well care visit what is

What Is a Well-Care Visit?

By stephanie watson  @yourcaree.

March 17, 2023

Have you ever wondered why you need a well-care visit or how often you should see your doctor to check on your health? Here's why and when you might need one.

Once a year, millions of Americans head to their primary care doctor's office for their annual check-up. More than 90 percent of Americans surveyed say they think it's important to see their doctor for a yearly check of their health and wellness, but only 62 percent have an annual physical.

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What is a well-care visit?

A well-care visit is a chance for you to check in with your doctor about your health. You can discuss ongoing concerns, along with lifestyle strategies to prevent you from getting sick. This appointment also gives you a chance to ask your doctor questions.

The typical well-care visit looks something like this:

• First, a nurse will check your weight, blood pressure, and pulse. They'll also go over your list of medications. You may be asked to give a urine or blood sample.
• When your doctor comes in, they'll ask about any changes to your health or your family medical history. The doctor will also want to know how you've been feeling and whether you've had any new or changing symptoms.

During the physical exam, your doctor might:

• Listen to your heart and lungs
• Look into your ears, eyes, nose, and throat
• Feel the lymph nodes in your neck
• Check your reflexes

The exam will end with a discussion of next steps, including any new medications and an appointment for your next visit. Your doctor will record the details of your well-care visit in your electronic health record .

How often do I need a well-care visit?

The yearly doctor's visit has been a routine part of healthcare for as long as many of us can remember. Yet science doesn't back up the benefits of seeing a doctor once a year for most healthy adults. Getting an annual check-up won't help you avoid illness or live longer , and it could lead to unnecessary tests and procedures.

It is important to have a primary care doctor you trust and to see them when you're sick. If you're generally healthy, ask your doctor how often you need to schedule well-care visits.

Even if you don't see your doctor every year, you should still visit him or her to:

• Manage chronic conditions like diabetes or high blood pressure .
• Get your recommended vaccinations.
• Control disease risk factors like a family history, smoking, or obesity.
• Talk about healthy lifestyle practices such as diet and exercise.
• Schedule mammograms , colonoscopies , and other recommended screenings.
• Refill expired medication prescriptions.

Note that these recommendations are for adults. Kids need more frequent doctor visits , especially during their first few years of life , to check their growth, get vaccinated, and monitor milestones like walking and talking.

As you get older, your doctor might suggest that you have an exam every year or more often to monitor for health problems that become more common with age.

Is my well-care visit covered by insurance?

The Affordable Care Act requires private health insurance plans to cover a range of preventive services . Your insurance, however, might not pay the entire cost of every test you get during a wellness exam. Check with your doctor's office before your visit to find out what you'll be responsible for paying out of pocket .

Medicare will cover the cost of an annual wellness visit, provided that you've been enrolled in Part B for at least one year. That visit might also include screening for dementia , falls, and other health risks.

What you can do

Research finds that primary care doctors spend an average of just 18 minutes with each patient. To get the most from your well-care visit, come prepared with:

• A list of questions you'd like to ask
• Any test results you want to share with your doctor
• A list of all the medications you take, including over-the-counter medicines and herbal supplements
• Any changes to your medical history since your last visit
• Your blood pressure, sleep, or any other health measures you track with your smartphone or watch

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What Happens During a Wellness Visit?

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

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Importance of a Wellness Visit

• What to Expect
• How to Prepare

A wellness visit is a health check-up that is typically conducted on an annual basis. It involves visiting your healthcare provider to check your vitals, screen for health conditions , and develop a healthcare plan for your needs.

The aim of a wellness visit is to promote health and prevent disease and disability.

This article explains why annual wellness visits are important, what you can expect during the process, and how to prepare for it.

These are some reasons why wellness visits are important.

Prevent Diseases

Most healthcare visits are categorized under diagnostic care; when you have a health problem, you visit a healthcare provider who assesses your symptoms, diagnoses your condition, and prescribes a treatment plan.

A wellness visit on the other hand is a preventative healthcare measure. The aim of preventative healthcare is to help you maintain good health and prevent health problems before they develop. The goal is to help you live a longer, healthier life.

Wellness visits assess your lifestyle, evaluate health risks, and screen for health conditions, in order to prevent health problems or catch them in the early stages. Instead of waiting to see a healthcare provider once you have a health problem, the idea is to be proactive about your health and work with your healthcare provider to prevent health problems.

People tend to think that it’s fine to skip their annual wellness visit if they’re feeling healthy. However, a 2021 study notes that wellness visits can play a role in catching chronic health conditions early, as well as helping people control for risk factors that could cause them to develop health issues down the line.

Reduce Medical Costs

Wellness visits can help prevent disease and disability, which in turn can help reduce medical costs. According to a 2016 study, a focus on preventive healthcare can significantly reduce medical costs and improve the quality of healthcare services.

What to Expect During a Wellness Visit

A wellness visit may be performed by a healthcare provider such as a doctor, nurse practitioner, clinical nurse specialist, physician assistant, or other qualified health professional.

These are some of the steps a wellness visit may involve:

• Family history: Your healthcare provider may ask you detailed questions about your family’s medical history, to determine whether you are at an increased risk for certain health conditions that may be passed on genetically .
• Medical history: You may also be asked questions about your personal medical history. It can include information about any current or previous diseases, allergies, illnesses, surgeries, accidents, medications, vaccinations, and hospitalizations, as well as the results of any medical tests and examinations.
• Measurements: Your healthcare provider may measure your height, weight, heart rate, blood pressure, and other vital signs. Doing this regularly can help you establish a baseline as well as track any changes in your health.
• Cognitive assessment: Your healthcare provider may assess your ability to think, remember, learn, and concentrate, in order to screen for conditions such as Alzhemer’s disease and dementia.
• Mental health assessment: Your healthcare provider may also assess your mental health and state of mind, to help screen for conditions such as depression and other mood disorders.
• Physical assessment: Your healthcare provider may perform a physical examination to check your reflexes. They may also perform a neurological exam, a head and neck exam, an abdominal exam, or a lung exam.
• Functional assessment: Your healthcare provider may assess your hearing, your vision, your ability to perform day-to-day tasks, your risk of falling, and the safety of your home environment.
• Lifestyle factors: Your healthcare provider may ask you questions about your nutrition, fitness, daily habits, work, stress levels, and consumption of substances such as tobacco, nicotine, alcohol, and drugs.
• Health risk assessment: Based on this information, your healthcare provider will evaluate your health, and determine whether you are at an increased risk for any health conditions.
• Health advice: Your healthcare provider may advise you on steps you can take to improve your health, control risk factors, and prevent disease and disability. This may include nutrition counseling, an exercise plan, flu shot and vaccination recommendations, and fall prevention strategies, among other things.
• Screenings: Your healthcare provider may recommend that you get screened for certain health conditions such as depression , cholesterol, blood pressure, diabetes, cancer, heart disease, or liver conditions. This may involve blood work, imaging scans, or other screening tests. 
• Medication review: Your healthcare provider may review your medication and adjust it, if required. This can include prescription medication, over-the-counter medication, vitamins, supplements, and herbal or traditional medication.
• Referrals and resources: If required, your healthcare provider will provide a referral to other healthcare specialists. They can also provide other resources that may be helpful, such as counseling services or support groups , for instance.
• Medical providers: Your healthcare provider will work with you to create or update a list of your current medical providers and equipment suppliers. This list can be helpful in case of an emergency.
• Healthcare plan: Your healthcare provider will work with you to create a healthcare plan that is tailored to your needs. The plan will serve as a checklist that will list any screenings or preventive measures you need to take over the next five to 10 years.

The screenings, assessments, and healthcare plan can vary depending on factors such as your age, gender, lifestyle, and risk factors.

How to Prepare for a Wellness Visit

These are some steps that can help you prepare for a wellness visit:

• Fill out any required questionnaires: Your healthcare provider may ask you to fill out a questionnaire before your visit. The questionnaire may include some of the factors listed above. Make sure you do it before your visit, so that you can make the most of your time with your healthcare provider.
• Carry your medications: If possible, try to carry your medications with you to show them to your healthcare provider.
• Take your medical documents along: It can be helpful to carry your prescriptions, immunization records, as well as the results of any medical tests or screenings you have had, to help give your healthcare provider a more accurate picture of your health status.
• Ask someone to go with you: You may want to take a trusted friend or family member along with you for the wellness visit. They can assist you if required, take notes for you, ask questions, and help you remember your healthcare provider’s instructions.
• Note down questions and concerns: A wellness visit is a good opportunity to ask your healthcare provider any questions you have about your health and tell them about any health problems or concerns you have. Making a list and carrying it with you to the visit can help ensure that you don’t miss anything.
• Check your insurance plan: Most insurance plans cover wellness visits; however, what is covered as part of the wellness visit can vary depending on the plan. It can be helpful to know what preventative services and wellness visits your plan offers. It’s important to check that your healthcare provider takes your insurance and to inform them that you’ll be coming for a wellness visit when you schedule your appointment.

A Word From Verywell

A wellness visit can help you evaluate your health status, understand your risk for specific health conditions, and give you the information and resources you need to improve your health.

After you go for a wellness visit, it’s important that you start implementing your healthcare provider’s advice, take any follow-up appointments necessary, and take steps to improve your health.

U.S. Department of Health and Human Services. Get your wellness visit every year .

University Hospitals. What you need to know about wellness visits .

Liss DT, Uchida T, Wilkes CL, Radakrishnan A, Linder JA. General health checks in adult primary care: a review . JAMA . 2021;325(22):2294-2306. doi:10.1001/jama.2021.6524

Musich S, Wang S, Hawkins K, Klemes A. The impact of personalized preventive care on health care quality, utilization, and expenditures . Popul Health Manag . 2016;19(6):389-397. doi:10.1089/pop.2015.0171

Alzheimer’s Association. Annual wellness visit .

University of Michigan Health. Your yearly wellness visit .

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

• Second Opinion

Well-Care Visits

What is a well-care visit?

It's important to take your child to the healthcare provider when your child is ill. Or when you child needs an exam to take part in a sport. But routine well-care visits are also recommended.

Well-care, well-baby, or well-child visits are routine visits to your child's healthcare provider for the following:

Physical exam

Immunization updates

Tracking growth and development

Finding any problems before they become serious

Providing information on health and safety issues

Providing information on nutrition and physical fitness

Providing information on how to manage emergencies and illnesses

Your child's healthcare provider can also provide guidance on other issues, such as the following:

Behavioral problems

Learning problems

Emotional problems

Family problems

Socialization problems

Puberty and concerns about teenage years

When should well-care visits be scheduled?

Your child's healthcare provider will give you a schedule of ages when a well-care visit is suggested. The American Academy of Pediatrics recommends well-care visits at the following ages:

Before a newborn is discharged from the hospital, or at 48 to 72 hours of age

3 to 5 days

2 to 4 weeks

Annually, between ages 6 and 21

• Child Wellness Checkups
• Well Child/Baby Visit Questionnaires
• Make Time for Well-Child Visits

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Health Encyclopedia

Well-care visits, what is a well-care visit.

It's important to take your child to the healthcare provider when your child is ill. Or when your child needs an exam to take part in a sport. But routine well-care visits are also advised.

Well-care, well-baby, or well-child visits are routine visits to your child's healthcare provider for the following:

Physical exam

Mental health screening

Immunization updates

Tracking growth and development

Finding any problems before they become serious

Providing information on health and safety issues

Providing information on nutrition and physical fitness

Providing information on how to manage emergencies and illnesses

Your child's healthcare provider can also provide guidance on other issues, such as:

Behavioral problems

Learning problems

Emotional problems

Family problems

Socialization problems

Puberty and concerns about the teen years

When should well-care visits be scheduled?

Your child's healthcare provider will give you a schedule of ages when a well-care visit is suggested. The American Academy of Pediatrics advises well-care visits at the following ages:

Before a newborn is discharged from the hospital, or at 48 to 72 hours of age

3 to 5 days

2 to 4 weeks

Each year, from 3 to 21 years

Medical Reviewers:

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Well Visits vs. Sick Visits – Know the Difference

Published on Jan 11, 2024

Primary Care Locations

Thank you for trusting Children’s Hospital of Philadelphia (CHOP) with your child’s care. We know there’s often confusion about the different types of visits we offer and how they are billed. Even if your insurance plan covers your visit to CHOP, you may be responsible for cost-sharing expenses, such as co-pays, co-insurance and deductibles. We hope the information below is helpful.

What is included in a well visit?

A preventive visit — also called a well visit — is a scheduled check-up focused on keeping your child's whole body healthy and safe. These checkups are recommended for infants, children and teens. Kids need one preventive visit every year from age 3 through age 21; babies and young toddlers need them more frequently. These appointments can include preventive care like: 

• A general physical exam – This includes measuring height, weight and blood pressure, and other age-specific growth and development checks.
• Age-specific immunizations (vaccinations) such as chicken-pox, measles, whooping cough, hepatitis, etc.
• Age-specific screenings, such as hearing and vision screenings.

These visits are typically covered by your health insurance, often at no cost to you. Some of the specific tools used during screenings may be billed separately.

What is a sick (office) visit?

This type of visit is made when your child is having a specific health problem, illness or injury, or for management of chronic, ongoing health problems and/or medications. Reasons for this type of visit can include:

• Illness such as the flu, strep throat or an ear infection
• Anxiety/depression
• ADHD management
• Other chronic condition

There is usually a cost for this type of visit. Your insurance provider may pass some or all of the costs to you. You may be responsible for a copay, co-insurance or deductible.

Can I be charged for both types of visits?

Sometimes at a well visit, an issue comes up that's not part of the regular check-up but that needs to be addressed during that visit. Your provider could address a problem to manage a condition or illness and may prescribe medication, order additional tests like lab work or X-rays, or refer you to a specialist.

In these cases, insurance requires us to bill the visit as both a well visit and a sick (office) visit, so you will likely have to pay an additional co-pay or co-insurance, or the cost will be applied to your deductible.

For more information

See a list of insurance plans CHOP accepts.

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Well-Care Visits

What is a well-care visit.

It's important to take your child to the healthcare provider when your child is ill. Or when your child needs an exam to take part in a sport. But routine well-care visits are also advised.

Well-care, well-baby, or well-child visits are routine visits to your child's healthcare provider for the following:

Physical exam

• Mental health screening

Immunization updates

Tracking growth and development

Finding any problems before they become serious

Providing information on health and safety issues

Providing information on nutrition and physical fitness

Providing information on how to manage emergencies and illnesses

Your child's healthcare provider can also provide guidance on other issues, such as:

Behavioral problems

Learning problems

Emotional problems

Family problems

Socialization problems

Puberty and concerns about the teen years

When should well-care visits be scheduled?

Your child's healthcare provider will give you a schedule of ages when a well-care visit is suggested. The American Academy of Pediatrics advises well-care visits at the following ages:

Before a newborn is discharged from the hospital, or at 48 to 72 hours of age

3 to 5 days

2 to 4 weeks

Each year, from 3 to 21 years

Your Annual Wellness Visit: What to Expect

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Your annual preventive health exam (aka well visit or annual physical) is scheduled with your primary care physician to catch potential health issues early, before they become serious, and to help you focus on wellness and a healthy lifestyle while identifying important screening tests, vaccinations and other necessary testing.    

Most insurance plans cover your annual wellness exam—no copay required. However, says Dr. Adam Stracher , Chief Medical Officer , Director of the Primary Care Division and Associate Dean at Weill Cornell Medicine, you may find the actual components of a wellness visit a bit confusing .

Read on for answers to your FAQs—and learn what to expect when you visit your doctor’s office, in times of sickness and in health. 

What is included in a wellness visit?  

Your annual wellness visit includes the following:

• A review of your medical and surgical history  
• Screenings  
• Blood tests  
• Immunizations  
• A physical exam  
• Counseling to prevent future health problems    

How should I prepare for my visit?  

“ You can check in via Connect   up to 5 days before your visit to make sure we have your most up-to-date information , including your medications, medical history and insurance. You will be able to update these, along with your preferred pharmacy . And you can also review and update your responses to your health questionnaire ,” Dr. Stracher says.    

Please fast for at least 4 hours prior to your visit. You may drink water or black coffee, and take your maintenance medications.  

On the day of your appointment, please arrive on time and bring your insurance card and ID.  

What if I need to ask my doctor about a specific medical issue?  

Specific issues, whether raised by you or identified by your physician during the visit, are considered part of a follow-up or “sick” visit, he explains. “These aspects of your visit will be billed to your insurance, and you may be responsible for copayments, coinsurance or deductible payments, based on the terms of your policy. If you would like to address non-routine concerns during your wellness visit,” he adds, “let us know about these issues when you schedule your appointment. Depending on their complexity, we may need to deal with them at a later time."   

What does a follow-up or “sick” visit include?  

• Treatment of a chronic condition such as diabetes, asthma or high blood pressure  
• Any new problems or complaints  
• Your need for new medications or tests  
• Referrals to a specialist  
• Additional treatment options  

What is a Medicare annual wellness visit and what does it include?  

The Medicare annual wellness visit, covered by Medicare, allows your health-care provider to conduct a health risk assessment and propose screenings and prevention strategies. As well, your provider will make sure all your immunizations, cancer screenings and other screenings are discussed and scheduled.  

Your Medicare wellness visit does not include a detailed physical exam or management of chronic or new medical problems. Your physician may be able to perform a complete physical and address new or existing medical issues during your Medicare annual wellness visit, but you could incur additional charges.  

What to expect during your Medicare a nnual w ellness v isit  

At your Medicare annual wellness visit, y our health care provider will :  

• Review your blood pressure, heart rate, height, weight and body mass index (BMI).  
• Review your current health problems, as well as your medical, surgical, family and social histories.  
• Review your current medications.  
• Conduct a health risk assessment.  
• Provide nutrition counseling.  
• Discuss an exercise plan to fit your lifestyle.  
• Discuss smoking cessation and arrange for counseling, if needed.  
• Discuss fall prevention.  
• Discuss advance care planning.  
• Discuss preventive screenings recommended by evidence-based practice guidelines that are indicated for you based upon your age, risk factors and family history

How t o p repare for your Medicare wellness visit  

Bring these items to your visit:  

• Immunization records  
• A list of current prescribed medicines, supplements and over-the-counter medications  
• A list of your patient care team—any specialists you see for various types of care  
• Be prepared to review your family medical history.  

Can I combine a Medicare or non-Medicare wellness visit with a physical exam?  

Combining a wellness visit with a physical or follow-up office visit will save you time by eliminating an extra appointment, but doing so may affect your costs. Additional concerns beyond a wellness visit may be billed to your insurance, which can result in unplanned out-of-pocket costs to you. For these reasons, Weill Cornell Medicine Primary Care recommends that you schedule your annual wellness visit and any follow-up or sick office visits separately.  

What are the most important points I need to keep in mind?  

• Review your insurance plan’s summary of benefits before your appointment to understand what your insurance company will or will not cover.  
• When scheduling a wellness visit, clearly state that you would like to make an appointment for your annual wellness or preventive care exam. That will help the practice prepare for your visit and bill your insurance company appropriately.  
• When you speak with your doctor or other practitioner, let them know you are there for a wellness exam. Or, if you need to discuss a specific concern that may require treatment, make sure to bring their attention to any non-routine concerns at the start of your appointment.  

You can schedule your annual wellness or follow-up office visit with a provider in Primary Care  .

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AAP Schedule of Well-Child Care Visits

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children.

The Bright Futures /American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the " periodicity schedule ." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.

Schedule of well-child visits

• The first week visit (3 to 5 days old)
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old
• 15 months old
• 18 months old
• 2 years old (24 months)
• 2 ½ years old (30 months)
• 3 years old
• 4 years old
• 5 years old
• 6 years old
• 7 years old
• 8 years old
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old
• 18 years old
• 19 years old
• 20 years old
• 21 years old

The benefits of well-child visits

Prevention . Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

Tracking growth & development . See how much your child has grown in the time since your last visit, and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors and learning.

Raising any concerns . Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.

Team approach . Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

More information

Back to School, Back to Doctor

Recommended Immunization Schedules

Milestones Matter: 10 to Watch for by Age 5

Your Child's Checkups

• Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (periodicity schedule)

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The Fidelis Care Blog

Both preventive care and sick care are important to keep you healthy. But what is the difference? Preventive care means you are seeing your healthcare provider regularly to help you stay healthy. Regular well visits can help keep you from getting sick and find health problems early. On the other hand, sick care is when you see a provider because you are not feeling well.

What is Preventive Care?

Regular preventive care gives you the chance to talk to your provider about your health and goals for the year. It is a way to keep you from getting sick. Even if you feel healthy, you should get a preventive checkup once a year. For children, these visits are often called well-child exams. For adults, they may be called annuals, annual wellness visits, or physicals.

These preventive care visits, depending on your age, might include:

• Complete physical exam
• Immunizations and/or vaccinations
• Blood pressure, blood glucose, and cholesterol screenings
• Screenings as recommended by your provider (mammograms, cervical cancer screening, colorectal cancer screening, and others)
• Sexually transmitted infection testing
• Review of medical history, general health, and well-being
• Developmental screenings in children
• ​A review of your medical and family history
• A review of your current prescriptions
• A reminder to schedule your regular dental appointment
• A basic vision check (at children’s well-child exams)

All Fidelis Care plans fully cover ONE preventive office visit per year. Children’s annual well visits are also covered for Fidelis Care members. Learn more about Fidelis Care's health plans here .

Here are some questions you might ask your provider:

• Am I due for any vaccinations?
• Do I need any health screenings or blood tests?
• Do I need any changes to my prescriptions?
• What lifestyle changes should I consider to improve my overall health?
• When should I schedule my next visit?

It is important to have an ongoing doctor-patient relationship with a primary care provider (PCP) who knows you and your health. Visit your PCP at least once a year for a regular checkup, so your PCP can see any changes in your health and help you develop a plan that’s right for you. See your PCP regularly if you have an ongoing health problem. Having a primary care provider can lower your annual cost of care by more than 40 percent by catching health issues early before costly procedures or tests are needed.

What is Sick Care?

Sick care includes seeing your provider to treat an illness or injury. This type of care helps to make you feel better. Your provider will address your current condition and suggest ways to feel healthier.

You should see your provider for sick care if you feel sick or if something feels wrong. The care you get depends on your symptoms and your pain.

Overall, preventive care is an important way to help you live a healthy, happy life. Talk to your provider today to schedule your annual visit.

https://www.columbiadoctors.org/specialties/primary-care/preventive-care

https://www.myhorizonhealth.org/blog-news/2023/october/preventive-care-vs-office-visit/

https://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/preventive-or-medical

https://www.uclahealth.org/news/preventive-vs-diagnostic-care-what-to-know-and-why-it-matters

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What Does a Medicare Wellness Visit Include?

Routine medical care is important when you’re sick or suffering from an ailment, but what about when you’re feeling fine? The truth is, scheduling an annual doctor’s visit to assess your health, often referred to as a wellness visit, is just as important to do when you’re feeling fine as it is when you’re feeling under the weather. These visits provide your physician the chance to discuss any healthcare concerns you may have, and they also give you the opportunity to ask questions about any medications or supplements you’re taking or about changes to your diet or exercise routine.

The Difference Between a Physical and a Wellness Visit

For many people, the terms “physical” and wellness visit” are used interchangeably, but they are actually quite different. During a physical, your doctor carries out a physical exam of your major systems, takes measurements, documents any changes and reviews concerns. During a wellness visit, there is typically no examination that takes place other than a general inspection of the body. A wellness visit is more like checking in with your doctor while a physical is more like an in-depth examination to assess body systems and functions. During a wellness visit, you may bring up a medical concern which prompts a physical exam, and during a physical, you may discuss wellness concerns, but the two are billed as separate types of visits.

Fortunately for Medicare recipients, an annual wellness visit is included with Part B coverage. During a wellness visit under Medicare, patients will have the chance to discuss any changes to existing conditions that have previously been documented, and the physician will review medical history to ensure that the patient is still in need of any prescribed medications. A doctor may also provide the patient with a preventive health plan designed to encourage healthy lifestyle choices. This plan may detail dietary changes or weight loss exercises, smoking or alcohol cessation information, a list of support groups or therapeutic care providers and more.

While wellness visits usually do not include any type of treatment in the doctor’s office unless an emergency occurs, patients are often directed to make a follow-up appointment for further screening if the wellness visit brings to light concerns that need to be addressed in detail. Keep in mind that this follow-up visit will not be covered as a wellness visit under Medicare and will be billed as a regular outpatient visit.

Additionally, a cognitive assessment is typically performed during the wellness visit, but this is usually done simply by conversing in the office. Finally, patients will fill out a wellness questionnaire while waiting to see the doctor, and the answers will be assessed to ensure that the doctor is able to address any symptoms that are deemed problematic that may not have been expressed directly by the patient.

Medicare Coverage Beyond Wellness Visits

If further medical treatment is required subsequent to a wellness visit, the good news is that Medicare provides a range of coverage options in the forms of inpatient, outpatient and prescription drug benefits. Medicare Part A covers things like inpatient hospitalization and skilled nursing care, and Medicare Part B provides coverage for outpatient care when it comes to doctor’s visits and treatments at clinics or testing at a lab. Medicare Part D is the prescription drug benefit and covers most medications that can be purchased at a retail pharmacy to be administered at home.

If you’re unsure as to your benefits or you’re considering Medicare in the future and would like to know more about your options, contact your current plan and/or research your options to find the Medicare coverage that will meet your needs.

Related articles:

Retiring under the age of 65? Understanding Your Medicare Benefits (Opens in a new browser tab)

Do Medicare Advantage Plans Cover Wellness Exams? (Opens in a new browser tab)

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, Simply, UnitedHealthcare®, Wellcare, WellPoint

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The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical. Also, this service is similar to but separate from the one-time Welcome to Medicare preventive visit .

Eligibility

Medicare Part B covers the Annual Wellness Visit if:

• You have had Part B for over 12 months
• And, you have not received an AWV in the past 12 months

Additionally, you cannot receive your AWV within the same year as your Welcome to Medicare preventive visit.

Covered services

During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:

• Check your height, weight, blood pressure, and other routine measurements
• This may include a questionnaire that you complete before or during the visit. The questionnaire asks about your health status, injury risks, behavioral risks, and urgent health needs.
• This includes screening for hearing impairments and your risk of falling.
• Your doctor must also assess your ability to perform activities of daily living (such as bathing and dressing), and your level of safety at home.
• Learn about your medical and family history
• Medications include prescription medications, as well as vitamins and supplements you may take
• Your PCP should keep in mind your health status, screening history, and eligibility for age-appropriate, Medicare-covered preventive services
• Medicare does not require that doctors use a test to screen you. Instead, doctors are asked to rely on their observations and/or on reports by you and others.
• Screen for depression
• Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.

AWVs after your first visit may be different. At subsequent AWVs, your doctor should:

• Check your weight and blood pressure
• Update the health risk assessment you completed
• Update your medical and family history
• Update your list of current medical providers and suppliers
• Update your written screening schedule
• Screen for cognitive issues
• Provide health advice and referrals to health education and/or preventive counseling services

If you qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider . This means you pay nothing (no deductible or coinsurance ). Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.

During the course of your AWV, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.

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If you get sick or hurt, you have several options that are less expensive than visiting a hospital emergency room. For issues that aren't life threatening but require immediate attention, you can find urgent care centers in our provider directory, called the Wellcare Medicare Provider and Pharmacy Directory.

We want you to know that some freestanding medical facilities may look like Urgent Care Centers, but they are actually freestanding Emergency Rooms and charge the same rates as hospitals. You will find freestanding Emergency Rooms under hospital listings in the provider directory, but you won't find them under Urgent Care Centers.

Please consider these options before visiting an emergency room:

Primary Care Physician

Your PCP is your main doctor. If you don't need medical care right away, you can call the office and sched­ule your visit. You may also visit for health issues like asthma or diabetes.

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Connect with nurse practitioners to chat about symptoms and get advice on what to do next. Call the Nurse Advice Line any time of day or night 1-800-581-9952 (TTY: 711).

Call the Nurse Advice Line if you need:

• Answers to questions about your health
• To determine whether you should see a doctor immediately

In-Network Urgent Care Centers

Go to these if your PCP's office is closed and you need care for a noncritical health issue like flu symptoms with vomiting, ear infections, high fevers and sprains.  Search for in-network Urgent Care Centers with our Find a Provider tool .

These examples show how you could save money by visiting an Urgent Care Center for less critical issues instead of an Emergency Room:

When to go to the Emergency Room:

Please go to the emergency room right away for life-threatening conditions. These include issues like broken bones, bleeding that won't stop, chest pains or heart attack symptoms, labor pains or other bleeding (if pregnant) and shock symptoms (sweat, thirst, dizziness, pale skin).

Others include drug overdose, injecting poison, bad burns, convulsions or seizures and difficulty breathing. 

As a consumer protection measure, freestanding Emergency Rooms are required to post signs that say: "THIS IS A HOSPITAL EMERGENCY DEPARTMENT," and "THIS IS NOT AN URGENT CARE CENTER. HOSPITAL EMERGENCY DEPARTMENT RATES ARE BILLED FOR OUR SERVICES."

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Yearly "Wellness" visits

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.

Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.

Your costs in Original Medicare

You pay nothing for this visit if your doctor or other health care provider accepts assignment .

The Part B deductible  doesn’t apply. 

However, you may have to pay coinsurance , and the Part B deductible may apply if your doctor or other health care provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit.

If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Your doctor or other health care provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your doctor develop a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include:

• Routine measurements (like height, weight, and blood pressure).
• A review of your medical and family history.
• A review of your current prescriptions.
• Personalized health advice.
• Advance care planning .

Your doctor or other health care provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your doctor or other health care provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium and design a care plan.

If you have a current prescription for opioids, your doctor or other health care provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your doctor or other health care provider will also review your potential risk factors for substance use disorder, like alcohol and tobacco use , and refer you for treatment, if needed. 

Related resources

• Preventive visits
• Social determinants of health risk assessment

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