Medicare Annual Wellness Visits for Seniors

Medicare covers annual wellness visits with our Wilmington providers, which are yearly preventive appointments for seniors that create future care plans. A senior wellness checkup provides patients opportunities to review medication and immunizations, discuss their health history, and identify future screenings or follow-up care.

Our senior primary care providers’ goals are patient-focused, aiming to get patients the most out of these annual visits as possible, within the preventive services covered by Medicare. Patients and physicians find senior wellness checkups beneficial.

  • Enhanced patient engagement with their primary care providers
  • Create or update the patient’s personal and family health history for improved disease prevention
  • Identify health risks, such as depression, and beneficial behavioral counseling, such as dietary counseling
  • Identify preventive care for seniors that requires follow-up, such as vaccinations or cancer screenings

What Is Covered in a Medicare Annual Wellness Visit?

If the provider accepts the assignment, an Initial Preventive Physical Examination (IPPE) or an annual wellness visit (AWV) is care covered by Medicare. Generally, risk assessments are covered, but diagnostic tests, lab work, X-rays, medication adjustments, or treatment for new or existing illnesses are not covered. Our patient resources offer additional information on Medicare, insurance, support groups, and services.

What To Expect During a Medicare Wellness Visit and Exam

During your visit, your provider will take routine measurements (height, weight, blood pressure), and you’ll complete a wellness form with your health history. These appointments focus on risk assessments and future care recommendations—not on physical examinations or internal medicine specialties. Seniors are encouraged to bring a family member or friend to an appointment to take notes or ask questions, especially if this person is involved in their caregiving. 

Types of Senior Wellness Checkups Covered by Medicare

We understand how important it is to receive affordable healthcare. Preventive care for seniors is typically covered by Medicare if it falls into one of these two visits: Initial Preventive Physical Examination (IPPE) or an Annual Wellness Visit (AWV).

Initial Preventive Physical Examination (IPPE)

  • Review of medical and social health history, and preventive services education
  • Covered only once, within 12 months of Part B enrollment
  • Patient pays nothing (if provider accepts assignment)

Annual Wellness Visit (AWV)

  • To develop or update a personalized prevention plan and perform a health risk assessment
  • The wellness visit can be done by your family medicine physician or another member of the healthcare team, such as a Physician’s Assistant or Nurse Practitioner
  • Covered once every 12 months
  • Patient pays nothing (if provider accepts assignment)
  • The wellness exam only covers the topics detailed above. Additional charges may occur if other issues are addressed during a patient’s wellness visit.

Senior Wellness Exams and Sick Visits

Seniors need to understand the differences between sick visits and wellness exams to understand what questions or elements will not be covered under Medicare Annual Wellness visits. Medical billing typically sticks to wellness exams or sick visits, and these are not considered the same. Here are the differences between these two exam types:

  • An office visit for an acute problem, flare-up of a chronic problem, or a follow-up of chronic problems (e.g., diabetes, cholesterol, blood pressure) is considered a sick visit. 
  • An office visit for a routine physical exam or yearly health maintenance is considered a well visit.

Billing for Combination Wellness/Sick Visits

When an appointment covers both aspects of wellness and discusses a sickness or condition, it is considered a combination visit and may be billed differently. Issues in areas not covered by the Medicare Annual Wellness visit will be billed separately due to the additional time, expertise, and documentation required for a combination visit. 

Controlling Your Healthcare Costs

Although many insurance companies acknowledge the sick/well visit combination, some require two co-pays or apply additional costs to your annual deductible. Please contact your insurance carrier to determine how your coverage works for a sick visit, a well visit, and a combination visit. 

If you want to keep your annual wellness visit at a low or no cost, avoid discussing other conditions outside of what Medicare covers and book a separate appointment with a geriatric medicine provider in the greater Wilmington, NC area. Connect with a provider through any of these convenient methods: