It’s Time to Ax the Medicare Annual Wellness Visit

Within 12 months of enrolling in Medicare Part B, patients are permitted a one-time “Welcome to Medicare” visit, also called the initial preventive physical exam (IPPE). Though “physical exam” is in the name, Medicare warns patients that “This isn’t a comprehensive physical exam.”¹

Adding to the confusion, 12 months after the IPPE, Medicare covers annual wellness visits (AWVs). These are preventive visits intended to review a beneficiary’s health status and create a personalized prevention plan — but not to diagnose, treat, or address their medical problems nor to perform a physical exam. Most patients (75% in one survey) incorrectly believe that Medicare wellness visits include a physical exam.² In actuality, Medicare never covers routine physical exams.^3,4

While many physicians may view AWVs as a commendable idea, others (myself included) question the real-world value of these often confusing and time-consuming visits.

Because of the way they’re structured, Medicare AWVs have a number of limitations.

Limited clinical utility. The AWV does not include routine exam components such as listening to the heart or checking for physical findings that require a hands-on approach. These visits therefore won’t catch most chronic conditions or even many acute illnesses.

Low patient understanding and satisfaction. Many patients don’t understand that the AWV is not an annual “physical” or a problem-based visit. Dissatisfaction risks running high when their expectations aren’t met, often leading to confusion and additional appointments. Physicians may be able to add a comprehensive physical exam or a problem-focused visit alongside an AWV if needed; however, patients expecting that their visit will be covered without a deductible or co-pay may be unhappy to find out that this creates a charge to them.⁵

No diagnostic services. During the AWV, physicians can’t order labs for chronic disease management, address non-preventive concerns, or handle the majority of what drives clinical care. As a result, patients often require an additional appointment, which leaves both patients and physicians dissatisfied.

Administrative time burden. Instead of providing a meaningful health assessment, the AWV requires clinicians to complete standardized checklists, questionnaires, and health risk assessments, often with limited impact on care or outcomes. Some practices use medical assistants or nurses to handle much of this work, taking some of the burden from the physician. But these visits still take up valuable time; the patient still has to be present for the visit, and the physician still has to review the visit information and oversee the care plan.

Corporate misuse. Some large insurance companies have been accused of pushing their Medicare Advantage (MA) patients to complete AWVs primarily to maximize opportunities to capture diagnosis codes that map to payment hierarchical condition categories (HCCs).⁶ That in turn increases government payments to MA plans for covering these patients, even if it doesn’t meaningfully improve their health.

Unclear mortality benefit. In adults between the ages of 18 to 64 years, research has failed to conclusively demonstrate that general health checks like the AWV reduce cardiovascular events, cancer mortality, or major health outcomes, unlike proven interventions such as vaccinations or diabetes management.⁷ While studies have shown that some specific screenings reduce mortality among certain groups of older adults,⁸ they don’t support a standardized, broad-based set of screenings such as the AWV for all older adults.