A Medicare Annual Wellness Visit (AWV) is a chance to connect one on one with your care team to get questions answered, review medications and create a personalized prevention plan for the year ahead. The goal of an AWV is to keep you healthy, spot risks early, and guide you toward the right preventive screenings and lifestyle choices.
AWVs are always 100% covered when you go to an in-network provider. Still, some people are surprised by a bill afterward. This usually happens when part of the visit goes beyond preventive care. Below, we explain why this can happen and how to avoid unexpected costs.
Why you might be charged after your Annual Wellness Visit
Per Centers for Medicare and Medicaid Services rules, an AWV covers preventive care only. If your visit ends up including diagnosing or treating a specific health concern, that part of the visit may be billed as a regular office visit. Some people choose to combine their AWV with other appointments, such as primary care or their annual physical. When this happens, the AWV portion is covered fully, but other services during the same visit may result in charges.
Knowing what is and isn’t considered preventive care can help you better understand your costs.
What’s considered preventive care
Preventive care services usually covered during an AWV include:
- Reviewing medical and family history
- Checking weight, height, temperature, blood pressure and pulse
- Test for cognitive wellness
- Preventive screenings and immunizations recommended for you by your doctor
- Reviewing current medications
- Talking about your overall health and lifestyle
What’s considered treatment care
These services aren’t considered preventive and may be billed separately:
- Discussing or treating a specific health concern, condition or injury
- Ordering or reviewing lab work, X‑rays or other tests to diagnose health concerns
An AWV example: When part of an AWV turns into a billed office visit
Anne comes in for her AWV. During that visit, her doctor checks her vitals, makes sure her current medications are still working effectively and recommends small lifestyle changes she can make to help her continue to feel her best. All of those topics are covered at no cost as part of her AWV.
However, during the visit, Anne also mentions she’s experiencing occasional shortness of breath. To address this, Anne’s doctor performs a physical exam to listen to her lungs, and orders an X-ray and lab work to diagnose what’s causing her shortness of breath. That portion of her visit results in Anne receiving a bill for her office visit copay.
How HealthPartners members can avoid unexpected charges during their Medicare AWVs
It’s important to talk openly with your doctor and ask questions. Don’t avoid topics because you’re worried about cost. Instead, make sure you understand what services are covered so there are no surprises later.
Before your visit, you can:
- Call Member Services with questions about billing, coverage or what counts as preventive care
- Confirm the appointment is scheduled as an AWV
During your visit, try to:
- Ask your doctor if a topic is covered under the AWV
- Ask, “Will this be billed separately?” if you’re concerned about the possibility of being billed
- Mention to your doctor that you only want to cover topics included in an AWV
After the visit, make sure to:
- Review your Explanation of Benefits (EOB)
- Contact Member Services if you have questions about charges
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