I have Medicare Advantage with a PPO, and I'm curious if my annual wellness visit is free or if I'll owe something for it.
Answered by 27 licensed agents
Answered by Gregg Matheny on March 25, 2025
Agent Licensed in AZ & UT
Physicals are not covered. Be sure to let your doctor know your coming for the annual wellness.
Answered by Gary Church on July 13, 2025
Broker Licensed in Ca, AZ, NV & TX
Answered by Andrew Zurbuch, MBA on April 7, 2025
Broker Licensed in IN, FL, KY, MO, OH & TN
Answered by Michael Denniston on July 9, 2025
Agent Licensed in FL, AL, AR & 11 other states
Answered by Nikki Rowland on April 14, 2025
Broker Licensed in SC & NC
Answered by Jennifer McDonnell on May 26, 2025
Broker Licensed in MI, AZ, CA & 10 other states
Answered by Jonathan Potter on July 14, 2025
Broker Licensed in UT, AZ, CA & 14 other states
Answered by David Quintal on May 23, 2025
Broker Licensed in NH, AL, AZ & 14 other states
A Medicare Annual Wellness Exam is meant to create or update your personalized health plan, it is not a Hands On Exam. It is typically a series of questions meant to assess your current health status. It does not include lab work, follow up on chronic conditions, etc. For that type of an exam (an Annual Physical) you would want to schedule a separate visit with your Primary Care Physician.
Answered by Marie Terhune on April 21, 2025
Broker Licensed in NH
Answered by Steven Bleicher on August 2, 2025
Broker Licensed in AZ
Answered by Steven Lovell on May 10, 2025
Broker Licensed in GA, CA, FL & 7 other states
Answered by Jon Maves on March 31, 2025
Broker Licensed in TN, AZ, CA & 9 other states
Answered by Barbara Margucci on April 16, 2025
Agent Licensed in PA, OH & WV
Here's why:
Medicare law requires it: All Medicare plans, including Medicare Advantage plans, must cover an annual wellness visit at no additional cost to the beneficiary.
It's a preventive service: The annual wellness visit is considered a preventive service, and Medicare covers such services without requiring deductibles or coinsurance.
PPO or HMO doesn't matter: The PPO aspect of your plan (Preferred Provider Organization) doesn't change the fact that the annual wellness visit is covered without any out-of-pocket costs.
Important Note: While the annual wellness visit itself is free, you might incur costs for any additional tests or procedures that your doctor recommends during the visit, such as lab work or screenings. These costs would depend on your specific plan's coverage for those services.
Answered by Fred Manas on May 13, 2025
Agent Licensed in NY, CT, DC & 7 other states
answer must be 100 characters long, so i'm sorry for the filler data.
Answered by Gary Henderson on May 23, 2025
Agent Licensed in TX, AK, AL & 46 other states
Answered by Steve Brauer on April 8, 2025
Broker Licensed in AZ & CA
Answered by Mike Henry on August 1, 2025
Agent Licensed in TX
Answered by Todd Bostic on July 21, 2025
Broker Licensed in TX, AL, AZ & 12 other states
Answered by Andre Cabral on April 18, 2025
Agent Licensed in NJ
Answered by William Scott on May 27, 2025
Broker Licensed in GA, CO, NC, OH, SC & TX
Answered by Bob Nunn on April 12, 2025
Agent Licensed in FL, AL, AR & 36 other states
Answered by Kevin Chaikin on June 27, 2025
Broker Licensed in VA, AL, AZ & 31 other states
Answered by Dominic Javier on April 22, 2025
Broker Licensed in TX
What Is an Annual Wellness Visit?
An Annual Wellness Visit (AWV) is a preventive service that Medicare covers to help assess your overall health and identify any potential issues before they become serious. It’s not the same as a routine physical exam, but rather a visit with your primary care doctor to review your health history, risk factors, and create a preventive care plan for the upcoming year. The visit may include:
A health risk assessment.
A review of your medical history and medications.
A list of screenings and immunizations you may need.
A discussion about healthy lifestyle choices.
Coverage Under Medicare Advantage (PPO):
Medicare Advantage plans are required to cover everything Original Medicare covers, including the Annual Wellness Visit. However, because you have a PPO plan, there are a few things to consider regarding how your specific plan works:
Preventive Services Are Typically Covered at No Cost:
Most Medicare Advantage PPO plans will cover the Annual Wellness Visit with no out-of-pocket cost, as long as you stay within the plan's guidelines. This means you should not have to pay a copayment or coinsurance for the wellness visit itself if it’s coded correctly as a preventive service and is not linked to any additional treatment or procedures.
Out-of-Network Providers:
If you see an out-of-network provider for your wellness visit, your PPO plan will likely still cover it, but the cost-sharing might differ compared to seeing an in-network provider. In-network providers typically charge lower copayments, and you may pay more if you see someone out-of-network.
Answered by Jim Towle on July 31, 2025
Agent Licensed in AL
If you've had Medicare Part B for over 12 months, Medicare will cover the cost of an annual wellness visit.
The Centers for Medicare and Medicaid Services (CMS) has a phone app called "What's Covered. " It is available on the App Store and the Google Play Store. It contains information about what is covered under Original Medicare Part A and Part B.
Answered by Vernon Pate on April 29, 2025
Broker Licensed in AR, MO & OK
Answered by David Alelishvili on June 9, 2025
Broker Licensed in NY
Answered by Donald Heath on May 12, 2025
Agent Licensed in CA, AZ, CO & NM, NV, TX & WA
Tags: Medicare Advantage
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