Medicare Annual Wellness Visit Coverage
Yes, Medicare beneficiaries receive a completely free Annual Wellness Visit (AWV) with no copayment or deductible when the provider accepts Medicare assignment. 1
Coverage Details
Since January 1,2011, the Affordable Care Act mandated that Medicare cover annual wellness visits and personalized prevention plan services at no cost to all Medicare Part B beneficiaries. 1 This represents a fundamental shift in Medicare's preventive care coverage, eliminating the previous requirement where beneficiaries had to pay 20% of the cost for preventive health services. 1
Key Coverage Points
Zero out-of-pocket costs: The AWV is provided with no copayment, coinsurance, or deductible when performed by a provider who accepts Medicare assignment. 1
Eligibility: Any patient enrolled in Medicare Part B is eligible for these visits, including both traditional Medicare and Medicare Advantage beneficiaries. 2
Initial vs. subsequent visits: Medicare covers both the "Welcome to Medicare" initial preventive physical examination and subsequent Annual Wellness Visits using specific G-codes (G0438 for initial AWV, G0439 for subsequent AWVs). 3
What the Free Visit Includes
The AWV focuses on health risk assessment and personalized prevention planning rather than a comprehensive physical examination. 3 Required components include:
- Health risk assessment with medical and family history review 4, 5
- Cognitive assessment using validated screening tools 4, 5
- Depression and mental health screening 4, 5
- Functional status evaluation 4
- Review of prescription and over-the-counter medications 4, 5
- Screening for chronic disease risk factors 5
- Personalized prevention plan development 4, 5
Important Caveats
Additional services beyond the wellness visit scope may incur costs. If the visit becomes complex and requires significant problem-focused evaluation for acute or chronic conditions, the provider may bill a separate evaluation and management service with modifier 25, which could result in copayments. 3
Preventive services mandated by the ACA must remain free. Physicians should not charge additional fees for preventive services included in the ACA benefit, even in direct-pay or concierge practice models. 1
Utilization Gaps
Despite being free, the AWV remains significantly underutilized. Approximately only half of Medicare beneficiaries report having an AWV, and fewer than one-third report receiving a structured cognitive assessment during the visit. 6 Medicare Advantage enrollees are nearly 20 percentage points more likely to utilize the AWV compared to traditional fee-for-service Medicare beneficiaries. 6
Barriers to utilization include: lack of patient awareness that the benefit exists at no cost, insufficient time during primary care visits, and provider concerns about reimbursement adequacy. 1