there are no surprises. Asking ahead of time what will be covered is always a good approach.
How to Make the Most of Your Medicare Wellness Visit
Come prepared. Bring a list of your current medications, any supplements you take, and questions you want to discuss. Use the visit as an opportunity to align with your doctor on upcoming screenings, preventive vaccines, and any chronic condition management.
Frequently Asked Questions
Does Medicare cover blood work at the annual wellness visit?
The AWV itself does not include routine lab work, but Medicare covers certain preventive screenings such as diabetes screening and cholesterol checks based on eligibility. Your doctor will let you know what applies to you.
Will I be charged if a health problem is discussed during my AWV?
If a new or existing health issue is addressed during the AWV, the doctor may bill that portion as a separate office visit, which may involve cost-sharing.
Does Medicare Advantage cover annual physical exams?
Many Medicare Advantage (Part C) plans do cover routine physical exams as an added benefit. Check your specific plan’s Summary of Benefits.
How do I schedule a Medicare Annual Wellness Visit?
Call your primary care office and specifically request a Medicare Annual Wellness Visit. Letting the scheduling team know helps ensure the visit is documented correctly.
Is the Annual Wellness Visit available every year?
Yes, once every 12 months after your initial enrollment period, at no cost to you under Original Medicare Part B.
Medical Disclaimer: This blog post is intended for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making any changes to your health regimen. If you have questions about your health, please speak with Dr. Iram Qureshi, DO, or another licensed medical professional.
Dr. Iram Qureshi is a dedicated board-certified Internal Medicine physician with a strong passion for preventative care and weight-loss management. With over five years of experience as a hospitalist, Dr. Qureshi has honed her expertise in treating acute medical conditions and focusing on preventing hospitalizations. She is committed to providing compassionate care and evidence-based guidance to help patients lead healthier lifestyles.
As the co-founder of Express Internal Medicine, Dr. Qureshi works alongside her husband, Dr. Adeel Khan, to create a welcoming and supportive environment for patients. She specializes in weight-loss management, offering personalized treatment plans aimed at achieving sustainable health outcomes. Dr. Qureshi holds degrees from Ohio State University and The University of Pikeville-Kentucky College of Osteopathic Medicine, with internal medicine training from Midwestern University OPTI in Sierra Vista, Arizona.
Fluent in English and Urdu/Hindi, Dr. Qureshi is passionate about educating her patients and empowering them to take charge of their health. Outside of her medical practice, she enjoys cooking, traveling, photography, and movies.
