Medicare Annual Wellness Visit: What It Covers, What It Isn't, and When You Get a Bill

Medicare's annual wellness visit costs you nothing if your provider accepts assignment, and it comes around once every 12 months. It is also not a physical. Medicare.gov says so in plain words: the yearly visit is "a conversation-based visit" to build a prevention plan, and "it isn't a routine physical exam." Original Medicare doesn't cover routine physicals at all.

That gap between what people expect and what Medicare pays for is where the surprise bills come from. You book what you think is your yearly physical, mention your knee, get bloodwork, and a few weeks later a statement shows the Part B deductible and 20% coinsurance. Nothing went wrong. Part of the visit just stopped being preventive. Here's how the three visits differ, what happens in the room, and what turns part of it into a bill.

Source: Medicare.gov, Yearly Wellness visits; Medicare.gov, Welcome to Medicare preventive visit; CMS, 2026 Medicare Parts A and B premiums and deductibles. CMS hasn't announced 2027 Part B amounts yet.

Three visits that get confused

The "Welcome to Medicare" preventive visit (CMS calls it the initial preventive physical examination) is a one-time visit you can get within the first 12 months you have Part B. Medicare.gov is careful here too: it "isn't a comprehensive physical exam."

The annual wellness visit (Medicare.gov says yearly "Wellness" visit) starts after your first 12 months of Part B and repeats every 12 months. Its job is to create and then update a personalized prevention plan.

A routine physical, the head-to-toe exam with no particular complaint behind it, is on Medicare.gov's list of things Original Medicare doesn't cover. CMS's provider guidance defines it as an exam "performed without relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury" and says patients pay 100% out of pocket.

Source: CMS, Medicare Wellness Visits; Medicare.gov, Welcome to Medicare preventive visit; Medicare.gov, Yearly Wellness visits; 42 CFR 410.15; 42 CFR 410.16.

The cost line is the one that matters most. Both preventive visits are paid at 100% of the Medicare amount under 42 CFR 410.152(l), and, per CMS's claims manual, the Affordable Care Act waived the Part B deductible and coinsurance for the annual wellness visit starting January 1, 2011. "Accepts assignment" means the provider agrees to take the Medicare-approved amount as full payment. Ask when you book.

When you're eligible: the 12-month clock

The rules are short. Under 42 CFR 410.15, you're eligible for an annual wellness visit if you are "no longer within 12 months after the effective date" of your first Part B coverage, and you haven't had a Welcome to Medicare visit or an annual wellness visit "within the past 12 months."

Two things follow from that. You can skip the Welcome to Medicare visit entirely and still get annual wellness visits; Medicare.gov says you don't need the first to qualify for the second. And the two can't overlap: if you take the Welcome visit late in your first year, your first annual wellness visit waits until 12 months after it.

You may have seen "11 full months" online. That counting rule exists in CMS's claims manual, but for other screening services. For the wellness visit, the regulation says 12 months, and the notice Medicare sends after an approved visit says: "You will qualify for another Annual Wellness Visit 12 months after the date of this visit." If you book a later wellness visit too early, Medicare denies the claim with a notice that it "occurred too soon after your last covered Annual Wellness Visit." My advice: don't book next year's visit for the same week. Give it a few weeks of cushion.

Source: 42 CFR 410.15 (eligible beneficiary); 42 CFR 410.16; Medicare Claims Processing Manual, ch. 18, sec. 140. Dates are a hypothetical illustration.

If you're still working through enrollment itself, start with our guide to applying for Medicare in Washington. Your Part B start date is the date that starts this clock.

What happens at the annual wellness visit

Expect a questionnaire first. Medicare.gov says your provider will ask you to fill out a "Health Risk Assessment." The regulation sets the minimum: it collects your own answers, can be filled out before or during the visit, and should take no more than 20 minutes. It covers your health status and physical functioning; mood, stress, loneliness, pain and fatigue; tobacco, alcohol, physical activity, nutrition and oral health, seat belt use and home safety; and everyday tasks like dressing, bathing, cooking, shopping, managing medications and handling money.

Those are the questions you'll be asked. None of it is a test you pass or fail; it's what the provider uses to build the plan. The first visit and later ones differ, per 42 CFR 410.15:

Source: 42 CFR 410.15(a), current text; Medicare.gov, Yearly Wellness visits.

Two optional pieces are worth knowing about. Advance care planning is a conversation about the care you'd want if you couldn't speak for yourself, and the advance directive forms that put it in writing. It happens only if you want it. CMS's provider guidance says the deductible and coinsurance are waived for it when the same provider does it on the same day as the wellness visit and bills it with that visit; done on another day, normal Part B cost sharing applies.

The physical activity and nutrition risk assessment is new as of 2026. In its 2026 Physician Fee Schedule final rule, CMS replaced the optional social determinants of health risk assessment with this one. Same deal on cost: waived once a year when it's done with the wellness visit, normal cost sharing when it's billed with a problem visit.

A doctor, physician assistant, nurse practitioner or clinical nurse specialist can do the visit, or another medical professional, such as a registered dietitian, or a team of such professionals, working under a doctor's direct supervision. CMS also pays for it when it's done by telehealth.

The cognitive check

Every annual wellness visit includes "detection of any cognitive impairment." The regulation defines that as the provider's direct observation, taking into account what you report and any concerns raised by family members, friends or caregivers. Medicare.gov describes it as an assessment "to look for signs of dementia, including Alzheimer's disease."

It isn't a diagnosis. If your provider sees signs of a problem, Medicare covers a separate cognitive assessment and care plan visit to look more closely, confirm or rule out conditions like dementia, and set up a care plan. That second visit isn't preventive: after the Part B deductible, you pay 20% of the Medicare-approved amount. If memory is already a worry in your family, bring a spouse, friend or caregiver to the wellness visit too: the regulation specifically counts what family members tell the provider.

When the visit turns into a bill

Medicare.gov's cost language is precise. You pay nothing for the visit, "however, you may have to pay coinsurance, and the Part B deductible may apply if your provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit." And if Medicare doesn't cover the extra service at all, "like a routine physical exam," you can owe the full amount.

The most common way this happens is a health problem. CMS lets the provider bill a "significant, separately identifiable, medically necessary" problem visit on the same day as the wellness visit. The wellness part stays covered at 100%. The problem part is billed like any office visit.

Source: Medicare.gov, Yearly Wellness visits; CMS, Annual Wellness Visit (provider guidance); Medicare.gov, Cognitive assessment and care plan services; Medicare.gov, Doctor and other health care provider services; CMS, Medicare Wellness Visits.

Example (hypothetical): Say you go in for your annual wellness visit and also ask about knee pain. The provider examines the knee and bills a same-day office visit with a Medicare-approved amount of $130. The wellness visit costs you nothing. For the knee visit, if you haven't met any of your 2026 Part B deductible ($283), the whole $130 goes toward it and you pay $130. If you'd already met the deductible, you'd pay 20%, or $26.

Don't stay quiet about your knee. Just know what you're agreeing to, or follow Medicare.gov's suggestion and book a separate appointment for specific concerns "so your 'Wellness' visit stays focused on prevention." If you think a claim was coded wrong, call the provider's billing office first; if Medicare denied something you believe it should cover, our post on the Medicare appeal process walks through the steps.

Medicare Advantage, Medigap and Apple Health

Medicare Advantage. A Medicare Advantage plan has to cover everything Part A and Part B cover (42 CFR 422.101), and federal rules bar it from charging a deductible, copayment or coinsurance for in-network Medicare-covered preventive services (42 CFR 422.100(k)). The annual wellness visit and the Welcome to Medicare visit are on that list. The word to notice is "in-network." Check your own plan's Evidence of Coverage for its network rules and for how it handles a problem visit on the same day.

Medigap. A Medicare Supplement policy doesn't change the wellness visit, which already costs nothing with an assigning provider. Where it matters is the extra, billed part: Medigap pays some or all of your Part B cost sharing depending on the plan letter. Our Washington Medicare Supplement page explains the letters.

Apple Health and the Medicare Savings Programs. In Washington, Apple Health coverage you have alongside Medicare works as secondary: Medicare pays first. If you're in the QMB program, HCA says it pays your Part A and B premiums, deductibles and copayments, and Medicare.gov says Medicare providers aren't allowed to bill QMB members for Medicare-covered services, including deductibles and coinsurance. For a single person, the QMB limit in HCA's chart is $1,483 a month in income (effective April 1, 2026), and Washington's MSPs have no asset test. Our Medicare Savings Program guide for Washington has the full chart.

How to get the most out of it

1. Book it as what it is. Say "Medicare annual wellness visit" (or "Welcome to Medicare preventive visit" in your first year). That way it gets scheduled and billed as the preventive visit, not a physical.
2. Check your date. Look at your last Medicare Summary Notice or ask the office when your last wellness visit or Welcome visit was billed. Book more than 12 months after it.
3. Bring a list. Every prescription, over-the-counter drug, vitamin and supplement, plus the names of your other doctors. For the Welcome visit, Medicare.gov also suggests immunization records and family history.
4. Fill out the questionnaire honestly. Falls, loneliness, trouble with stairs or bills: that's exactly what it's for, and it drives the referrals you get.
5. Leave with the written plan. The visit should end with a screening checklist. Ask which items Medicare covers as preventive and which would be billed with normal cost sharing.
6. Decide on advance care planning. If you want that conversation, have it at the wellness visit with the same provider. That's when the cost sharing is waived.

For questions about your Medicare bills or coverage, SHIBA, the Statewide Health Insurance Benefits Advisors program of the Office of the Insurance Commissioner, gives unbiased, confidential Medicare help at no cost. Call SHIBA at 1-800-562-6900 (8:30 a.m. to 4:30 p.m., Monday through Friday), or read our SHIBA guide. For an overview of how Medicare coverage fits together in this state, see our Washington Medicare page. Dental, by the way, isn't part of any of these visits; our Medicare dental coverage post covers what is and isn't paid.

FAQ

Is the Medicare annual wellness visit a physical?

No. Medicare.gov describes it as a conversation-based visit to create a prevention plan and says it isn't a routine physical exam. Original Medicare doesn't cover routine physicals, so a physical exam added to the visit can be billed to you in full.

How often does Medicare pay for an annual wellness visit?

Once every 12 months. Your first one can't happen within 12 months of your Part B start date or within 12 months of a Welcome to Medicare preventive visit.

Does the annual wellness visit cost anything?

You pay nothing for the visit itself if your provider accepts assignment, and the Part B deductible doesn't apply. You can owe the Part B deductible and 20% coinsurance for extra services in the same visit, such as evaluating a new health problem.

What is the cognitive assessment in the annual wellness visit?

Every annual wellness visit includes a check for signs of cognitive impairment, such as dementia, based on the provider's observation and what you and your family report. If the provider sees signs of a problem, Medicare covers a separate, more thorough cognitive assessment visit, where the Part B deductible and 20% coinsurance apply.

Federal Medicare rules and your own plan or policy documents control what's covered and what you pay. Confirm your situation with Medicare, SHIBA or a licensed agent before your visit.

Sources

1. Medicare.gov: Yearly "Wellness" visits
2. Medicare.gov: "Welcome to Medicare" preventive visit
3. Medicare.gov: Cognitive assessment & care plan services
4. Medicare.gov: Doctor & other health care provider services
5. Medicare.gov: What's not covered (Original Medicare)
6. Medicare.gov: Medicare Savings Programs
7. Medicare.gov: What Medigap covers
8. eCFR: 42 CFR 410.15, Annual wellness visits
9. eCFR: 42 CFR 410.16, Initial preventive physical examination
10. eCFR: 42 CFR 410.152, Amounts of payment (preventive services)
11. eCFR: 42 CFR 422.100, General requirements (Medicare Advantage)
12. eCFR: 42 CFR 422.101, Requirements relating to basic benefits
13. CMS: Medicare Wellness Visits
14. CMS: Annual Wellness Visit (provider guidance)
15. CMS: Medicare Claims Processing Manual, Chapter 18 (Preventive and Screening Services)
16. Federal Register: CY 2026 Physician Fee Schedule final rule (90 FR 49266, Nov. 5, 2025)
17. CMS: 2026 Medicare Parts A and B premiums and deductibles
18. HCA: Medicare Savings Program
19. HCA: Washington Apple Health income standards, effective April 1, 2026
20. HCA: Age 65 and older or Medicare eligible
21. Washington OIC: SHIBA