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Is the Medicare annual wellness visit mandatory?

Category: Closing the Coverage Gap
Updated: Sep, 22 2022


No. The Medicare annual wellness visit is not mandatory - but, the visit is provided at no cost every 12 months for people who have Medicare Part B coverage (and who see a provider who accepts Medicare) and is usually recommended by Medicare health plans to better understand your current health - and to see if there indications of healthcare issues that can be prevented.

The annual wellness visit is only a basic health (and cognitive) review and should not be considered equivalent to a comprehensive physical examination.

The Centers for Medicare & Medicaid Services Medicare & You handbook notes under "Preventive service":
“Yearly 'Wellness' visit

If you’ve had Part B for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to prevent disease or disability based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam. Medicare covers this visit once every 12 months.

Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit.

Your visit may include:
  • routine measurements [such as height, weight, blood pressure, and body mass index or BMI],
  • health advice,
  • a review of your medical and family history,
  • [a review of] your current prescriptions [and healthcare providers],
  • [advice about] advance care planning [where, if you become unable, legal documentation are in place for someone else to make healthcare decisions] and more [including nutrition information, recommendations of additional routine screenings and preventative services].
Your provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease.

Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life.

If your provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium and design a care plan.” [links and formatting added]
Although provided at no cost, you may be responsible for additional coverage costs if additional tests or services are required beyond this routine visit.  In Medicare Advantage plan documentation, you may find such language as:
“Annual wellness visit

If you've had Part B for longer than 12 months, you can get an annual wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. This is covered once every 12 months.

There is no coinsurance, co-payment, or deductible for the annual wellness visit.

Note: Your first annual wellness visit can't take place within 12 months of your "Welcome to Medicare" preventive visit.

However, you don't need to have had a "Welcome to Medicare" visit to be covered for annual wellness visits after you've had Part B for 12 months.

If your physician performs additional diagnostic or surgical procedures or if other medical services are provided for other medical conditions in the same visit, then the appropriate cost-share applies for those services rendered during that visit.” [links and formatting added]
Potential for Substance Abuse

As noted on the Medicare website, during the the annual wellness visit you may also be asked questions to assess your potential for substance abuse:
"If you have a current prescription for opioids, your provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your provider will also review your potential risk factors for substance use disorder and refer you for treatment, if needed."
How to prepare for your wellness visit

The Medicare plan provider, United Healthcare, offers the following suggestions of what to bring to your wellness visit:
  • Bring all the medications you take (prescription, non-prescription, vitamins, supplements and herbal).
  • Complete a list of all the health care providers you see, including names and contact information.
  • Bring your completed health history form and health risk assessment if sent to you by your doctor’s office ahead of time.
  • Bring a list of questions or things you want to discuss with your doctor.

See also:
https://www.medicare.gov/coverage/yearly-wellness-visits
https://www.medicare.gov/coverage/advance-care-planning
https://www.medicare.gov/coverage/welcome-to-medicare-preventive-visit
https://www.uhc.com/news-articles/medicare-articles/how-prepare-your-medicare-wellness-visit
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html






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