Is my wellness visit free with Advantage PPO?

Your plan more than likely will have a zero dollar co-pay for your annual wellness visit however, it’s always a good idea to double check your summary of benefits to make sure.

Answered by Gregg Matheny on March 25, 2025

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Medicare Advantage plans include the annual wellness visit as a free part of preventive care.

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 Gary Church Medicare Insurance Agent

Annual Wellness Vists or AWV should be free to anyone with Part B of Medicare. It doesn't matter if you have a PPO or an HMO Medicare Advantage Plan.

Answered by Steve and Sue Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve and Sue Brauer Medicare Insurance Agent

Your Annual Wellness visit should be covered by your PPO as long as you are In-network, the provider codes the visit as Annual Wellness Visit and there are no extra services added. This means if you tell the doctor your shoulder hurts, there could be additional charges. If any blood work is done, there could be additional charges. If you receive treatment for anything, there could be additional charges.

Remember, your Annual Wellness Visit is NOT an annual physical.

Answered by Mark Bilgere on February 23, 2026

Broker Licensed in TX, AR, IN & LA, MN, NE & OK

Answered by Mark Bilgere Medicare Insurance Agent

Wellness should be free and most plans pay you to do it. Call your plan and ask about it. It will vary slightly from plan to plan

Answered by Daniel Brechin on March 2, 2026

Agent Licensed in AL, FL, KY, MS & TN

Answered by Daniel Brechin Medicare Insurance Agent

Any preventive medical services will be zero cost with any Medicare Advantage program. It just depends if the doctor is in network.

Answered by Jonathan Potter on July 14, 2025

Broker Licensed in UT, AZ, CA & 14 other states

Answered by Jonathan Potter Medicare Insurance Agent

Your annual wellness visits should be covered at no extra cost. Now, if you are seeing a specialist with for this, you will have a specialist Co-pay.

Answered by Nikki Rowland on April 14, 2025

Broker Licensed in SC & NC

Answered by Nikki Rowland Medicare Insurance Agent

Yes, just like your Original Medicare Medicare Advantage plans are required to cover the same preventive services, which includes the annual wellness visit typically at no cost.

Answered by Steven Lovell on May 10, 2025

Broker Licensed in GA, AL, CA & 11 other states

Answered by Steven Lovell Medicare Insurance Agent

Your annual wellness visit is free. That is a Medicare benefit. Medicare Advantage plans PPO or HMO must cover what Medicare covers and can add additional benefits too. Contact us today for a free consultation.

Answered by Michael Denniston on July 9, 2025

Agent Licensed in FL, AL, AR & 11 other states

Answered by Michael Denniston Medicare Insurance Agent

Most Medicare Advantage plans do include an annual wellness visit. Check with the Summary of Benefits of your plan to see if it covers the annual wellness or annual physical benefit and at what cost if any.

Answered by Jennifer McDonnell on May 26, 2025

Broker Licensed in MI, AZ, CA & 10 other states

Answered by Jennifer McDonnell Medicare Insurance Agent

Your annual wellness exam will be covered by your plan. The co-pay on most 2025 plans, for PCPs, is $0. If your PCP orders some type of testing, that isn't included in a basic "yearly wellness exam", you could have a co-pay for the testing/imaging/lab work.

Answered by Amy Putrino on September 8, 2025

Agent Licensed in RI, AZ, CT & 12 other states

Answered by Amy Putrino Medicare Insurance Agent

Your anual wellnes exsam is fully covered with your Medicare Advantage PPO plan. Diagnostic screenings and procedures are subject to copays.

Answered by Bubi Gorgevich on October 4, 2025

Broker Licensed in SC, AZ, CA & 7 other states

Answered by Bubi Gorgevich Medicare Insurance Agent

Everyone get a free annual wellness visit on a Medicare Advantage plan whether it is a PPO or an HMO. You also get free screenings for procedures like colonoscopies, Mammograms, Diabetic Screening and may more. Vaccinations are also free.

Answered by Mark Garrett on October 21, 2025

Broker Licensed in FL, AL, AZ & 19 other states

Answered by Mark Garrett Medicare Insurance Agent

Your annual wellness visit with your PCP has a ZERO copay with most companies. Some Advantage plans might cost more.

Answered by Roger Werking on February 23, 2026

Agent Licensed in FL

Answered by Roger Werking Medicare Insurance Agent

On all Medicare Advantage plans - hmo or ppo . The wellness visits are zero dollars.

With medicare advantage you are entitled to one free annual wellness visit every 12 months .

Answered by Jamie Goble on March 17, 2026

Broker Licensed in IL, AR, FL, MD & MO

Answered by Jamie Goble Medicare Insurance Agent

Your annual wellness visit should be covered at 100%. If you also have other medical problems reviewed at the same visit, you may need to pay something out of pocket.

Answered by Duane Everding on February 2, 2026

Broker Licensed in NC, AZ, MD & 6 other states

Answered by Duane Everding Medicare Insurance Agent

Yes, an annual wellness visit is covered by Medicare. This would include a PPO Medicare Advantage plan.

Answered by David Quintal on May 23, 2025

Broker Licensed in NH, AL, AZ & 14 other states

Answered by David Quintal Medicare Insurance Agent

The Medicare Annual Wellness visit does not have a cost or copayment, but it is important to note that the Annual Wellness visit is not the same as an Annual Physical. The Medicare Annual Wellness visit is a preventative exam.

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 Marie Terhune Medicare Insurance Agent

Answered by Nolan Popel on October 5, 2025

Agent Licensed in NY, AZ, CA & 15 other states

Answered by Nolan Popel Medicare Insurance Agent

Medicare advantage plans both HMO and PPO allow you to do Preventive service.

You should be able to see your primary doctor and get your Annual wellness physical at $0 cost.

Answered by Sharri Crawford on January 30, 2026

Broker Licensed in NM

Answered by Sharri Crawford Medicare Insurance Agent

Your annual wellness visit under a Medicare Advantage PPO is covered at no cost to you as long as the provider accepts Medicare/your plan — it's a preventive benefit with no copay or deductible like Original Medicare's Part B annual wellness visit.

Answered by Jeffrey Horn on April 21, 2026

Agent Licensed in IL, AZ, CO & 17 other states

Answered by Jeffrey Horn Medicare Insurance Agent

When getting your annual wellness visit on Medicare there should be no out of pocket cost for you. If you are on any of the advantage plans then you MUST stay inside of your network, seeing a doctor that takes your particular plan.

Answered by Jennifer Melancon on November 19, 2025

Agent Licensed in FL & VA

Answered by Jennifer Melancon Medicare Insurance Agent

Your annual wellness visit is free. However, keep in mind that this is not a physical exam in any way. It is a series of questions usually on three pages that you answer. If the NP or PCP notices something amiss with your health, then they may pursue it. So, bear in mind that when you want a complete physical, this must be told to the scheduler since that visit will take up more time with the physician though it is usually a no-cost situation, unless you're seeing a doctor that is not a part of their regular network. Don't forget a PPO allows you to see doctors both in and out of the network but once you see an out of network doctor, there will be a copay for you. It's best to ask your agent for a doctor in your Advantage plan's network in terms of cost to you.

Answered by Steven Bleicher on August 2, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Medicare Advantage covers many preventative care measures. Please check your Evidence Of Coverage document of your Policy or call your Medicare Advantage Insurance Company & request a copy be mailed to you.

Answered by Andrew Zurbuch, MBA on April 7, 2025

Broker Licensed in IN, FL, KY, MO, OH & TN

Answered by Andrew Zurbuch, MBA Medicare Insurance Agent

Yes, it is free, as long at is an annual wellness visit, and it is your Primary Care Foctor that is in network for your Plan.

Answered by Jim Tretola on October 9, 2025

Broker Licensed in NJ, CA, CT & 6 other states

Answered by Jim Tretola Medicare Insurance Agent

If you have an Advantage plan typically the wellness visit is free. You can look at your summary of benefits to check and see what is covered at no cost.

Answered by Kristen Skinner on November 5, 2025

Broker Licensed in OK

Answered by Kristen Skinner Medicare Insurance Agent

That is typically preventive coverage and is covered at 100%. Most Medicare advantage plans do this.

Answered by Barbara Patterson, CFP on January 26, 2026

Agent Licensed in TX

Answered by Barbara Patterson, CFP Medicare Insurance Agent

Yes, wellness visits are included with a Medicare Advantage plan at no cost. These visits are part of the preventive care services covered by Medicare Advantage plans, which must provide the same medical services as Original Medicare Parts A and B. This includes the annual wellness visit, which is a free part of preventive care.

Answered by Lou Spatafore on March 16, 2026

Broker Licensed in WV, FL, GA & 10 other states

Answered by Lou Spatafore Medicare Insurance Agent

Your wellness visit is viewed as are other preventative procedures such as mammograms and colonoscopies etc, You will not incur any charge for Your annual wellness visit. Medicare and Your PPO plan for Your sake and benefit desire that any potential health issues be detected the earlier rather than later.

Answered by D. Scott Harrod on October 26, 2025

Agent Licensed in KY

Answered by D. Scott Harrod Medicare Insurance Agent

Every plan is different so we would need to take a look at your plan to give you a specific answer. The section we would look at is the Summary of Benefits.

Answered by Jon Maves on March 31, 2025

Broker Licensed in TN, AZ, CA & 9 other states

Answered by Jon Maves Medicare Insurance Agent

With most Medicare Advantage Plans, the Annual Wellness Visit is a covered benefit. To be certain, I can review your specific Plan and advise. If you would like more specific information, please contact me for a no-cost, no-obligation Plan Review.

Answered by Barbara Margucci on April 16, 2025

Agent Licensed in PA, OH & WV

Answered by Barbara Margucci Medicare Insurance Agent

Yes, your annual wellness visit is generally free, even with a Medicare Advantage PPO plan. Medicare Advantage plans must cover the same preventive services as Original Medicare, including the annual wellness visit, and it's covered at no cost to the beneficiary, regardless of whether they see an in-network or out-of-network provider (though out-of-network costs may be higher).

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

Answered by Fred Manas Medicare Insurance Agent

free at an in network doctor.

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 Gary Henderson Medicare Insurance Agent

Your annual wellness visit is free on all plans - HMO, PPO and original Medicare. There is no change to this feature of plans.

Answered by Andrew Kramer on September 22, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

If the annual wellness is part of the preventative care then yes it is usually covered. Most plans provide you will a list of the preventative care tests.

Answered by Carol Thompson on February 9, 2026

Broker Licensed in FL, LA, MI & NC, SC, VA & WI

Answered by Carol Thompson Medicare Insurance Agent

All wellness visits are covered whether HMO or PPO, that is a Medicare requirement. So it really doesn’t matter what type of plan you have to get a wellness visit covered.

Answered by Todd Bostic on July 21, 2025

Broker Licensed in TX, AL, AZ & 12 other states

Answered by Todd Bostic Medicare Insurance Agent

Should be paid for in full. Depends on what you policy says. Always a good thing to check with your Dr’s office and Medicare

Answered by Mike Henry on August 1, 2025

Agent Licensed in TX

Answered by Mike Henry Medicare Insurance Agent

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. Your annual wellness visit is free. preventive is no cost to you.

Answered by Ben Washington on September 7, 2025

Broker Licensed in IL, FL, MN, SC, TX & WI

Answered by Ben Washington Medicare Insurance Agent

The carriers generally provide the annual House Call at no charge to the member. They send a nurse to check your vitals and medicines. The information they obtain helps the carrier provide better services to members.

Answered by Andre Cabral on April 18, 2025

Agent Licensed in NJ

Answered by Andre Cabral Medicare Insurance Agent

As we know, PPO has in-network and out of network and the latter will cost you more. Annual wellness is usually covered and should be in-plan - free of cost within your PPO network. Check the plan with your PPO if indeed annual wellness is part of the program.

Answered by Dominic Javier on April 22, 2025

Broker Licensed in TX

Answered by Dominic Javier Medicare Insurance Agent

That question is best answered by the Medicare Advantage carrier you're currently with. Most annual wellness visits are at no cost to the consumer, however its best to review your co-pay schedule with the Agent/Broker that recommended the Medicare Advantage plan to you.

Answered by William Scott on May 27, 2025

Broker Licensed in GA, CO, NC, OH, SC & TX

Answered by William Scott Medicare Insurance Agent

Yes but when meeting certain criteria. Medicare already covers an annual wellness visit as a preventive service and since Medicare Advantage plans must also cover the same preventive visits at no cost, your PPO will also cover it IF you have been on Medicare Part B for 12+ months AND the wellness visit is at least 11-12 months after your welcome to Medicare visit. You should also check your plan's summary of benefits as it MAY also cover an annual physical, which is not the same as the wellness visit.

Answered by Kevin Chaikin on June 27, 2025

Broker Licensed in VA, AL, AZ & 31 other states

Answered by Kevin Chaikin Medicare Insurance Agent

Your annual Medicare wellness visit with an in-network provider is covered at no cost for someone with a Medicare Advantage PPO plan. Be advised though that a copay may be assessed if you have that done at an out-of-network provider.

Answered by Bruce Resnick on September 1, 2025

Broker Licensed in TX

Answered by Bruce Resnick Medicare Insurance Agent

Usually there is a list of no charge preventive services in the explanation of benefits and an annual wellness check certain screenings a blood work are customary included. Please look at your policy or call your customer service to verify.

Answered by Robert Nunn on April 12, 2025

Agent Licensed in FL, AL, AR & 36 other states

Answered by Robert Nunn Medicare Insurance Agent

Usually, you need to pay the Dr. visit co-pay and tests are almost always covered, depending on the details of your own plan. Check with the agent that help you enroll or contact any other license agent that can help you with the details!

Answered by Nora Alishahi on October 22, 2025

Broker Licensed in FL, CA, GA & 9 other states

Answered by Nora Alishahi Medicare Insurance Agent

My first answer is "always check your statement of benefits provided by your Medicare Advantage provider."

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 Vernon Pate Medicare Insurance Agent

Medicare Advantage plans are required to cover the annual wellness visits as part of their contract with Medicare.

Answered by Zachary Montgomery on May 20, 2026

Agent Licensed in GA, AL, IA, IL, SC & TN

Answered by Zachary Montgomery Medicare Insurance Agent

It depends on your insurance plan. Wellness visits usually fall under your Primary Care Provider (PCP), so if your insurance card shows $0 for PCP, you should be good to go. Lab work may have additional costs depending on your coverage. Having a broker like myself on your side is key—I review your plan in detail and answer questions like this right away.

Answered by David Alelishvili on June 9, 2025

Broker Licensed in NY & NJ

Answered by David Alelishvili Medicare Insurance Agent

If is done by an in-network provider, is usually covered with no additional cost. However, if any additional services, like lab tests or treatments, are provided during this visit, you might have to pay a portion based on your plan.

Answered by Zenaida Rivera on March 2, 2026

Agent Licensed in FL

Answered by Zenaida Rivera Medicare Insurance Agent

If you have a Medicare Advantage plan with a PPO (Preferred Provider Organization), your annual wellness visit is generally free. However, there are some important details to consider to understand how it works with your specific plan.

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

Broker Licensed in AL, FL, GA, LA, MS & TX

Answered by Jim Towle Medicare Insurance Agent

The Annual Wellness Visit is provided at no cost to you—no copay, deductible, or coinsurance—when you see a doctor in-network. With a PPO, you can go to any doctor you want, however if the doctor is out-of-network you will be charged a copay or coinsurance fee. A list of your copay and fees are listed in the Summary of Benefits (SOB) for your specific plan name.

Answered by Michael Waldron on September 22, 2025

Broker Licensed in FL, GA, NC, NJ, NY & VA

Answered by Michael Waldron Medicare Insurance Agent

Medicare advantage plan always cover one annual wellness visit a year for a $0 copay. Be sure to check providers and make sure they are in network with the plan.

Answered by Christopher Randall on December 15, 2025

Broker Licensed in OR, AZ & WA

Answered by Christopher Randall Medicare Insurance Agent

The annual wellness visit in no charge under Medicare rules on MAPD plans in network. Even if you are out of network, and the provider accepts your plan, the annual wellness visit will be no cost.

Answered by Donald Heath on May 12, 2025

Agent Licensed in CA, AZ, CO & NM, NV, TX & WA

Answered by Donald Heath Medicare Insurance Agent

You would want to check your Summary of Benefits to confirm. In general, if the provider accepts Medicare and is Network the Annual Wellness Visit should be covered as Medicare Part B considers the visit a preventive service and is covered at 100%

Answered by Kirsten Love on October 6, 2025

Broker Licensed in MT

Answered by Kirsten Love Medicare Insurance Agent

Wellness visits are typically 100% covered with Medicare Advantage plans, both PPO and HMO. However, I would have to look at your plan specifically to confirm. You should be able to call the customer service number on the back of your card to confirm specifically with your insurance carrier.

Answered by Debbie Coufal on February 10, 2026

Agent Licensed in AR, CO, FL, ND, TN & TX

Answered by Debbie Coufal Medicare Insurance Agent

Yes, your annual wellness visit is considered a preventative service, therefore it will be covered at a $0 copay. Medicare Advantage covers many preventative services at no cost when you see an in network provider.

Answered by Lauren Anderson on October 5, 2025

Agent Licensed in FL, AL, GA, IA & TX

Answered by Lauren Anderson Medicare Insurance Agent

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.

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