Annual Wellness Visit: What To Expect, What’s Covered, And How To Prepare (2026 Guide)

Your Annual Wellness Visit (AWV) is more than a check-in, it’s your yearly strategy session to stay healthy, catch risks early, and map out a practical prevention plan you’ll actually use. Unlike a traditional physical, the Medicare AWV focuses on your risks, goals, and screenings so you can spend less time guessing and more time doing what keeps you well. Here’s exactly what’s included, what isn’t, how billing works, and how to prepare so you get the most from your visit.

What Is An Annual Wellness Visit And Who Is It For?

Your Annual Wellness Visit is a covered Medicare service designed to review your health risks, update your medical and family history, screen for cognitive and mood concerns, and build a personalized prevention plan for the year ahead. It’s conversation-heavy and planning-focused, not a head-to-toe exam.

Medicare AWV Vs. Annual Physical

• Annual Wellness Visit (AWV): Prevention-focused and covered by Medicare Part B. It includes a Health Risk Assessment (HRA), screenings for cognitive health and depression, functional status checks, vitals, and a tailor-made prevention plan and schedule.
• Annual Physical: A traditional hands-on exam that may include a full physical exam, problem-focused evaluation, and potentially labs. Medicare does not cover an annual “routine physical.” If your visit shifts into diagnosing or treating a new or existing problem, it may be billed separately from the AWV.

Put simply: the AWV maps the road ahead: a physical (or problem visit) addresses current symptoms.

Eligibility And Timing: Initial Vs. Subsequent Visits

• You’re eligible for an AWV if you’ve had Medicare Part B for more than 12 months and haven’t had an AWV in the last 12 months.
• Initial AWV (code G0438): Your first AWV after you’re eligible.
• Subsequent AWV (code G0439): Once every 12 months thereafter.
• Related but different: The “Welcome to Medicare” preventive visit (IPPE, code G0402) is available within the first 12 months of Part B. After that window, and with 12 months since the IPPE, you move to the AWV schedule.

What’s Covered In An Annual Wellness Visit

Here’s what typically happens during a Medicare Annual Wellness Visit and what’s included in coverage when your provider accepts Medicare assignment.

Health Risk Assessment And Medical History Review

• You’ll complete a brief Health Risk Assessment (HRA) about your health habits, daily activities, falls risk, nutrition, alcohol/tobacco use, sleep, and home safety.
• Your clinician updates your medical history, family history, medication and supplement list, and your roster of other providers and durable medical equipment suppliers.

Vitals, Measurements, And Functional Status

• Basic vitals (blood pressure, heart rate, weight, BMI) are checked.
• You’ll be asked about your ability to perform daily tasks (bathing, dressing, shopping, managing meds) and any assistive devices you use. This helps flag mobility, balance, or vision/hearing concerns.

Cognitive, Mood, And Safety Screenings

• Brief screens for memory issues, depression, anxiety, fall risk, and substance use are included.
• Home and caregiver safety may be reviewed, along with risks like medication interactions.

Personalized Prevention Plan And Screening Schedule

• You’ll leave with a written prevention plan that lays out recommended vaccines, labs, imaging, and screening timelines (for example, colorectal cancer screening cadence, mammography, bone density testing, diabetes checks, abdominal aortic aneurysm screening if eligible, and more).
• Expect lifestyle guidance tailored to you, nutrition, activity, sleep, social connection, and chronic-condition risk reduction, plus referrals when helpful (PT for balance, audiology, vision, behavioral health, nutrition counseling, smoking cessation).

Optional Advance Care Planning Discussion

• If you’d like, you can discuss advance directives, medical power of attorney, and your care preferences. When provided as part of the AWV, Medicare generally waives coinsurance and deductible for advance care planning time: if done outside the AWV, typical cost-sharing may apply. Ask your clinic how they handle this so there are no surprises.

What’s Not Covered (And What May Cost Extra)

The Annual Wellness Visit is not a catch-all. Knowing what falls outside prevents unexpected bills.

Diagnostic Problem Visits And Treatment Services

• If you bring up a new or worsening symptom (for example, chest pain, shortness of breath, a new rash), your clinician may need to evaluate and treat it. That work is separate from the AWV and may generate a copay or deductible under Part B.
• Procedures (earwax removal, skin lesion treatment, joint injections) are treatment services and billed separately.

Labs, Imaging, And Vaccinations

• The AWV itself doesn’t include lab work or imaging. If ordered, coverage depends on the specific test and your plan. Many preventive services are covered, but diagnostic labs for problems typically apply to deductibles/coinsurance.
• Vaccines: Some are covered under Part B (influenza, COVID‑19, pneumococcal, and hepatitis B for those at medium/high risk). Others, like shingles, are often covered under Part D with no out-of-pocket under current rules, but plan details vary. Confirm before your visit if you plan to receive vaccines the same day.

Advance Care Planning Billing Considerations

• Advance care planning performed during the AWV is generally cost-sharing free. If you schedule a longer, separate ACP visit or complete it outside the AWV, standard Part B cost-sharing may apply. Always ask how your clinic will code the service.

Costs, Coverage, And Billing Basics

Good news: when performed by a provider who accepts Medicare assignment, your Annual Wellness Visit should have no copay or deductible. Extra services done the same day can change that, so here’s how the billing works.

Medicare Coverage, Copays, And Deductibles

• AWV: No copay or deductible under Medicare Part B if your clinician accepts assignment.
• Add-on services: Diagnostic evaluations, procedures, and non-preventive counseling are billed separately and may trigger cost-sharing.
• Preventive screenings: Many recommended screenings are fully covered on their own schedule. Coverage depends on eligibility criteria and timing.

Common AWV Codes: G0402, G0438, G0439

• G0402: Initial Preventive Physical Exam (IPPE), “Welcome to Medicare” visit within first 12 months of Part B.
• G0438: Initial Annual Wellness Visit (your first AWV after eligibility).
• G0439: Subsequent Annual Wellness Visit (once every 12 months).

If you see any of these on your paperwork, they’re the preventive visit codes, not problem-based evaluation codes.

Tips To Avoid Surprise Bills

• Set the agenda: Tell scheduling staff you want an “Annual Wellness Visit only.” If you also need a problem visit, consider booking a separate appointment.
• Ask before you add on: If you request labs, imaging, or procedures the same day, ask how they’ll be billed.
• Confirm network status: Make sure the clinic and ordering providers accept Medicare assignment or your Medicare Advantage plan.
• Bring your Part D info: If you plan to get vaccines like shingles, have your pharmacy/Part D details handy.
• Review your after-visit summary: Check what was coded and ask questions early if something looks off.

How To Prepare For Your Visit

A little prep goes a long way. You’ll save time, get clearer answers, and leave with a plan that fits your life.

Documents, Medications, And Family History To Bring

• Photo ID, Medicare card, and any supplemental/Advantage plan cards.
• A complete medication list, including doses for prescriptions, over-the-counter meds, vitamins, and herbal supplements, plus allergies.
• Names and contact info for your other providers, recent hospitalizations or surgeries, and your immunization record.
• Family history updates (new diagnoses of cancer, heart disease, diabetes, dementia, etc.).
• Any existing advance directive or healthcare proxy paperwork.

Lifestyle, Symptoms, And Goals To Share

• Jot down top health goals for the next year (walk 30 minutes most days, reduce falls risk, improve sleep, manage blood sugar, stay independent at home).
• Note any changes in memory, mood, balance, pain, hearing, or vision, even if they seem minor.
• Be honest about nutrition, alcohol or tobacco use, and activity level. Your plan only works if it matches reality.

Tech Prep: Patient Portals, Forms, And Wearables

• Complete pre-visit forms and your Health Risk Assessment in the patient portal to shorten check-in.
• Upload home readings (blood pressure, glucose, weight) or bring your device/notes.
• If you use a smartwatch or fitness tracker, share averages for steps, sleep, and heart rate, it can inform your plan and goals.

After The Visit: Turning Your Plan Into Action

Your Annual Wellness Visit is successful when the plan becomes habits. Here’s how to move from paper to progress.

Understanding Your Personalized Prevention Plan

• Expect a written summary listing your risk factors, recommended screenings, vaccine timing, and specific lifestyle steps. Keep it handy and share it with family or caregivers.
• Clarify anything unclear before you leave or send a quick portal message afterward.

Scheduling Screenings, Referrals, And Vaccines

• Book due screenings before you forget, most clinics can schedule mammograms, DEXA scans, colonoscopies/alternatives, low-dose CT (if eligible), and lab work directly or provide referral numbers.
• Ask to align appointments on the same day or location when possible to reduce trips.

Tracking Progress Year Over Year

• Keep a simple tracker for blood pressure, weight, A1C, or steps, whatever your plan targets.
• Update your medication list whenever something changes and upload it to the portal.
• Set a reminder at 11 months to book next year’s AWV so you stay on schedule with no lapse.

Conclusion

Your Annual Wellness Visit is your yearly blueprint for staying healthy: a focused conversation, evidence-based screenings, and a prevention plan tailored to what matters most to you. Arrive with your meds and goals, clarify what you want out of the visit, and don’t hesitate to schedule problem-focused care separately if you need it. With a little prep and a clear plan, you’ll leave with practical steps you can start the same day, and a head start on a healthier year ahead.

Helpful reference: See Medicare’s overview of the AWV and covered preventive services at the official site: Medicare preventive visit details and Medicare preventive services list.

Rikin Shah

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