January 9, 2020

What is the Difference Between an Annual Physical and a Medicare Annual Wellness Visit?

Typically, when it is time for an annual check-up, we simply schedule an annual physical with our primary care provider. However, if you are a Medicare patient, the language you use when you schedule your appointment is important. This is because Medicare only covers an Annual Wellness Visit (AWV) and does not cover an annual physical. There are small differences between the two, and knowing which type of appointment you need, and what Medicare will pay for can save you a lot of time and money. Read on to learn the differences between a Medicare annual wellness visit and an annual physical.


What is an Annual Physical?

An annual physical is a common exam performed by physicians to check the status of your health. This type of exam is commonly required by private health insurance providers so that they can get a full understanding of your health and ensure you have the health coverage you need. During a physical exam, your doctor may perform routine health and wellness checks, laboratory tests, or ask questions about your family history and lifestyle. 


Routine Health and wellness tests, checks and exams may include: 


  • Measuring your height and weight 
  • Checking your vital signs 
  • Examining your head, neck, eyes, and ears
  • Listening to your heart and lungs
  • Testing your reflexes


Health History and Lifestyle Updates:

Your doctor will probably ask for an update on your health history. If you are currently being treated for a condition, for example, your physician will want to check the status of the condition and ensure your medications or treatment plans are still working for you. During this time, your physician may also ask about your lifestyle habits including if and/or how often you exercise, smoke, or drink alcohol, if your diet is healthy and balanced, and if you are getting enough sleep. This is also the time where you may bring up any health concerns you have so that you can create a treatment plan and work towards a healthier life. 


Laboratory Tests:

Depending on any existing conditions you may have, or your family medical history, your doctor may have bloodwork, or a urine sample collected and tested for different conditions or diseases. For example, if you have a family history of heart disease, your doctor may test your cholesterol. Or if you have a family history of kidney disease, your doctor might want to ensure your kidneys are healthy and functioning properly. 


What is a Medicare Annual Wellness Visit?

A Medicare funded wellness visit differs from an annual physical in a few different ways. The focus of the Medicare annual wellness visit is to prevent disease and disability in the future, based on your health and risk factors. So, in this type of visit, your physician is likely to review your medical history, ask for a health history update, review your family’s medical history, and perform a health risk assessment. The goal of the Medicare annual wellness visit is to create a prevention plan to ensure you are able to maintain optimal health and wellness. 


What is a Health Risk Assessment?

A health risk assessment, or HRA, is a series of questions you’ll answer that will help your physician determine what medical conditions you might be at risk for. The goal of the HRA is to discover potential medical issues early on so that you and your physician can begin working towards a treatment plan to either avoid the condition or lessen its effects. 


It is important to fully understand the difference between these two types so that you do not have to pay for an unnecessary exam, and so that you know what to expect when you visit your doctor for your yearly check-in. If you are still uncertain of which type you need or which Medicare covers, your physician’s office will be able to help you determine which is best for you.