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Medicare Annual Wellness Visit 2022: Checklist, Requirements & Eligibility

medicare annual wellness visit

Medicare, as a health insurance-providing company in the United States, accesses the general healthcare of its beneficiaries through its many available services. And over the years, Medicare has been responsible for maintaining proper health care for qualified candidates through its intensive and health-specific services.

Those individuals eligible for Medicare plans mostly need added health services to monitor their health because they are either disabled or seniors; either way, these special services help to ensure that they get the best possible health benefits.

However, Medicare plans are not exclusive in their benefits since so many services are absent from Medicare, especially when these services are not categorized as beneficial to the recipient’s health.

Notwithstanding, if the service is approved by a health professional and is deemed necessary, Medicare would offer coverage with its policies to cover expenses resulting from the healthcare as well as a few other costs.

One of these services that are very crucial to the health of a Medicare recipient and any other individual is an Annual Wellness visit. Based on the Affordable Care Act in 2011, the Medicare Annual Wellness Visit helps to improve recipients’ health by providing needed services for preventive care as well as the immediate well-being of the patient.

With this program, recipients and their service providers can create preventive plans as well as medication charts that would greatly improve the individual’s prognosis via preventive measures. This plan can help you stay away from illnesses, injuries, and diseases.

From this visit, recipients can gain notable ideas and tips with which they’d know if there’s an underlying issue that needs attention. And most importantly, they’d learn how to prevent these issues.

Most times, issues like memory loss, dementia, depression, and post-traumatic stress disorder (PTSD) can also be addressed, with the main focus on how to prevent them. As of 2022, wide access has been made across the entire US, and with Medicare expansion spreading like wildfire, almost every US state’s Medicare program offers Annual Wellness Visit Coverage.

It is good to note that as of 2022, the Medicare annual wellness visit does not cover any other service aside from preventive care. Services like diagnosis and treatment of diseases will not be attended to during these visits.

However, you could discuss specific health problems as it relates to your intended coverage type with your appointed physician to know how to go about things.


medicare annual wellness visit


Medicare Annual Wellness Visit requirements 2022:

Who is eligible for Medicare annual wellness visits?

Although the Medicare annual wellness visits are quite helpful and greatly recommended for everyone, not everyone can be eligible for this program.

Normally, the Medicare Wellness Visit in 2022 has very similar requirements to the Original Medicare plan. Medicare recipients over 65 years, as well as younger recipients with disabilities, are eligible for a Medicare annual wellness visit from Medicare.

Also, the Medicare Part B plan helps to offer coverage for this specific service. Nevertheless, having met the criteria needed, you can be eligible for the Medicare annual wellness visit by meeting the requirements below;

  • You can only access this service if your Original Medicare Part B has lasted more than 12 months.
  • To be eligible, you should be void of any Annual Wellness for at least 12 months.
  • An individual that has received a welcome to Medicare preventive visit cannot receive Annual Wellness Visit.

Aside from these requirements above, certain other requirements must be met and must appear in your application form as you apply for a Medicare plan that offers coverage for Medicare annual wellness visits.

Some of these details that must appear on your application form include;

  • Your medical record carries your name on every page.
  • Your entries must carry the correct dates.
  • You would provide details of your health conditions, including monitoring signs, symptoms, and prognosis of any disease you have if you have any. You should also provide details of any suspected infection.
  • Your treatment with medications as well as therapies, if any.
  • A qualified physician’s signature should be on all your medical records, prescriptions, and tests.

After these details have been evaluated from your application, the insurance company would then verify if you’re eligible for the Medicare Annual Wellness Visit.


What is not covered in the Medicare annual wellness visit?

The Medicare Annual Wellness visit offers wide coverage to qualified individuals. This includes many services that are linked to the well-being of the individual.

However, this program does not cover every single health service, especially those that are seen as medically unnecessary.

Here we will talk about those services that you cannot access while on a Medicare annual wellness visit. But before we begin, let’s talk briefly about the services covered by Medicare during Medicare Annual Wellness visits.

Medicare Annual Wellness Visits cover the following;

  • Checking of height, blood pressure, etc., as other body measurements.
  • Your functional activities, as well as your safety, will be reviewed.
  • You’d be given a health risk assessment.
  • You’d be assessed on your ability to perform daily activities such as basic kinds of stuff like bathing yourself and dressing to assess your level of home safety. 
  • You’d be screened for depression.
  • You’d be given prescriptions of medications that you’d take if you needed any.
  • You’d be screened for cognitive disabilities such as diseases like dementia and Alzheimer’s.
  • You’d be given health education, counseling, and other educational programs that would help you live a safer and more healthy life.

Having gone through the most common services that you’d come across when you go for a Medicare Awareness Visit above, we’d talk about some other services that are ignored by Medicare during this visit.

  • There’d be no medical test or diagnosis for normal illnesses.
  • The Medicare Annual Wellness Visit is aimed at preventive care mostly hence, any healthcare services that are not preventive will be ignored.
  • Treatment of major illnesses will be overlooked by this program.

Medicare Annual Wellness Visit Checklist 

Although Medicare Annual Wellness Visits are an important aspect of modern healthcare, they can be tricky and quite complex to set up. Not to worry, there are quite a several actions to be taken and things to be done before one is said to be ready for a Medicare Annual Wellness Visit.

For instance, there are various appointments affiliated with subscribers; these appointments must be strictly adhered to; if you miss an appointment once, it might affect your overall Medicare Awareness Program.

There are various other uncertainties and technicalities associated with Medicare’s annual Wellness Visit. And that is why we’d be taking you around some checklists for Medicare Annual Wellness.

Some of these points include that;

You should verify your eligibility:

When it comes to health insurance, eligibility is always important because each plan and the health insurance company have requirements that must be met.

For instance, for the Annual Wellness Visits, it is important to take note of the timing of the appointments; this is because Medicare only offers Medicare Annual Visit Coverage to individuals that have been enrolled for Medicare for more than 12 months; anything other than this would not be accepted.

Also, for the individual to be eligible, he must not have had a Wellness visit or Medicare Welcome Visit for 12 months. Although these criteria and requirements are quite cumbersome, it is always required that individuals check if they meet up to the requirement of plans before they go for them. This will help protect the individual from spending unnecessarily or making the wrong choices.

Complete a Health Risk Assessment

One of the most important steps in any annual wellness visit is the utilization of a Health Risk Assessment. Although it sounds basic, this helps service providers to specifically evaluate the factors that can adversely affect different individuals’ health, especially when they have underlying illnesses.

These documents, when properly filled, help your physician to access your health records and history, giving them a proper insight into your healthcare. Usually, these assessments are completed online before the patient goes for his or her appointment.

This is because filling out the forms before the visit makes it easier for the patient to give better and more accurate pieces of information regarding their health since they’d have time to think and get proper facts and details before the actual appointment. Notwithstanding, it is still possible to fill out the form during the appointment.

Know your Medical Providers

One major limitation common among individuals who use over-the-counter drugs and take prescriptions as well as healthcare services is that it is most difficult for the individual to come up with a comprehensive health chart that would contain his or her previous treatments and drugs.

But by having just one or two health providers that have our records, it is easier to provide comprehensive and accurate health records.

Routine Measurements

Most times, individuals live without the foreknowledge of important measurements they should know. This is very bad as most of them end up not knowing it.

However, with this annual wellness visit, you can track your information such as weight, height, pressure, etc.


CPT code for Medicare annual wellness visit

CPT codes, or Current Procedural Terminology codes, are used to determine medical reimbursements. For operations, treatments, and care services, they categorize, specify, and charge at rates and according to rules.

If you work in the medical field, you probably already know this. But then, are you familiar with the costs and procedures for Medicare wellness programs? – like AWVs or annual wellness visits?

Knowing the AWV billing codes can help you understand what Medicare and the patient are expecting.

Understanding billing codes will also enable you to forecast sales and make the most of the productivity of your workforce. You run the danger of being disorganized and having a cloudy outlook without this knowledge.

To streamline and collect Medicare reimbursements, we’ve partnered with many medical offices and clinics. Additionally, our software solution helps AWVs comply with laws and regulations.

It makes it simpler to bill for by keeping track of all program-related actions, such as performing patient assessments. As we’ll briefly discuss the requirements of AWVs as well as the program’s CPT codes, it is therefore thought appropriate to make part of the material available elsewhere in this post.

The seniors and elderly should therefore endeavor to take advantage of the reimbursement they can get from healthcare through the current procedural terminology codes (CPT) to know how to sort out the rates and billings associated with getting Medicare annual wellness visits in 2022.

Medicare Annual Wellness Visit Questionnaire 2022

  • Can you refuse a Medicare wellness visit?

Although Medicare beneficiaries can choose to engage in any visit type, they are not compelled to do so to keep their Part B coverage.

So yes, you can refuse a  Medicare annual wellness visit if you don’t want it. You have the option to decline a Medicare Wellness Visit; it is not mandatorily required.

  • Why would I want to refuse Medicare’s annual wellness visit?

You might wish to forego your annual health checkup for several reasons. You are entirely permitted to do so because it is not required.

Many people believe they don’t need a wellness check because they confuse it with a physical. Others worry that if they make the wrong appointment, they’ll have to pay for what they believed would be a free Medicare wellness check out of pocket. Others might only think the check is superfluous.

  • What other service comes with the Medicare annual wellness visit?

Your doctor or another healthcare provider may ask you to answer a few health-related questions before or during your session. The term for this is a health risk assessment (HRA).

The answers could offer crucial details to share with your doctor during the annual wellness visit. The heart, lungs, and other bodily systems may be examined by the doctor (or other health care provider).

In addition to taking standard measurements like your height, weight, and blood pressure, the doctor will likely interview you about your daily activities, medical history, and memory.

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