People can refuse a Medicare annual wellness visit, but it is worth considering the potential benefits. Wellness visits can help healthcare professionals detect health issues early on and are an important part of preventive care.
A Medicare annual wellness visit (AWV) is a preventive care service that helps identify potential health problems. Medicare covers the cost of AWVs.
This article discusses whether people can refuse a Medicare wellness visit, its potential benefits, costs, and who qualifies for it.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare AWVs are not compulsory, and people have a right to refuse them.
However, a Medicare AWV may have many potential benefits for a person’s health. Preventive care and health maintenance
- detect and treat health conditions early on, which may improve outcomes and reduce the risk of complications
- save people time, money, and emotional, mental, or physical difficulties that may occur if a health issue progresses
- improve overall well-being and quality of life
- build relationships with healthcare professionals and allow them to understand a person’s health, medical history, and risk factors for health conditions
An AWV is a preventive service that aims to identify any health issues before they begin or become serious.
An AWV provides people with a health plan personalized to their health needs and risk factors to help prevent illness and disability.
An AWV also includes checking cognitive health, which can help detect early signs of cognitive impairment and dementia.
An AWV is not the same as an annual physical.
A wellness visit focuses on preventing health problems in the future and maintaining good health. It also ensures people stay up to date with vaccines and screenings rather than addressing specific health issues.
During an AWV, a doctor can assess a person’s risk factors and create a personalized health plan. They may refer people for tests or other services if necessary.
An annual physical examination involves a doctor performing a physical examination and taking blood tests or other medical tests to check for health problems. During the physical, people can also discuss any health concerns they may have with the doctor.
Medicare covers the cost of annual AWVs but not routine physicals. Medicare only covers the cost of an initial checkup within 12 months of enrolling in Medicare Part B.
An AWV typically takes place in a doctor’s office or another healthcare setting. People who are homebound may be able to request an AWV at home.
Any of the following healthcare professionals may conduct an AWV:
- doctor
- doctor’s assistant
- nurse practitioner
- clinical nurse specialist
- another medical professional, such as a health educator, registered dietitian, or nutritionist
- a team of medical professionals working under the supervision of a doctor
A Medicare AWV may include:
- a Health Risk Assessment (HRA) questionnaire to help a doctor create a personalized health plan
- a social determinants of health (SDOH) risk assessment to assess nonmedical factors that may affect health, such as access to food
- routine measurements, such as height, weight, and blood pressure
- a review of personal and family medical history
- a review of current prescriptions
- a review of risk factors for opioid use disorder or substance use disorder
- personalized health advice
- advance care planning, which is a care plan to use in case people are unable to make their own decisions about their health in the future
- a discussion about recommended preventive screenings
- a cognitive assessment to check for signs of dementia
- referrals for any further services or tests, if necessary
What a wellness visit does not address
An AWV is not a physical exam and
If a person has a specific problem, a wellness visit will not address this. It also does not check up on any chronic health conditions a person may have, such as diabetes.
Wellness visits focus on maintaining health and preventing health issues in the future.
People who have had Medicare Part B insurance for more than 12 months qualify for wellness visits.
People cannot have their initial AWV within 12 months of enrolling in Part B or having their Welcome to Medicare visit. People do not need to have had their welcome visit to qualify for their AWV.
An AWV does not cost anything as long as the healthcare professional or provider carrying out the visit accepts Medicare. This means people will have no out-of-pocket costs.
The Part B deductible does not apply to annual wellness visits. However, if a doctor performs further tests during the wellness visit, which Medicare does not cover, people may have to pay the Part B deductible and coinsurance. In 2024, the Part B deductible is $240.
If a doctor performs tests and services not included in the standard AWV, people may have to pay the full cost of the additional services. Medicare does not cover any tests or services people may require outside the AWV.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
People do not have to attend a Medicare AWV, but the visits may provide health benefits.
A wellness visit is a preventive service that aims to identify any health issues early on. This may help prevent a health problem from progressing and becoming more serious, which could make it difficult and costly to treat.
If people have any concerns about a wellness visit, they can discuss these with a healthcare professional.