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    By Core Insurance SolutionsSeptember 25, 2026
    5 Steps U.S. Beneficiaries Need Before a Medicare Wellness Visit

    5 Steps U.S. Beneficiaries Need Before a Medicare Wellness Visit

    The Medicare Annual Wellness Visit (AWV) is a yearly Part B benefit built to create or update your personalized prevention plan, not to diagnose or treat problems like a routine physical would. Providers who accept assignment generally bill it at no cost to you, with no Part B deductible applied. You become eligible for your first one 12 months after your Part B start date, and after that, it repeats once every 12 months.

    TL;DR:

    • The initial Wellness Visit cannot occur until 12 months after your Part B start date, with subsequent visits every 12 months from your last appointment.
    • The visit relies on a comprehensive Health Risk Assessment and does not include a full physical exam or diagnostic tests for current symptoms.
    • Costs are generally covered in full when providers accept assignment, but separate or expanded evaluations and outside tests may generate additional charges.
    • Preparing a medication list, recent records, and a list of concerns can help maximize the visit’s usefulness and avoid unexpected bills.
    • The visit can be performed by various healthcare providers, including nurse practitioners and physician assistants, not just primary doctors.
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    Table of Contents

    What Is a Medicare Wellness Visit, and How Is It Different From a Physical?

    An Annual Wellness Visit is a planning conversation, not a hands-on exam. The clinician builds or refreshes a personalized prevention plan based on a Health Risk Assessment, your medical history, and your current risk factors. There’s no stethoscope-and-reflex-hammer routine here. Blood pressure and weight get checked, but the visit’s real purpose is figuring out what screenings, vaccines, and lifestyle changes could matter for you over the next year.

    That’s a sharp contrast to a traditional physical, which typically includes a hands-on examination aimed at diagnosing or managing specific health issues. Medicare that the AWV isn’t a physical exam, and it doesn’t cover diagnostic workups for symptoms you’re currently having.

    A few things to keep straight about scope:

    • The AWV does not include a head-to-toe physical exam or lab work for symptom diagnosis.
    • It’s billed under HCPCS code G0438 for your first AWV, and G0439 for every visit after that.
    • If your provider finds something during the visit that needs follow-up, that follow-up usually happens as a separate, billable appointment.

    When Can You Get Your First Wellness Visit?

    Timing trips up more beneficiaries than any other part of this benefit, so it’s worth walking through in order.

    1. Welcome to Medicare visit first (optional). The Initial Preventive Physical Exam, better known as the Welcome to Medicare preventive visit, is a one-time benefit available only during your first 12 months of Part B coverage.
    2. Twelve-month wait for your first AWV. Your first Annual Wellness Visit can’t happen until 12 months after your Part B enrollment date, or 12 months after a Welcome to Medicare visit if you had one. You don’t need the Welcome visit to qualify for an AWV.
    3. G0438 is a one-time code. It applies once per beneficiary, for life, no matter how many providers you see afterward.
    4. G0439 repeats annually. Every AWV after your first gets billed under G0439, once every 12 months.
    5. Switching doctors doesn’t restart the clock. If you change primary care providers, your new doctor bills your next visit as a subsequent AWV (G0439), not a first one. The billing history follows you, not your provider.

    What Happens During the Wellness Visit?

    The centerpiece of the AWV is the Health Risk Assessment, and it goes further than most people expect. CMS guidance lists the minimum elements a provider has to cover, and it’s a fairly thorough list.

    • Review of your medical and family history, including past surgeries and chronic conditions
    • Full list of current medications and supplements
    • Height, weight, blood pressure, and body mass index
    • A cognitive assessment to screen for signs of dementia or memory decline
    • Screening for depression and other behavioral health risks
    • Review of psychosocial risks, including social isolation and loneliness
    • Functional ability check, covering activities of daily living (ADLs) and instrumental ADLs like managing finances or medications

    Providers may also assess physical activity and nutrition, though those elements are optional rather than required. Everything gets rolled into a written personalized prevention plan, which typically includes a schedule of recommended screenings, immunizations, and referrals for the next five to ten years.

    Pro Tip: Ask your provider for a printed or portal copy of your prevention plan before you leave. It becomes your reference sheet for scheduling mammograms, colonoscopies, shingles vaccines, and other preventive care throughout the year.

    How Much Does a Medicare Wellness Visit Cost?

    When your provider accepts assignment, Medicare Part B generally covers the AWV completely. You generally pay nothing out-of-pocket when your provider accepts assignment, with no Part B deductible applied. That’s the good news, and it’s the reason the AWV is one of the more genuinely free benefits in the Medicare system.

    The catch is what happens if the visit expands. If your doctor performs a separate, medically necessary evaluation during the same appointment, such as addressing a new symptom or managing a chronic condition in detail, that portion can be billed as a distinct evaluation and management service, which may carry its own coinsurance or deductible.

    • Extra lab tests ordered outside the AWV’s required screenings can generate a bill.
    • A “quick look” at an unrelated problem, like a rash or joint pain, may trigger a separate charge.
    • Non-covered services should come with an Advance Beneficiary Notice (ABN) so you know what you’re agreeing to pay for.

    One number worth remembering: CMS’s own claims-processing guidance confirms G0438 and G0439 are the two codes that determine whether your visit gets billed as free preventive care or something else. If you don’t see one of those codes on your paperwork, ask why.

    How to Prepare for Your Wellness Visit

    A little prep turns a rushed 20 minute appointment into something genuinely useful. Bring these with you:

    1. A complete medication and supplement list, including exact doses and how often you take each one.
    2. Contact information for every other provider you see, from your cardiologist to your physical therapist.
    3. Recent medical records or a summary from any specialist visits in the past year.
    4. Your immunization history, especially if you’ve moved or switched providers recently.
    5. A written list of concerns: memory changes, fall risk, mood, medication side effects, or advance directive questions.

    Pro Tip: If something on your list needs real diagnostic attention, say so and ask to schedule it separately. Folding a new symptom into your AWV is the single most common way people end up with an unexpected bill.

    How Often Can You Get a Wellness Visit?

    Once you’ve had your first AWV, subsequent visits are available every 12 months, timed from the date of your last visit rather than the calendar year. Mark the month you had your last one and set a reminder to schedule the next roughly 11 months later, giving your provider’s office scheduling room. If you’re enrolled in a Medicare Advantage plan, call your plan directly to confirm how they handle scheduling and any network requirements, since procedures can vary by carrier.

    Who Can Give You a Wellness Visit?

    The AWV doesn’t have to come from your primary doctor. Physicians, nurse practitioners, physician assistants, and clinical nurse specialists can all furnish the visit, and CMS also permits supervised teams including health educators and registered dietitians working under a physician’s direction. If you’re covered through a Medicare Advantage Organization, the plan must offer the AWV benefit on terms consistent with Original Medicare, though scheduling and telehealth options can differ, so it’s worth checking with your plan directly.

    Who Can Give You a Wellness Visit? — overview diagram

    Practical Ways to Avoid a Surprise Bill

    Before you hang up the phone with the scheduler, ask one direct question: will this be billed as an Annual Wellness Visit under G0438 or G0439? That single question resolves most billing confusion before it starts.

    • Confirm any labs or tests ordered alongside the visit are covered preventive services, not add-ons that trigger coinsurance.
    • If you have an active health concern, request a second, separate appointment rather than mixing it into the AWV.
    • Ask whether your provider is billing under assignment, since that’s what makes the $0 cost possible in the first place.

    Pro Tip: Hand your provider a one-page sheet listing your top three prevention goals alongside your medication list. It keeps the visit focused and makes sure your priorities, not just the checklist, shape the conversation.

    How Core Insurance Solutions Fits Into Your Wellness Visit Results

    What comes out of your AWV, especially the medication review and risk screenings, often points straight at coverage decisions: does your Part D plan still fit your prescriptions, or would Medigap serve you better than Advantage given new health findings? Core Insurance Solutions helps beneficiaries translate those results into plan choices through a Holistic Health Needs Assessment and unbiased carrier comparison. If your wellness visit surfaced questions worth a second opinion on coverage, a local advisor can walk through them with you.

    — Core Insurance Solutions

    Where to Verify These Rules Yourself

    For the official word on coverage, timing, and billing codes, go straight to Medicare.gov’s wellness visit page and CMS’s Annual Wellness Visit guidance. Check CMS claims-processing updates directly if a billing question comes up.

    This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.

    Sources

    FAQ

    Is It Mandatory to Do a Medicare Wellness Visit?

    No. The AWV is a covered benefit, not a requirement. Skipping it doesn’t affect your other Medicare coverage, but it does mean missing a no-cost opportunity to catch risks early and update your prevention plan.

    What Are the CMS Wellness Visit Rules for 2026?

    The core rules haven’t changed: CMS requires a Health Risk Assessment, billed under G0438 for your first visit and G0439 for every visit after. The visit remains available once every 12 months with no Part B deductible when your provider accepts assignment.

    Does a Wellness Visit Have to Be 365 Days Apart?

    It has to be roughly 12 months from your last visit, and Medicare.gov confirms providers won’t bill a new AWV before that window closes. Scheduling a few weeks early or late from month to month generally isn’t a problem, but booking significantly ahead of the 12 month mark can result in a denied claim.

    What Do People Mean by “Medicare Wellness Visit”?

    It usually refers to the Annual Wellness Visit, sometimes shortened to AWV, or confused with the one-time Welcome to Medicare visit. All three phrases point to preventive, Part B covered visits focused on planning rather than diagnosis, though the Welcome visit and the AWV have different eligibility windows.

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