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Medicare Wellness Visits vs. Routine Physical Exams

Under Medicare guidelines, the Annual Wellness Visit is a yearly appointment with your primary care team, where together you develop or update your Personalized Prevention Plan, and a medical professional performs a Health Risk Assessment (HRA). Medicare covers this visit, once every 12 months.

Routine physical exams are unrelated to treatment or diagnosis for a specific illness, symptom, complaint or injury. These exams are not covered by Medicare, so patients will pay 100% out-of-pocket.

Learn more about Medicare Wellness Exams.

What to expect at your first Annual Wellness Visit

A member of your healthcare team will do a Health Risk Assessment, which will cover the following:

  • Updating your other current healthcare providers, if any
  • Review current prescriptions, including any opioid prescriptions
  • Demographic data (age, race, sex, etc.)
  • Height, weight, BMI, and blood pressure
  • Health status self-assessment
  • Medical and family history
  • Psychosocial risks (depression, stress, social isolation, pain, fatigue, etc.)
  • Behavioral risks (tobacco use, physical activity, motor vehicle safety, etc.)
  • Activities of daily living (dressing, feeding, fall risks, bathing, etc.)
  • Advance care planning services

Using your information from the above areas, the team will create a screening schedule for preventative
services and other relevant medical services. The team will also give you personalized advice
and referrals (if needed) to health education or preventative counseling services or programs.

Subsequent Annual Wellness Visits
Each year’s annual wellness visit will include a review and update of your Health Risk Assessment.

Learn more about
Medicare Wellness Visits
at CMS.GOV

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