Making Sense of Your Medicare Annual Wellness Visit

Preventive care is fundamental to modern healthcare, and Medicare Annual Wellness Visits (AWVs) exemplify this shift. These visits give patients a regular, structured opportunity to review their overall health, understand risk factors, and stay current on recommended screenings.

Yet despite their importance, AWVs are often misunderstood. Many patients assume the wellness visit is the same as a traditional physical exam or expect chronic conditions to be reviewed during the visit. When that expectation doesn’t align with Medicare's coverage, it can lead to frustration or unexpected billing.

Door County Medical Center is committed to helping patients understand the purpose of this appointment and ensuring they receive the right care in the right setting.

What Makes an AWV Different from a Physical?

A traditional physical exam includes hands-on examination and discussion of active medical issues. The AWV focuses entirely on preventive care and long-term health planning based on your age, risk factors, and biological sex. That includes:

• Reviewing medical and family history
• Updating the medication list
• Screening for fall risk, depression, or cognitive concerns
• Assessing functional abilities and safety
• Reviewing vaccinations
• Ensuring you are up to date on recommended cancer and chronic disease screenings
• Creating or updating a personalized prevention plan

Because this appointment is prevention-focused, it does not involve a physical exam such as listening to the heart or lungs, nor does it include diagnosis or management of symptoms, injuries, or chronic diseases.

This distinction is essential to how Medicare processes and pays for these visits.

When topics like diabetes management, blood pressure concerns, chest pain, menopausal symptoms, joint pain, or other medical issues arise, Medicare considers these problem-focused services. Addressing them requires additional time, clinical decision-making, and documentation, and therefore must be billed separately. This is not a matter of choice for your provider. It is a federal billing rule designed to distinguish between preventive care and medical evaluation.

The Preventive Purpose of the AWV

The AWV exists because evidence shows preventive care saves lives, reduces complications, and improves quality of life. Screening recommendations are based on research about how diseases progress and when early detection matters most.

For example:

• Colon cancer screening intervals may be 5–10 years after a normal result.
• Breast cancer screening may be recommended more frequently.
• Mood disorders or memory changes may need annual evaluation because they can emerge quickly.

What We Recommend at Door County Medical Center

Many patients with chronic conditions come in once a year for a wellness visit, believing that this appointment fulfills all their care needs. Depending on the specific condition, your provider may need to see you every 3 to 6 months. To reduce confusion and ensure the best care possible, we encourage patients to:

• Use the AWV strictly for preventive services
• Schedule separate visits to address concerns or new symptoms
• Understand that combined visits may lead to additional charges due to Medicare rules
• Stay up to date on recommended screenings and vaccinations
• See their provider regularly if they have chronic conditions that require ongoing monitoring

If you have questions about how your visit will be billed, what services are included, or how often you should be seen for your health conditions, our team is always here to help. Our Patient Financial Services team can be reached at (920) 746-3502.

Sources:

American Medical Association. What doctors wish patients knew about Medicare annual wellness visits. AMA News Wire. January 12, 2024. https://www.ama-assn.org/public-health/prevention-wellness/what-doctors-wish-patients-knew-about-medicare-annual-wellness