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.

Question

Gregg Matheny · Accepted Answer

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.

Steve and Sue Brauer · Answer

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.

Gary Church · Answer

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.

Andrew Zurbuch, MBA · Answer

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

Nikki Rowland · Answer

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.

Michael Denniston · Answer

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

Jennifer McDonnell · Answer

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

Jonathan Potter · Answer

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

David Quintal · Answer

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

Marie Terhune · Answer

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.

Steven Bleicher · Answer

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

Steven Lovell · Answer

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.

Jon Maves · Answer

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.

Barbara Margucci · Answer

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

Fred Manas · Answer

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.

Gary Henderson · Answer

free at an in network doctor. 

answer must be 100 characters long, so i'm sorry for the filler data.

Mike Henry · Answer

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

Todd Bostic · Answer

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.

Andre Cabral · Answer

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

William Scott · Answer

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

Bob Nunn · Answer

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 Bob Nunn on April 12, 2025

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

Answered by Bob Nunn Medicare Insurance Agent

Kevin Chaikin · Answer

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

Dominic Javier · Answer

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

Vernon Pate · Answer

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.

Jim Towle · Answer

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.

David Alelishvili · Answer

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

Answered by David Alelishvili Medicare Insurance Agent

Donald Heath · Answer

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.

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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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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