If you're a Medicare beneficiary, you may have heard the terms "annual physical" and "annual wellness visit" used interchangeably—but here’s the thing: they're not the same . Understanding the difference can help you avoid confusion at your doctor's office and ensure you’re using your Medicare benefits wisely. In this article, we’ll break down what each visit includes, what Medicare covers, and how you can prepare for each one to make the most of your health care experience. The Basics: Two Very Different Appointments Annual Physical Exam An annual physical is a comprehensive, head-to-toe examination typically performed by your primary care provider to check your overall physical health. It’s a common practice in traditional health insurance plans and often includes: A hands-on physical exam Blood tests or other lab work Screenings (like EKGs or urinalysis) Updating vaccines Review of ongoing medical issues Listening to your heart, lungs, and checking reflexes Think of the annual physical as a full body checkup , focused on identifying or treating current issues. Annual Wellness Visit (AWV) The Medicare Annual Wellness Visit, introduced through the Affordable Care Act, is a preventive visit that focuses more on planning and prevention than diagnosing new health conditions and/or addressing current ones. It includes: A review of your medical and family history Discussion of your current health providers and prescriptions Height, weight, blood pressure, and BMI measurements Cognitive function screening Personalized health advice and screening schedule Creating (or updating) your Personalized Prevention Plan The goal of the Annual Wellness Visit is to create a roadmap for your future health , helping you stay well and independent as long as possible. What Does Medicare Cover? This is one of the most important distinctions for beneficiaries to understand. Covered by Medicare (one of these per year): Welcome to Medicare Visit: Within the first 12 months of being enrolled in Medicare Part B, you’re eligible for a one-time “Welcome to Medicare” preventive visit—a more comprehensive introduction that also comes at no cost. Annual Wellness Visit: Medicare Part B covers an annual wellness visit every 12 months at no cost to you, as long as it’s been 12 months or longer since your Welcome Visit. Your provider must accept Medicare for this to be covered, and it’s important to note that it will not be covered if additional tests or services are performed during the same visit. Not Covered by Medicare: Annual Physical Exam: Medicare does not cover a traditional physical exam. If you schedule this thinking it’s the same as the AWV, you may end up with unexpected out-of-pocket costs, especially if lab work or screenings are performed that aren’t preventive in nature. Why the Confusion? Many people grew up hearing they should get a “yearly physical,” and naturally assume that’s what Medicare offers. But Medicare takes a preventive care approach with the Annual Wellness Visit. Because the two visits often happen in the same setting (your doctor’s office), it’s easy to mix them up—especially if your provider uses terms like “annual exam” loosely. That’s why it’s important to clarify what you’re scheduling and make sure it aligns with what Medicare covers. When Should You Get an AWV? You’re eligible for your first Annual Wellness Visit 12 months after your initial Welcome Visit (or after you’ve been enrolled in Medicare Part B for 12 months, if you choose to skip the Welcome Visit). After that, you can go back for an Annual Wellness Visit once every year . Your provider may ask you to fill out a health risk assessment questionnaire, which helps them understand your lifestyle, health concerns, and risks. This allows them to build a personalized prevention plan that might include: Recommended screenings (like mammograms, colonoscopies, etc.) Fall prevention strategies Cognitive assessments Referrals for services like nutrition counseling or mental health Tips for a Successful Wellness Visit Want to get the most out of your AWV? Here’s how: Bring your medical history – including hospitalizations, chronic conditions, and family history List all your current medications – including over-the-counter supplements Note any recent changes in your health – fatigue, mood, memory, mobility Write down questions in advance – this is a great opportunity to talk through any concerns Bring your completed health risk assessment if provided in advance by your provider Does Medicare Cover More than One Visit in the Same Year? No, Medicare Part B will only cover one of these visits per year. There are a few scenarios in which you may need to have two different visits discussed above in the same 12-month period, but in all cases, only one of them will be covered: Annual physical + Annual Wellness Visit → Only the AWV is covered by Medicare Annual physical + Welcome to Medicare Visit → Only the Welcome Visit is covered by Medicare Welcome to Medicare Visit + Annual Wellness Visit → Only one of these (whichever occurs first) is covered by Medicare If you schedule a physical in conjunction with your AWV, or if your doctor includes extra services not considered part of preventive care, you may have to pay out of pocket. To avoid surprises, ask your provider: “Is this visit being billed as an Annual Wellness Visit under Medicare Part B?” Bottom Line: Know Before You Go Understanding the difference between an annual physical and a Medicare-covered wellness visit can help you: Avoid unexpected costs Make informed decisions Take full advantage of your preventive benefits Medicare is focused on prevention. The Annual Wellness Visit is your yearly opportunity to check in with your doctor, set health goals, and stay on top of screenings—all at no cost to you. If you’re still unsure which appointment is right for you, talk to your provider—or reach out to a licensed Medicare agent who can guide you based on your plan and needs. Need Help Understanding Your Medicare Benefits? Our team is here to help you make sense of your coverage and get the most from your Medicare plan. We’re just a phone call away at 602-960-0017 .
When you enroll in Medicare, you get access to hospital and medical insurance through Parts A and B—but many people are surprised to learn that it doesn’t cover everything. In fact, some of the most commonly needed services—like routine dental, vision, and hearing care—are not included in Original Medicare . The good news? You do have options . Whether through Medicare Advantage plans or standalone coverage, there are several ways to make sure these essential health needs don’t fall through the cracks. The Limitations of Original Medicare Original Medicare (Parts A and B) does a great job of covering hospital stays, doctor visits, and medically necessary procedures. But it does not cover most routine care for your eyes, ears, or teeth. That means these important services are entirely out-of-pocket expenses on Original Medicare: Dental cleanings, fillings, dentures, and extractions Eye exams for glasses or contacts Hearing tests and hearing aids There are a few exceptions to this. For example, Medicare may cover an eye exam if you have diabetes, or it might pay for eyeglasses after cataract surgery. Similarly, it could cover a dental procedure if it's necessary before a major surgery like a heart valve replacement. But as a general rule of thumb, routine care in these areas isn't covered. Medicare Advantage: An All-in-One Option If you’re looking for more complete coverage, a Medicare Advantage Plan (also known as Part C) might be a good fit. These plans are offered by private insurance companies and provide the same coverage as Original Medicare—and beyond. Most Medicare Advantage plans include benefits for: Dental care : Routine exams, x-rays, cleanings, and sometimes more complex services like crowns or dentures. Vision care : Annual eye exams, and allowances for glasses or contact lenses. Hearing care : Screenings and sometimes partial or full coverage for hearing aids. These plans often require you to use a network provider, so it's important to check which dentists, eye doctors, or audiologists are included. Costs can vary—some benefits may be included at no extra charge, while others might involve copays or set annual limits. To enroll in a Medicare Advantage plan, you must already be enrolled in both Parts A and B, and live in the plan’s service area. You can compare plans during the Annual Enrollment Period (Oct. 15–Dec. 7) or if you qualify for a Special Enrollment Period. Learn more about Medicare Advantage with this handy booklet from Medicare.gov. Standalone Coverage and Other Resources If you prefer to stick with Original Medicare or your current Medicare Advantage plan doesn’t include the coverage you want, you can fill in the gaps with other options instead: 1. Standalone Dental, Vision, and Hearing Insurance Many private insurers offer separate policies specifically for dental, vision, or hearing coverage. These plans vary in price and coverage, but typically include preventive care and a network of providers. 2. Discount Plans Discount plans are not insurance plans, but rather offer reduced rates on services for a monthly or annual fee. This might be a good fit if you just need occasional care and want to lower the out-of-pocket cost. 3. Community and Federally Funded Clinics Some Federally Qualified Health Centers (FQHCs) and local health departments offer dental and vision services at a reduced cost or on a sliding fee scale. These can be especially helpful for people on a fixed income. 4. Veterans Benefits If you’re a veteran, you may have access to dental, vision, or hearing benefits through your local VA, depending on your eligibility. Don’t Skip Out on These Services It might be tempting to put off a dental cleaning or skip an eye exam, especially if it’s not covered—but these services are vital to your overall health. Gum disease has been linked to heart disease, untreated vision problems can increase fall risk, and hearing loss has been associated with cognitive decline. Preventive care matters, and making sure you have the right coverage in place can help you stay healthier—and save money—in the long run. Final Thoughts If you’re on Medicare, dental, vision, and hearing benefits aren’t automatic—but they are available. Whether through a Medicare Advantage plan or other coverage, you can build a plan that supports your total health. Need help comparing options or understanding what’s available in your area? We’re here to help you make sense of it all.
Understanding Heat-Related Illnesses
Grateful for Our Community of Advocates
Resolution To Be Announced Next Week
Scammers are posing as grandchildren to trick seniors into sending money. Learn how the grandparent scam works, warning signs to watch for, and how to stay safe.
Heading out of state this summer? Learn how ACA health insurance works when you travel, what’s covered, and how to avoid surprise bills with our easy travel checklist.
If you're a Medicare beneficiary, you may have heard the terms "annual physical" and "annual wellness visit" used interchangeably—but here’s the thing: they're not the same . Understanding the difference can help you avoid confusion at your doctor's office and ensure you’re using your Medicare benefits wisely. In this article, we’ll break down what each visit includes, what Medicare covers, and how you can prepare for each one to make the most of your health care experience. The Basics: Two Very Different Appointments Annual Physical Exam An annual physical is a comprehensive, head-to-toe examination typically performed by your primary care provider to check your overall physical health. It’s a common practice in traditional health insurance plans and often includes: A hands-on physical exam Blood tests or other lab work Screenings (like EKGs or urinalysis) Updating vaccines Review of ongoing medical issues Listening to your heart, lungs, and checking reflexes Think of the annual physical as a full body checkup , focused on identifying or treating current issues. Annual Wellness Visit (AWV) The Medicare Annual Wellness Visit, introduced through the Affordable Care Act, is a preventive visit that focuses more on planning and prevention than diagnosing new health conditions and/or addressing current ones. It includes: A review of your medical and family history Discussion of your current health providers and prescriptions Height, weight, blood pressure, and BMI measurements Cognitive function screening Personalized health advice and screening schedule Creating (or updating) your Personalized Prevention Plan The goal of the Annual Wellness Visit is to create a roadmap for your future health , helping you stay well and independent as long as possible. What Does Medicare Cover? This is one of the most important distinctions for beneficiaries to understand. Covered by Medicare (one of these per year): Welcome to Medicare Visit: Within the first 12 months of being enrolled in Medicare Part B, you’re eligible for a one-time “Welcome to Medicare” preventive visit—a more comprehensive introduction that also comes at no cost. Annual Wellness Visit: Medicare Part B covers an annual wellness visit every 12 months at no cost to you, as long as it’s been 12 months or longer since your Welcome Visit. Your provider must accept Medicare for this to be covered, and it’s important to note that it will not be covered if additional tests or services are performed during the same visit. Not Covered by Medicare: Annual Physical Exam: Medicare does not cover a traditional physical exam. If you schedule this thinking it’s the same as the AWV, you may end up with unexpected out-of-pocket costs, especially if lab work or screenings are performed that aren’t preventive in nature. Why the Confusion? Many people grew up hearing they should get a “yearly physical,” and naturally assume that’s what Medicare offers. But Medicare takes a preventive care approach with the Annual Wellness Visit. Because the two visits often happen in the same setting (your doctor’s office), it’s easy to mix them up—especially if your provider uses terms like “annual exam” loosely. That’s why it’s important to clarify what you’re scheduling and make sure it aligns with what Medicare covers. When Should You Get an AWV? You’re eligible for your first Annual Wellness Visit 12 months after your initial Welcome Visit (or after you’ve been enrolled in Medicare Part B for 12 months, if you choose to skip the Welcome Visit). After that, you can go back for an Annual Wellness Visit once every year . Your provider may ask you to fill out a health risk assessment questionnaire, which helps them understand your lifestyle, health concerns, and risks. This allows them to build a personalized prevention plan that might include: Recommended screenings (like mammograms, colonoscopies, etc.) Fall prevention strategies Cognitive assessments Referrals for services like nutrition counseling or mental health Tips for a Successful Wellness Visit Want to get the most out of your AWV? Here’s how: Bring your medical history – including hospitalizations, chronic conditions, and family history List all your current medications – including over-the-counter supplements Note any recent changes in your health – fatigue, mood, memory, mobility Write down questions in advance – this is a great opportunity to talk through any concerns Bring your completed health risk assessment if provided in advance by your provider Does Medicare Cover More than One Visit in the Same Year? No, Medicare Part B will only cover one of these visits per year. There are a few scenarios in which you may need to have two different visits discussed above in the same 12-month period, but in all cases, only one of them will be covered: Annual physical + Annual Wellness Visit → Only the AWV is covered by Medicare Annual physical + Welcome to Medicare Visit → Only the Welcome Visit is covered by Medicare Welcome to Medicare Visit + Annual Wellness Visit → Only one of these (whichever occurs first) is covered by Medicare If you schedule a physical in conjunction with your AWV, or if your doctor includes extra services not considered part of preventive care, you may have to pay out of pocket. To avoid surprises, ask your provider: “Is this visit being billed as an Annual Wellness Visit under Medicare Part B?” Bottom Line: Know Before You Go Understanding the difference between an annual physical and a Medicare-covered wellness visit can help you: Avoid unexpected costs Make informed decisions Take full advantage of your preventive benefits Medicare is focused on prevention. The Annual Wellness Visit is your yearly opportunity to check in with your doctor, set health goals, and stay on top of screenings—all at no cost to you. If you’re still unsure which appointment is right for you, talk to your provider—or reach out to a licensed Medicare agent who can guide you based on your plan and needs. Need Help Understanding Your Medicare Benefits? Our team is here to help you make sense of your coverage and get the most from your Medicare plan. We’re just a phone call away at 602-960-0017 .
When you enroll in Medicare, you get access to hospital and medical insurance through Parts A and B—but many people are surprised to learn that it doesn’t cover everything. In fact, some of the most commonly needed services—like routine dental, vision, and hearing care—are not included in Original Medicare . The good news? You do have options . Whether through Medicare Advantage plans or standalone coverage, there are several ways to make sure these essential health needs don’t fall through the cracks. The Limitations of Original Medicare Original Medicare (Parts A and B) does a great job of covering hospital stays, doctor visits, and medically necessary procedures. But it does not cover most routine care for your eyes, ears, or teeth. That means these important services are entirely out-of-pocket expenses on Original Medicare: Dental cleanings, fillings, dentures, and extractions Eye exams for glasses or contacts Hearing tests and hearing aids There are a few exceptions to this. For example, Medicare may cover an eye exam if you have diabetes, or it might pay for eyeglasses after cataract surgery. Similarly, it could cover a dental procedure if it's necessary before a major surgery like a heart valve replacement. But as a general rule of thumb, routine care in these areas isn't covered. Medicare Advantage: An All-in-One Option If you’re looking for more complete coverage, a Medicare Advantage Plan (also known as Part C) might be a good fit. These plans are offered by private insurance companies and provide the same coverage as Original Medicare—and beyond. Most Medicare Advantage plans include benefits for: Dental care : Routine exams, x-rays, cleanings, and sometimes more complex services like crowns or dentures. Vision care : Annual eye exams, and allowances for glasses or contact lenses. Hearing care : Screenings and sometimes partial or full coverage for hearing aids. These plans often require you to use a network provider, so it's important to check which dentists, eye doctors, or audiologists are included. Costs can vary—some benefits may be included at no extra charge, while others might involve copays or set annual limits. To enroll in a Medicare Advantage plan, you must already be enrolled in both Parts A and B, and live in the plan’s service area. You can compare plans during the Annual Enrollment Period (Oct. 15–Dec. 7) or if you qualify for a Special Enrollment Period. Learn more about Medicare Advantage with this handy booklet from Medicare.gov. Standalone Coverage and Other Resources If you prefer to stick with Original Medicare or your current Medicare Advantage plan doesn’t include the coverage you want, you can fill in the gaps with other options instead: 1. Standalone Dental, Vision, and Hearing Insurance Many private insurers offer separate policies specifically for dental, vision, or hearing coverage. These plans vary in price and coverage, but typically include preventive care and a network of providers. 2. Discount Plans Discount plans are not insurance plans, but rather offer reduced rates on services for a monthly or annual fee. This might be a good fit if you just need occasional care and want to lower the out-of-pocket cost. 3. Community and Federally Funded Clinics Some Federally Qualified Health Centers (FQHCs) and local health departments offer dental and vision services at a reduced cost or on a sliding fee scale. These can be especially helpful for people on a fixed income. 4. Veterans Benefits If you’re a veteran, you may have access to dental, vision, or hearing benefits through your local VA, depending on your eligibility. Don’t Skip Out on These Services It might be tempting to put off a dental cleaning or skip an eye exam, especially if it’s not covered—but these services are vital to your overall health. Gum disease has been linked to heart disease, untreated vision problems can increase fall risk, and hearing loss has been associated with cognitive decline. Preventive care matters, and making sure you have the right coverage in place can help you stay healthier—and save money—in the long run. Final Thoughts If you’re on Medicare, dental, vision, and hearing benefits aren’t automatic—but they are available. Whether through a Medicare Advantage plan or other coverage, you can build a plan that supports your total health. Need help comparing options or understanding what’s available in your area? We’re here to help you make sense of it all.
Understanding Heat-Related Illnesses
Grateful for Our Community of Advocates
Resolution To Be Announced Next Week
Scammers are posing as grandchildren to trick seniors into sending money. Learn how the grandparent scam works, warning signs to watch for, and how to stay safe.
Heading out of state this summer? Learn how ACA health insurance works when you travel, what’s covered, and how to avoid surprise bills with our easy travel checklist.