Medicare Wellness Visits and physical exams can sound similar, but they serve different purposes. Understanding how they work can help you choose the right visit and avoid unexpected costs.
What do I need to know about Medicare Wellness Visits and physical exams?
A yearly wellness visit is focused on prevention planning, while a routine physical exam is a hands-on checkup that Original Medicare doesn’t cover. When you schedule, ask for the visit you want and confirm what costs may apply if extra services or tests are added.
What is a Medicare Annual Wellness Visit?
A Medicare Annual Wellness Visit (AWV) is a yearly appointment that focuses on prevention planning. You and your primary care provider (PCP) review your health history, risks and goals. Then you work together on a personalized plan for the year ahead.
This visit isn’t a head-to-toe physical exam. It’s designed to help you stay on track with preventive services, like screenings and vaccines.
Your visit may include:
- A health risk assessment questionnaire
- A review of your medical and family history
- Routine measurements like height, weight and blood pressure
- A review of your current prescriptions
- A cognitive assessment
- Personalized health advice and a screening schedule
- Optional advance care planning
You can usually get an annual wellness visit once every 12 months after you’ve had Medicare Part B for at least 12 months. Your first Medicare yearly wellness visit can’t happen within 12 months of Part B enrollment or your “Welcome to Medicare” preventive visit.
You typically pay nothing for the wellness visit if your provider accepts Medicare. But if extra services or tests are added during the same appointment, you may have to pay coinsurance or a copay depending on your plan, and your deductible may apply.
What is a routine physical exam?
A routine physical exam is a hands-on checkup that looks at your overall health. It may include a head-to-toe exam and tests to check things like cholesterol and blood sugar. It’s often the visit where you bring up concerns and your doctor decides what follow-up care you may need.
A routine physical may include:
- Vital signs and general appearance
- Heart and lung exam
- Abdomen exam
- Skin, head and neck checks
- Extremities and neurological checks
- Lab tests, such as cholesterol or blood sugar
Because a routine physical includes an exam and possible tests, it’s different from a wellness visit that’s focused on prevention planning. If you book a wellness visit but receive a routine physical or other non-preventive services, you may get a bill.
What is a Healthy Home Visit?
A Healthy Home Visit is a yearly preventive visit that brings care to you. It’s part of some Aetna® Medicare Advantage plans and may be available at no added cost.
During the visit, a licensed clinician meets with you in your home. They focus on your overall health and help you stay on track with preventive care.
Your visit may include:
- Checking vital signs and reflexes
- Reviewing your medical history
- Going over your medications
- Looking at areas like breathing, eyes or feet
- Helping find health concerns early
After your visit, you get a summary to review. Your primary care provider (PCP) may also get a copy so they can stay informed.
Prefer not to meet in person? Some plans may offer a virtual visit instead.
Common questions about Medicare Annual Wellness Visits and physical exams
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These three visits can all support prevention, but they don’t do the same job. Here’s an at-a-glance comparison of what each one is designed to do.
Annual Wellness Visit (AWV):
- Focus: prevention planning and a screening schedule
- Who you see: your PCP
- What it may include: a questionnaire, routine measurements, a medication review and a cognitive assessment
Healthy Home Visit (HHV) (available through some Aetna Medicare plans):
- Focus: a preventive check-in that brings care to you
- Who you see: a licensed clinician through an Aetna accepted vendor
- What it may include: it doesn’t replace your relationship with your PCP, and your doctor may get a visit summary
Routine physical exam:
- Focus: a hands-on exam and possible lab tests
- Who you see: your PCP
- What it may include: a full exam plus tests your doctor orders
Even when a plan covers these visits, you may have to pay for some tests your doctor orders. If you’re not sure what’s included, ask before your appointment.
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Medicare Part B covers a one-time “Welcome to Medicare” preventive visit within your first 12 months of Part B coverage. It helps establish a baseline and creates a checklist of screenings and shots, but it isn’t a routine physical exam.
Part B also covers a yearly wellness visit once every 12 months. You generally pay nothing if your provider accepts Medicare, but other costs may apply if extra services or tests are added.
Original Medicare doesn’t cover routine physical exams. If you get a routine physical under Original Medicare, you typically pay 100% out of pocket.
Medicare Advantage plans must cover the same preventive visits as Original Medicare. Some plans also offer extra benefits, and they may include an annual routine physical exam or in-home preventive visits. Aetna Medicare plans may include a $0 copay annual routine physical exam and may offer a yearly Healthy Home Visit at no added cost. Coverage and costs vary by plan, so check your Evidence of Coverage for details.
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Some Medicare Advantage plans with prescription drug coverage may include an annual routine physical exam as part of their benefits. These plans combine medical and drug coverage and may offer services beyond Original Medicare. Coverage and costs can vary, so it’s important to review plan details. Checking what’s covered, your doctors and your prescription needs can help you find a plan that fits your health and budget.
Compare Aetna Medicare Advantage plans and explore your options
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Tell the office which type of visit you want when you book. If you want both a wellness visit and a routine physical, ask if they can be scheduled separately and what costs may apply.
Before your appointment, it can help to:
- Make a list of your current medications and dosages
- Gather key family health history
- Write down any preventive screenings or vaccines you want to ask about
Ready to plan your next preventive visit? Use our preventive care glossary to understand visit types, timing rules and common preventive services.
