Is the Annual Wellness Visit really free?

Yes — the Medicare Annual Wellness Visit has no Part B deductible and no coinsurance. It is fully covered as a preventive service. The key caveat: if your provider bills for additional services during the same visit — diagnosing and treating a new or existing condition, for example — those additional services may be billed separately and trigger cost-sharing. Medicare is clear that the AWV itself is free; add-ons are not.

How often can I have an Annual Wellness Visit?

Once per calendar year, starting 12 months after either your Welcome to Medicare Visit (if you had one) or your last AWV. So if your first AWV was in April 2025, you can schedule the next one any time after April 2026 within that calendar year. You don't have to schedule it exactly one year later — just not within 12 months of the previous one.

My doctor tried to charge me for my Annual Wellness Visit. Is that allowed?

No, if the visit consisted only of AWV components. The AWV is a preventive service with no patient cost-sharing. If your doctor added a separate evaluation and management (E&M) service during the same visit — treating a new symptom, adjusting a medication — that portion may be billed separately. Ask your doctor before your appointment whether they plan to bill separately for anything beyond the wellness visit itself, so you can decide whether to address non-preventive concerns at a separate visit.

Does the AWV include blood work or lab tests?

No — lab tests are not part of the Annual Wellness Visit itself. However, your doctor may order preventive laboratory tests separately based on your health history and risk factors. For example, a fasting glucose test ordered during the AWV is billed separately and may have its own cost-sharing depending on the indication. Discuss with your doctor which labs are recommended for you and whether they will be billed as preventive (usually covered at 100%) or diagnostic (subject to deductible and coinsurance).

Can I have my Annual Wellness Visit with a nurse practitioner or PA instead of a physician?

Yes. The AWV can be performed by a physician, physician assistant, nurse practitioner, clinical nurse specialist, or a health educator in some settings working under physician supervision. Medicare doesn't require the visit to be with a physician — you don't need to wait for a physician appointment if your care team includes nurse practitioners or PAs who can conduct the AWV.

Medicare Annual Wellness Visit: What to Expect and How to Prepare

AWV vs. Physical Exam: A Critical Distinction {#awv-vs-physical}

One of the most common Medicare surprises: beneficiaries schedule their Medicare Annual Wellness Visit expecting a complete head-to-toe physical examination — and discover that’s not what the AWV provides.

The Annual Wellness Visit is a wellness and prevention focused appointment, not a comprehensive medical examination. Understanding this distinction matters practically, because many beneficiaries who try to combine a traditional physical with their AWV find they’ve been billed separately for the physical portion.

What the AWV is: A structured conversation and assessment focused on your health risks, prevention priorities, and cognitive status. It was created specifically to help Medicare patients and their providers identify preventive care needs — vaccines you’re due for, cancer screenings you haven’t had, depression or cognitive changes that might be emerging.

What a traditional physical exam is: A comprehensive clinical evaluation where your doctor examines your organ systems, diagnoses symptoms, and evaluates ongoing conditions. This generates a different billing code (typically 99397 or an E&M code) and is not covered the same way as the AWV.

You can have both in the same year — but the physical may carry cost-sharing that the AWV does not. Some providers try to combine them into one visit; be clear about what you want, and ask upfront whether any additional services beyond the wellness visit components will result in a separate bill.

What the Annual Wellness Visit Includes {#what-included}

Medicare defines specific required components of the Annual Wellness Visit. Your provider is required to address each:

Health Risk Assessment

A questionnaire covering your self-reported health status, psychosocial risks, behavioral health risks, and ability to perform activities of daily living. You may complete this in the waiting room on paper or electronically before your appointment. This is the foundation of your personalized prevention plan.

Vital Signs and Basic Measurements

Blood pressure
Height and weight (body mass index)
Heart rate

Note: unlike a physical, the AWV does not include a full physical examination of organ systems.

Cognitive Assessment

A brief cognitive screening to detect early signs of cognitive impairment, Alzheimer’s, or other dementia. The most commonly used tool is the Mini-Cog (a 3-minute test involving word recall and clock drawing) or the MMSE. If impairment is detected, your provider should refer you for further evaluation. This screening is one of the most valuable components of the AWV for detecting early cognitive changes when intervention is most effective.

Depression Screening

A brief depression screening questionnaire (typically the PHQ-2 or PHQ-9). Depression is significantly underdiagnosed in older adults and often presents differently than it does in younger populations. If screening is positive, your provider should discuss treatment options or refer you.

Review of Functional Ability and Safety

Assessment of your ability to perform daily activities, home safety risk (fall risk especially), and hearing or vision concerns that may not be on your provider’s radar.

Review of Your Medical and Family History

Your provider reviews your current medications, allergies, family history of hereditary conditions, and updates to your health history since the last visit.

Current Providers and Suppliers List

A list of all your healthcare providers and any medical equipment suppliers — useful for care coordination and preventing drug interactions that can happen when multiple prescribers are managing your care independently.

Personalized Prevention Plan

Based on everything above, your provider develops a written prevention plan identifying screenings, vaccines, and health counseling you should receive. This is the deliverable of the AWV — a roadmap for your preventive care in the coming year.

Advance Care Planning (Optional But Important)

Discussing and documenting your preferences for end-of-life care — advance directives, healthcare proxy designation, and your values around medical intervention. This is optional but covered separately as a billable service that can occur during the AWV without additional patient cost-sharing.

What the AWV Does NOT Include {#not-included}

A full physical examination. The AWV includes measurement of vitals and basic health metrics, but not an examination of organ systems (listening to your heart, feeling your abdomen, examining your skin). If you want a traditional physical exam, that’s a separate appointment.

Laboratory tests. Blood work — cholesterol panels, blood sugar, kidney function — is not part of the AWV itself. Labs may be ordered separately and billed separately.

Diagnosis or treatment of existing conditions. If you bring up a symptom or problem at your AWV, and your provider evaluates and manages it, that service is billed separately. The AWV is preventive by design; management of conditions is a separate clinical encounter.

Specialist referrals. The AWV can generate referrals, but the referral appointments themselves are not part of the AWV.

Pap smear or pelvic exam. These are separate preventive services with their own Medicare coverage rules and scheduling intervals.

The Welcome to Medicare Visit (One-Time Only) {#welcome-to-medicare}

Your first year of Medicare includes a special, one-time visit called the Welcome to Medicare preventive visit (formally called the “Initial Preventive Physical Examination” or IPPE). It is not the same as the Annual Wellness Visit.

When: Within the first 12 months of your Medicare Part B coverage. Cost: No deductible, no coinsurance — free, like the AWV. What it covers: Similar to the AWV but with additional components — a comprehensive review of your medical history, a physical examination with height, weight, BMI, and blood pressure, and an electrocardiogram (EKG) if you are at risk for cardiovascular conditions.

Many beneficiaries don’t realize this visit exists and miss the 12-month window. If you’re newly enrolled in Medicare Part B, call your primary care doctor and ask to schedule your Welcome to Medicare visit — it’s a different visit from the annual wellness visit and disappears if you don’t use it in year one.

How to Prepare and Maximize Your Visit {#how-to-prepare}

The AWV is most valuable when you come prepared. Here’s how to get the most out of the appointment:

Bring your complete medication list. Include prescription drugs, over-the-counter medications, vitamins, and supplements. Use a printed list with drug names, doses, and prescribing physicians. Your provider is looking for potential drug interactions and gaps in your care — the more complete the list, the better.

Know your vaccination history. Bring documentation or be prepared to discuss which vaccines you’ve received and when: flu (annual), Shingrix (shingles, 2-dose series), Pneumovax/Prevnar (pneumococcal), COVID-19 boosters, Tdap (tetanus). Medicare covers many vaccines at 100% — you may be overdue for some.

Prepare a list of concerns. The AWV is primarily preventive, but you can use the appointment to identify which issues should be addressed in a separate clinical visit. Write down health questions you want to raise so nothing gets forgotten.

Bring someone with you. A trusted family member or friend can help you remember what the doctor said, raise concerns you might overlook, and flag any behavioral or cognitive changes they’ve noticed.

Ask about recommended screenings. Based on your age, sex, and risk factors, certain cancer screenings are covered by Medicare at 100% as preventive services. Your doctor should address these in the personalized prevention plan. Ask specifically:

Colorectal cancer screening (colonoscopy or stool test, depending on age and risk)
Mammography (annually for women 50+)
Lung cancer screening (low-dose CT for eligible smokers/former smokers)
Osteoporosis screening (bone density for women 65+)

Request advance care planning. If you don’t have a living will, healthcare proxy, or advance directive, the AWV is an ideal time to discuss this with your provider. Advance care planning is a covered, zero-cost-sharing service — it can take place during the AWV without additional billing.

Key Takeaways

The Annual Wellness Visit is completely free — no deductible, no copay — but it is not a comprehensive physical exam. If a provider evaluates or treats a condition during the same visit, that portion may be billed separately.
Core AWV components: health risk assessment, vital signs, cognitive screening, depression screening, functional assessment, medication review, and a personalized prevention plan.
Labs and physical examination of organ systems are NOT included in the AWV — they are billed separately if ordered.
New Medicare enrollees get one Welcome to Medicare visit (IPPE) in their first 12 months — don’t miss this window; it’s different from and additional to the annual wellness visit.
Come prepared: bring your full medication list, your vaccination history, and written health questions to make the most of the appointment.