Medicare’s Annual Wellness Visit Is Free. One Knee Complaint Turned It Into a $34 Bill.

8 min read · Last updated August 20, 2026

In this article

• What the Annual Wellness Visit actually is
• Who qualifies, and when your clock starts
• What the visit covers, and what it does not
• How one billing mistake turns a free visit into a bill
• What people get wrong about this benefit
• Frequently asked questions

Dorothy Alvarez turned 67 this spring and booked what she assumed was her free annual physical through Medicare. Forty minutes into the appointment, her doctor asked about the knee she’d mentioned wincing over while getting out of the car. He examined it, ordered an X-ray, and adjusted her pain medication. Three weeks later, a bill for $34 showed up in her mailbox for a visit she’d been told was covered at no cost.

Nothing went wrong with Dorothy’s coverage. Her Annual Wellness Visit itself was billed correctly at $0. The knee exam was a separate, medically necessary service tacked onto the same appointment, and Medicare only waives cost-sharing for the wellness portion.

What the Annual Wellness Visit actually is

The Annual Wellness Visit (AWV) is a yearly benefit under Medicare Part B, the part of Medicare that pays for outpatient and provider services. According to Medicare.gov, it’s a conversation-based appointment built around prevention, not a hands-on medical exam. Your provider is not required to listen to your heart, check your reflexes, or perform any of the diagnostic tasks people associate with a “physical.”

Instead, the visit centers on a questionnaire called a Health Risk Assessment (HRA). You fill it out before or during the appointment, and your provider uses your answers, along with your medical and family history and current prescriptions, to build a Personalized Prevention Plan. That plan is a written checklist telling you which screenings, vaccines, and preventive services you’re due for over the next five to ten years, based on guidance from the U.S. Preventive Services Task Force, according to CMS.gov.

Your provider will also take routine measurements like height, weight, and blood pressure, run a cognitive screening for signs of dementia, and screen for depression risk and substance use risk. Advance care planning, a conversation about documenting your future medical wishes, is offered as an optional add-on at your discretion. None of this replaces a diagnostic exam. If you have a symptom you’re worried about, that’s a separate appointment.

Who qualifies, and when your clock starts

Anyone enrolled in Medicare Part B for at least 12 months qualifies for an Annual Wellness Visit, and you get one every 12 months after that, according to Medicare.gov. There’s a separate, one-time benefit called the “Welcome to Medicare” preventive visit, available only within your first 12 months of Part B enrollment. It covers similar ground (medical history, risk screening, a written prevention plan) but is not the same benefit and does not repeat.

Here’s the timing rule that trips people up: your first Annual Wellness Visit can’t happen within 12 months of either your Part B start date or your “Welcome to Medicare” visit, whichever applies. You do not need to have had the “Welcome to Medicare” visit at all to qualify for your first Annual Wellness Visit. On the billing side, CMS confirms providers can only bill the Annual Wellness Visit once in a 12-month period, and can’t bill it within 12 months of billing the “Welcome to Medicare” code for the same patient.

In practice, that means a beneficiary who enrolled in Part B in March 2026 becomes eligible for their first Annual Wellness Visit in March 2027 at the earliest, whether or not they used the “Welcome to Medicare” visit in year one.

What the visit covers, and what it does not

The Annual Wellness Visit covers the Health Risk Assessment, routine measurements, a review of your medications and providers, cognitive and depression screening, substance use and opioid risk review, a written prevention plan, and optional advance care planning, all with no deductible and no coinsurance when your provider accepts assignment (agrees to Medicare’s approved amount as full payment), per Medicare.gov.

What it does not cover is a physical exam in the traditional sense: no stethoscope exam of your heart and lungs, no hands-on abdominal check, no treatment of a new symptom. If you bring up a new complaint (a knee that hurts, a rash, chest tightness), your provider can address it in the same appointment, but that part of the visit becomes a separate, billable service.

Feature	Annual Wellness Visit	“Welcome to Medicare” Visit
When it’s available	Every 12 months, starting 12 months after Part B enrollment	Once, only in your first 12 months of Part B
Cost with assignment	$0, no deductible, no coinsurance	$0, no deductible, no coinsurance
Includes a hands-on physical exam	No	No
Includes a Health Risk Assessment	Yes, required	No HRA, but similar history review
Advance care planning offered	Yes, optional	Yes, optional
Best for	Anyone past their first Part B year wanting an annual prevention checkup	New Part B enrollees in their first 12 months

How one billing mistake turns a free visit into a bill

This is the part that catches people off guard, so walk through it carefully before your next visit.

When a doctor addresses a new or ongoing health problem during the same appointment as your Annual Wellness Visit, Medicare allows the provider to bill that portion separately using what’s called modifier 25, according to CMS.gov. In plain terms, modifier 25 splits the appointment into two claims on paper: the wellness portion, which stays at $0, and a problem-focused office visit, which is billed like any other doctor’s appointment.

That second claim is subject to the regular Part B deductible ($283 in 2026) and 20% coinsurance after you meet it, the same cost-sharing rules that apply to any other Part B service, per Medicare.gov.

Here’s Dorothy’s visit worked through the numbers. Her Annual Wellness Visit itself was billed at $0, exactly as it should be. Her doctor also billed a separate office visit for the knee exam, at a Medicare-approved amount of $170 for this example (actual amounts vary by provider and location). Dorothy hadn’t yet met her 2026 Part B deductible of $283, so she owed the full $170 for the knee portion out of pocket. If she’d already met her deductible for the year, she would have owed 20% coinsurance instead, or $34, with Medicare paying the remaining $136. Either way, the wellness visit stayed free. The knee exam did not.

If a bill like Dorothy’s would strain your budget, it’s worth checking whether you qualify for a Medicare Savings Program. These state-run programs can cover your Part B deductible and coinsurance on your behalf, which would have erased Dorothy’s $170 bill entirely.

What people get wrong about this benefit

Don’t assume “free annual visit” means every question you raise stays free. If you want to keep your Annual Wellness Visit at $0, save unrelated health concerns for a separate appointment, and tell the front desk you’re scheduling “just the wellness visit” when you book. If a new problem comes up in the room and your doctor treats it on the spot, that’s still the right medical call. Just expect a separate line on your statement for that part, and ask your provider’s billing staff to confirm which portion carries the modifier 25 code before you leave.

Also don’t assume you’ve used up your only free preventive visit if you already had the “Welcome to Medicare” visit. That one-time visit and your ongoing Annual Wellness Visit are two different benefits with two different clocks. And don’t assume you need the “Welcome to Medicare” visit first. You don’t. Your Annual Wellness Visit eligibility starts on its own timeline, 12 months after your Part B enrollment date.

If you’re weighing Original Medicare against a Medicare Advantage plan, or deciding whether a Medigap policy is worth adding, the same $0 wellness visit is available either way. See Medigap vs. Medicare Advantage open enrollment windows for how that separate decision affects what a bill like Dorothy’s would look like under each option.

A wellness visit is also a good moment to ask your doctor what would happen if a hospital stay led to rehab afterward. Medicare’s skilled nursing facility benefit has its own 3-day hospital-stay rule and its own coverage cliff, one worth understanding before you ever need it.

Frequently asked questions

Do I have to get a physical exam during my Annual Wellness Visit? No. Medicare’s Annual Wellness Visit is a conversation-based prevention checkup, not a hands-on physical exam. Your provider isn’t required to examine your heart, lungs, or abdomen. If you want an actual physical exam, ask your provider to schedule that as a separate visit.

What happens if my doctor treats a new health problem during the same visit? Medicare allows your provider to bill that portion separately using modifier 25. Your Annual Wellness Visit stays at $0, but the problem-focused portion is billed like a regular office visit and can trigger your Part B deductible and 20% coinsurance.

Can I get my Annual Wellness Visit before 12 months have passed since my last one? No. Medicare only covers one Annual Wellness Visit every 12 months, counted from the month of your last visit, not the calendar year. Your provider can’t bill for a second one earlier than that, even if you want an extra check-in sooner or switch doctors mid-year.

I already had my “Welcome to Medicare” visit. Do I still get an Annual Wellness Visit this year? Yes, as long as it’s been at least 12 months since your “Welcome to Medicare” visit and since your Part B enrollment date. The two visits are separate benefits, and having one doesn’t use up the other.

Does advance care planning cost anything if I do it during my Annual Wellness Visit? No. When advance care planning is delivered as part of your Annual Wellness Visit by the same provider, Medicare waives the coinsurance and deductible for it once per year. It’s entirely optional. Outside that visit, or beyond once a year, regular Part B cost-sharing applies to advance care planning conversations.