An annual wellness exam is a yearly preventive visit focused on keeping you healthy: reviewing risks, updating screenings and building a prevention plan. In the USA the term covers two different visits: the Medicare Annual Wellness Visit (AWV) and the annual physical/preventive exam covered by most private insurance.
Here’s how they differ, what each includes, when it’s free and how to get the most out of the visit. Test what you know with the annual wellness exam quiz.
Key takeaways
- Medicare covers one Annual Wellness Visit every 12 months at $0 when your provider accepts assignment.
- The Medicare AWV is a prevention-planning visit, not a head-to-toe physical.
- Most private plans cover one preventive visit a year at no cost in-network.
- Extra tests or new problems discussed during the visit can be billed separately.
USA Annual Wellness Exam: Quick Facts
- Medicare coverage
- Part B, once every 12 months
- Cost (Medicare)
- $0 if the provider accepts assignment
- First-year visit
- “Welcome to Medicare” preventive visit (within 12 months of Part B)
- Typical length
- 30–60 minutes
- Billing codes
- G0438 (first AWV), G0439 (later AWVs)
- Private insurance
- Preventive visit usually $0 in-network (ACA)
What Is an Annual Wellness Exam?
For people with Medicare, the annual wellness exam is the Annual Wellness Visit: a yearly appointment to create or update your personalized prevention plan. It starts with a Health Risk Assessment questionnaire and focuses on screenings, risk factors and planning, not a full physical examination.
For people with employer or marketplace insurance, an “annual wellness exam” usually means a preventive physical. The Affordable Care Act requires most plans to cover recommended preventive services at no cost when you see an in-network provider.
More on What Is an Annual Wellness Exam →Annual Wellness Exam vs. Annual Physical
| Medicare Annual Wellness Visit | Annual physical (private insurance) | |
|---|---|---|
| Focus | Prevention plan, risk review, screening schedule | Physical exam plus preventive screenings |
| Hands-on physical exam | No (only basic measurements) | Yes, usually head to toe |
| Cost | $0 with assignment | Usually $0 in-network |
| Covered by Original Medicare? | Yes, once every 12 months | No, routine physicals aren’t covered |
Important
If you have Original Medicare and ask for a “physical,” you may be billed. Ask for your Annual Wellness Visit by name when you book.
What’s Included in a Medicare Annual Wellness Exam
- A Health Risk Assessment (health status, behaviors, daily activities, safety)
- Review of your medical and family history
- Updated list of your current providers, suppliers and prescriptions (including an opioid review)
- Height, weight, blood pressure and BMI
- Detection of any cognitive impairment
- Review of depression risk and functional ability and safety (such as fall risk)
- A written screening schedule for the next 5–10 years
- Optional advance care planning and a social-needs risk assessment
Screenings on your schedule, such as colonoscopy, mammogram and eye exams for people with diabetes, are ordered separately and may have their own coverage rules.
More on What’s Included in a Medicare Annual Wellness Exam →How Much Does an Annual Wellness Exam Cost?
With Original Medicare, the AWV costs $0 with no Part B deductible or coinsurance when your provider accepts assignment. Medicare Advantage plans must also cover it. If your doctor treats a new problem or orders extra tests during the same visit, you may owe the usual Part B deductible and 20% coinsurance for those services.
With private insurance, one preventive visit a year is usually free in-network. Without insurance, a preventive physical often costs roughly $100–$300 at a primary-care office.
More on How Much Does an Annual Wellness Exam Cost →How to Prepare for Your Annual Wellness Exam
- Bring every medication, over-the-counter drug and supplement you take, or a complete list.
- Update your family history (heart disease, cancers, diabetes, dementia).
- List every provider you see, including specialists and eye doctors.
- Write down your top 2–3 health questions.
- Bring any advance directive or health-care proxy documents you want reviewed.
Veterans may also have VA evaluations on file. The C&P exam guide explains how those differ from wellness visits. Commercial drivers need a separate DOT physical exam, which a wellness visit doesn’t replace.
More on How to Prepare for Your Annual Wellness Exam →Free practice test
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Go to the USA Annual Wellness Exam practice test →USA Annual Wellness Exam FAQs
What is a Medicare wellness exam?
The Medicare wellness exam is the Annual Wellness Visit: a yearly Part B visit to create or update your prevention plan, with a health risk assessment and cognitive check. It’s $0 when your provider accepts assignment.
Full answer →Is the annual wellness exam free?
The Medicare Annual Wellness Visit is free once every 12 months if your provider accepts assignment. Most private plans also cover one preventive visit a year at no cost in-network.
Full answer →Is a Medicare annual wellness visit a physical?
No. It’s a prevention-planning visit with basic measurements and assessments. Original Medicare doesn’t cover a routine head-to-toe annual physical.
Full answer →How often can I get an annual wellness exam?
Medicare covers one AWV every 12 months (11 full months must pass after your last one). You qualify after you’ve had Part B for more than 12 months.
Full answer →What is the “Welcome to Medicare” visit?
It’s a one-time Initial Preventive Physical Exam available within your first 12 months of Part B. After that, you get yearly Annual Wellness Visits.
Full answer →Does the annual wellness exam include bloodwork?
Not automatically. Your provider may order lab tests based on your risks, but those are billed separately and may involve cost-sharing.
Full answer →What is a wellness exam?
A preventive visit focused on screenings, vaccines and risk factors rather than a sick visit. For Medicare, the Annual Wellness Visit is a yearly prevention-plan visit, which is different from a head-to-toe physical.
Full answer →Official sources
Disclaimer: This guide is for general information and is not medical advice. Coverage, prices and requirements change and vary by provider and location. Confirm details with your provider, insurer or the agency listed in the sources. Read our editorial policy.