What’s a Medicare Wellness Visit?

November 11, 2011 in Health Insurance, Medicare

One of the highly publicized benefits of the 2010 Patient Protection and Affordable Care Act (PPACA) for Medicare subscribers is the “annual wellness visit” feature that kicked in in 2011.

I know I made the mistake of assuming – and may have even written somewhere on this blog — that “wellness visit” was just a government bureaucrat’s name for a physical.  Then recently I talked to a Medicare subscriber who actually had a wellness visit.  Unfortunately a Medicare wellness visit is like a physical only in that you talk to a doctor or nurse for a while. You’re never asked to say “ahhh” and you’re never touched with a stethoscope.  For guys, you are never asked to “assume the position” or turn your head and cough. 

From the description I heard, a wellness visit sounded more like applying for insurance coverage than a physical. So I made a note to follow-up and set the record straight.  Then — senior moment — I never followed up.  But Betsy Cliff of the the Bend, Oregon Bulletin is all over the story.  Of course her article is written from an Oregon perspective but the facts she outlines agree with what I heard. I think we’ll begin to see a lot of national coverage on this issue, maybe even someone from the Herald, Telegram, Republican or Globe will pick up on it. (Or maybe Martha, although this story doesn’t fit her station’s age demographic.)

So — as I currently understand it – before PPACA, only your first physical after joining Medicare was covered. Annual physicals were not covered by Medicare the way they are in many insurance plans for non seniors.  The bad news is that that both statements are still the case.  First physical is covered but annual physicals are still not covered in Medicare. But there are other new Medicare features in PPACA such as screening tests (e.g., mamography, colonoscopy, ironically PSA, etc.) that also received a lot of publicity.  To the best of my knowledge, they are being delivered as adverstised.

6 responses to What’s a Medicare Wellness Visit?

  1. Hi Dennis – I’m so glad you gave Betsy a shout out – she’s a great reporter. What’s our demographic – I missed that memo? I’m working on a story about your “delivered as advertised” comment. Let me know if you hear more on that topic.

    Hope all is well!

  2. I was still confused about Medicare Wellness visit after reading the information from Oregon. However, online I found the following description that seems quite clearly stated, although I do not vouch for the accuracy:

    Outside of Medicare, at least one health care insurance group has added online coverage of related wellness topics. Online questions ask for patient information, and offers programmed advice, all with employer incentives for participating. I can see how some people might feel this approach is intrusive, and the information provided may be seen as ‘one size fits all’. At the same time, the benefits may outweigh these concerns. As pointed out in the original posts, the benefits of this new approach and the acceptance by patients and physicians remain open questions.

  3. @lee

    that web link seems to be available only to members so not sure if it agrees with the person I talked to. the point I was trying to make is: a lot of seniors thought it meant a physical was now (after PPACA) included but it apparently is not. Medicare does not cover annual physicals and it should


    demographics: I am just assuming that a radio station and web site run by a university attended mostly by teens and twenty somethings isn’t aiming at seniors
    update: I am now trying to find out what my own supplemental Medicare insurer, Fallon Community Health Plan, is doing on this issue. Based on the 2012 Evidence of Coverage document for its senior HMO — a Part C Medicare Advantage plan — Fallon no longer covers a physical either. It offers only one once-in-your-life Welcome to Medicare physical, the longstanding Medicare minimum. Part C plans are supposed to offer extra “advantages” as part of their agreement with the Centers of Medicare Services (for which they get capitated money rather than simply passing through fees for service the way regular Original Medicare insurers such as National Heritage does). I’d personally rather they offered a physical as opposed to nature walks or whatever Silver Sneakers is about

  4. @dennis

    Here is a replacement web link with an itemized list of requirements for an Annual Wellness Visit. http://www.acponline.org/running_practice/practice_management/payment_coding/wellness_q2.htm

    Mentioned in the previous link was that ‘end of life’ counseling had been in a previous version of requirements but was then removed.

    A search term to find more information is: ‘medicare wellness visit requirements’. I had found a lot of discussion about what was NOT included, but had to search to find out the items actually included.

    In the description, as I read it, limited physical measurements ARE included “as deemed appropriate.” Left open but implied is who does the ‘deeming.’?.

  5. @ lee


    This pretty much agrees with what I’ve been told by Medicare except that in terms of the Welcome to Medicare “visit (or first AWV by your source’s terminology), Medicare left out the vague reference to an actual physical exam that is buried way down in your list. But Medicare did includde the end of life counseling that you say has been dropped.

    I say vauge reference to phsical exam because even in your source it only implies that that an exam takes place during the visit. It does not actually say that.

    Interestingly, Medicare read me most of these words but would not give me a link where I could look them up myself nor send me a copy of them. So this stuff is apparently just for docs. To hard for us seniors to understand I guess. In the link Medicare did supply (referenced in my latest blog post), Medicare does not even call the Welcome to Medicare physical a physical. It is called just a “visit.”

  6. @lee

    Sorry but I found further information from HHS/CMS. The first Annual Wellness Visit (AWV) and the Welcome to Medicare Visit are not the same thing. There are actually three separate Medicare billing codes related to what should be the same thing: one for the Welcome to Medicare Visit, one for the first AWV, and one for the second and subsequent AWVs.

    Wow!!!! And some people want Medicare for ALL!

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