- A Medicare Annual Wellness Visit (AWV) is a preventive, conversation-based appointment that builds a personalized prevention plan — it is not a head-to-toe physical exam.
- Under Medicare Part B the AWV costs $0 and the Part B deductible does not apply, as long as your provider accepts assignment and the visit stays preventive.
- The AWV is separate from the one-time "Welcome to Medicare" preventive visit and from a routine annual physical, which Original Medicare does not cover.
- You qualify for the AWV once you have had Part B for more than 12 months, and you can get one every 12 months.
- Mentioning a new symptom can turn part of the visit into a billable office visit ("visit splitting"), so save non-urgent complaints for a separate appointment.
- Coverage details vary — verify what is included and what you may owe with your own plan and provider before you go.
If you have ever asked “what is a wellness visit,” you are in good company. The term gets used loosely in healthcare, and many people confuse it with a traditional annual physical — two appointments that serve very different purposes and are billed very differently by insurance. Getting the distinction right can save you money and prevent a frustrating surprise bill.
A wellness visit is a preventive appointment focused on health risk assessment, screening schedules, and care planning. It is a conversation-based visit, not a hands-on physical examination. Understanding the difference helps you get the most from your preventive care benefits and avoid paying for services you thought were free.
Defining the Wellness Visit
In its most common usage — particularly in the Medicare world — a wellness visit refers to the Medicare Annual Wellness Visit (AWV), a benefit covered under Medicare Part B at no cost to the patient. The AWV was introduced as part of the Affordable Care Act in 2011 and is designed to help beneficiaries and their providers develop a personalized prevention plan.
According to Medicare.gov, the yearly “Wellness” visit is a conversation-based visit to create a prevention plan — it “isn’t a routine physical exam.” During the appointment, your provider reviews your health history, screens for cognitive changes and other risks, reviews your medications, and creates or updates a written prevention plan tailored to your age, sex, and individual risk factors. Crucially, it does not typically include a hands-on physical examination of your body, blood draws, or diagnostic testing.
Private insurance plans under the ACA also cover an annual preventive visit at no cost, though the specific components may vary. Check with your insurer to understand exactly what your plan’s “wellness visit” or “preventive visit” includes, because plan definitions differ.
What the Wellness Visit Costs in 2026
Under Medicare, the Annual Wellness Visit costs $0 when your provider accepts assignment, and the Part B deductible does not apply. That is different from most Part B services, where — after you meet the annual Part B deductible ($283 in 2026) — you generally pay 20 percent coinsurance. The AWV sits outside that cost-sharing as long as the visit stays preventive.
The catch is that “stays preventive” part. If additional, non-preventive services are added during the appointment, those extra services can be billed under normal Part B rules, and you may owe the deductible and coinsurance on that portion. These figures and rules can change year to year, so verify current costs and what your specific plan covers with Medicare or your provider before your appointment.
Wellness Visit vs. Annual Physical vs. “Welcome to Medicare”
This is where most confusion arises. There are actually three different appointments people tend to lump together. Here is a clear breakdown:
| Feature | Annual Wellness Visit (AWV) | “Welcome to Medicare” visit | Routine annual physical |
|---|---|---|---|
| Purpose | Prevention planning & risk assessment | One-time preventive review at the start of Medicare | Hands-on head-to-toe clinical exam |
| Hands-on physical exam? | No | Limited (height, weight, blood pressure, vision check) | Yes |
| Frequency | Once every 12 months | Once, within the first 12 months of Part B | Typically yearly |
| Original Medicare cost | $0 (deductible does not apply) | $0 (deductible does not apply) | Not covered by Original Medicare |
The wellness visit
- Focused on health risk assessment and prevention planning
- Includes height, weight, blood pressure, and BMI measurement
- Includes cognitive screening, a review of risks such as depression and substance use, and fall risk assessment
- Results in a personalized prevention plan with a screening schedule
- Does not include a hands-on physical exam (no stethoscope, no reflex test, no abdominal palpation)
- Covered at 100 percent by Medicare (no deductible, no copay) when the visit stays preventive
The annual physical
- A comprehensive, hands-on clinical examination
- Includes listening to your heart and lungs, checking reflexes, examining your abdomen, skin, throat, and eyes
- Often accompanied by lab work (CBC, metabolic panel, lipid panel)
- May address specific health complaints during the same visit
- Not covered by Original Medicare (though many Medicare Advantage plans include it as an extra benefit)
- Covered by most private insurance as part of a preventive visit, but coverage details vary
The “Welcome to Medicare” visit
- A one-time preventive visit available only during your first 12 months with Part B
- Slightly more comprehensive than a standard AWV and includes basic measurements and a vision check
- Also covered at $0 with no deductible when your provider accepts assignment
- You cannot have the AWV within 12 months of this visit
For a full walkthrough of the physical exam, see our guide on what an annual physical consists of. For a checklist you can bring to the wellness visit, read our annual wellness exam checklist.
What Happens During a Wellness Visit
The specific components of a Medicare AWV are defined by CMS. Here is what you can expect:
Health Risk Assessment (HRA): A standardized questionnaire covering your medical history, family history, lifestyle habits (diet, exercise, alcohol, tobacco), functional status, and psychosocial risks. Some practices send this electronically before the appointment.
Routine Measurements: Height, weight, blood pressure, and BMI. These data points are tracked year over year to identify trends that may signal emerging health issues.
Cognitive Assessment: A brief screening for memory and cognitive function, watching for signs of dementia, using validated tools. This is a screening, not a diagnosis — if concerns arise, your provider will recommend further evaluation.
Risk Screening: Your provider may screen for depression and evaluate other risks such as substance use, using tools like the PHQ-2 or PHQ-9 as recommended by the USPSTF. A discussion of advance directives may also be offered.
Fall Risk Evaluation: Especially important for adults 65 and older. The CDC reports that about one in four older adults falls each year, and many of these falls are preventable with proper assessment and intervention.
Personalized Prevention Plan: Your provider creates a written plan (essentially a checklist) that includes recommended screenings (mammogram, colonoscopy, bone density, and so on), vaccinations, and counseling based on your specific profile.
Who Is Eligible for a Wellness Visit?
Under Medicare, you are eligible for the Annual Wellness Visit once you have had Part B coverage for more than 12 months, and you can receive one every 12 months. During your first 12 months, you can instead receive the “Welcome to Medicare” preventive visit — a one-time benefit that is slightly more comprehensive than subsequent AWVs. You cannot have the AWV within 12 months of enrolling in Part B or within 12 months of your Welcome to Medicare visit.
Under private insurance governed by the ACA, most adults are eligible for an annual preventive visit at no cost, regardless of age. The specific services included depend on the plan, but ACA-compliant plans must cover USPSTF-recommended preventive services without cost-sharing when provided by in-network providers. Verify the details with your own plan.
For Medicare-specific coverage questions, see our article on whether Medicare covers annual physicals.
How to Prepare for Your Wellness Visit
Preparation is the difference between a productive wellness visit and a wasted appointment. Here is what to do before you go:
- Complete any pre-visit questionnaires your provider sends. These save time and ensure nothing is missed.
- Bring a complete list of all medications, supplements, and vitamins — including dosages.
- Update your family health history, noting any new diagnoses among parents, siblings, or children.
- Write down questions or concerns you want to discuss.
- Review your previous prevention plan (if you have had a prior AWV) and note any screenings you may have missed.
- Know which preventive services you are due for based on your age. Our annual physical exam checklist by age is a helpful reference.
Avoiding Surprise Charges at a Wellness Visit
The most common billing issue with wellness visits is “visit splitting” — when a portion of the visit shifts from preventive to diagnostic. If you mention a new symptom and your doctor addresses it, that part of the visit may be billed as an office visit, which can trigger the Part B deductible and 20 percent coinsurance (or a copay on a private plan).
To minimize unexpected charges:
- Schedule the appointment specifically as a “wellness visit” or “Annual Wellness Visit.”
- Save non-urgent medical complaints for a separate follow-up appointment.
- Ask your provider before any labs or tests are ordered whether they will be billed as preventive or diagnostic.
- Confirm your provider is in-network and accepts Medicare assignment.
- If you are unsure how something will be billed, ask the front desk to explain before the visit.
Frequently Asked Questions
Is a wellness visit worth it if I feel healthy?
Yes. The purpose of a wellness visit is prevention — catching risk factors and scheduling screenings before symptoms appear. Many serious conditions, including high blood pressure, prediabetes, and certain cancers, are asymptomatic in their early stages. The wellness visit is designed to help find them early.
Can I get a wellness visit and a physical in the same year?
Yes. They are separate services. You can have a Medicare-covered AWV and also schedule a physical exam — either covered by your Medicare Advantage plan or paid out of pocket. Many patients benefit from both.
What if my doctor does a physical exam during my wellness visit?
If your doctor performs a hands-on physical examination or addresses a new problem during what was scheduled as a wellness visit, that portion may be billed as an office visit or comprehensive exam. This can result in out-of-pocket costs. Discuss expectations with your provider at the start of the visit.
Do I need a referral for a wellness visit?
No referral is needed for a Medicare Annual Wellness Visit. You can schedule directly with any primary care provider who accepts Medicare. Private insurance plans may have their own referral requirements, so check with your plan if unsure.
How often can I get an Annual Wellness Visit?
Once every 12 months under Medicare, provided you have had Part B for more than 12 months and it has been at least a year since your last AWV or your Welcome to Medicare visit.
Your Wellness Visit Is Free — Use It
Now that you know what a wellness visit is, there is little reason to skip one. It is covered at no cost under Medicare and most private insurance plans, is conversation-based rather than a hands-on exam, and produces a personalized prevention roadmap that can guide your healthcare decisions for the year ahead.
Schedule your wellness visit, arrive prepared with your medication list and questions, and use the time to build a proactive relationship with your primary care provider. For broader strategies on maintaining your health, explore our wellness guide, and review the cost of urgent care visits so you know your options when unexpected health needs arise.
A “wellness visit” usually means the Medicare Annual Wellness Visit — a free, conversation-based prevention appointment that builds a personalized prevention plan. It is not a head-to-toe physical, it costs $0 under Part B (the deductible does not apply), and it is separate from both the one-time “Welcome to Medicare” visit and a routine physical, which Original Medicare does not cover. You qualify once you have had Part B for more than 12 months and can get one every 12 months. This article is general education, not medical or insurance advice — coverage rules and dollar figures change, so verify current details with Medicare or your own plan and provider before you go.
Sources
- Medicare.gov — Yearly “Wellness” visits (coverage; $0 cost and Part B deductible does not apply; conversation-based, not a routine physical; once every 12 months; requires Part B for more than 12 months; distinct from the “Welcome to Medicare” visit)
- Medicare.gov — “Welcome to Medicare” preventive visit
- Medicare.gov — Medicare costs 2026 (Part B deductible $283; 20% coinsurance after the deductible)
- Centers for Medicare & Medicaid Services (CMS) — Medicare preventive services and Annual Wellness Visit components (Health Risk Assessment, personalized prevention plan, cognitive assessment)
- U.S. Preventive Services Task Force (USPSTF) — recommended preventive services, including depression screening
- Centers for Disease Control and Prevention (CDC) — older-adult falls statistics