Medicare covers two different preventive checkups that share almost the same paperwork and confuse enough beneficiaries that Medicare’s own program materials go out of their way to distinguish them. The “Welcome to Medicare” visit is a one-time checkup available only in a new enrollee’s first 12 months of Part B, while the yearly “Wellness” visit repeats every 12 months for as long as someone keeps Part B — and neither one, despite the checklist of measurements and questions involved, is a physical exam Medicare will pay for as such.
Two visits, two different clocks
The Welcome to Medicare visit is available only once, within the first 12 months a person has Part B, and Medicare covers it at $0 if the provider accepts assignment. During the visit, a provider reviews medical and social history, calculates body mass index, gives a simple vision test, screens for depression risk, and hands over a written plan of the screenings and vaccines that provider recommends going forward.
For a new enrollee already taking a prescription opioid, that same visit adds a specific review: the provider evaluates risk factors for opioid use disorder, checks the person’s pain treatment and control, and shares information on non-opioid alternatives, referring the beneficiary to a specialist if appropriate. No comparable opioid-specific step is built into the recurring visit that follows it.
The yearly Wellness visit is different in structure, not just in timing. It repeats once every 12 months indefinitely, and Medicare states plainly that someone doesn’t need to have had a Welcome to Medicare visit first to qualify for it — the two are independent benefits rather than sequential steps of the same program. What they share is the $0 cost when the provider accepts assignment and a Part B deductible that doesn’t apply to either one.
There’s one timing rule that connects them anyway: a person’s first yearly Wellness visit can’t happen within 12 months of either their Part B enrollment or their Welcome to Medicare visit, whichever is later. That buffer is why someone who used their Welcome visit in month eleven of having Part B has to wait roughly another year before their first Wellness visit becomes available, rather than scheduling the two back-to-back.
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Why “covered” doesn’t mean “a physical exam”
Medicare describes the yearly Wellness visit as a conversation-based visit meant to create a prevention plan, explicitly stating it “isn’t a routine physical exam,” and instructs beneficiaries with specific health concerns to schedule a separate appointment so the Wellness visit can stay focused on prevention planning rather than diagnosis or treatment. The Welcome to Medicare visit carries the identical disclaimer, calling itself a preventive check-up rather than a comprehensive physical.
Both visits fold in a Health Risk Assessment questionnaire and a review of current prescriptions, but if a provider performs an additional test or service during either visit that Medicare doesn’t cover as a preventive benefit — a diagnostic test prompted by a symptom the beneficiary happens to mention, for instance — the Part B deductible can apply to that portion, and the beneficiary may owe coinsurance or the full cost depending on what Medicare covers.
The Wellness visit’s required components go beyond that questionnaire. Medicare’s coverage page lists routine measurements — height, weight, and blood pressure — a review of medical and family history, and general health advice as standard parts of the visit, layered under the written screening-and-vaccine checklist the provider hands over at the end. Providers may also offer an optional “physical activity and nutrition risk assessment,” a supplemental questionnaire meant to flag habits affecting long-term health; unlike the core components, offering it is standard practice but completing it is voluntary, so declining it changes nothing about what a beneficiary owes for the visit itself.
The cognitive and safety screening most people don’t expect
The Wellness visit carries a specific clinical requirement most beneficiaries don’t anticipate: a cognitive assessment intended to catch early signs of dementia, including Alzheimer’s disease, covering trouble with memory, learning, concentration, and everyday decision-making. If the provider suspects impairment, Medicare separately covers a more thorough follow-up visit to check for dementia, depression, anxiety, or delirium — a benefit layered on top of, not instead of, the annual visit itself.
Both visits also open the door to advance directives, the legal documents recording a person’s wishes about future medical treatment if they become unable to decide for themselves — providers are required to offer to discuss creating them at each visit, though filling one out is entirely optional and doesn’t affect coverage of the visit itself.
The two visits together give a Medicare beneficiary two guaranteed, no-cost conversations with a provider every year that have nothing to do with treating an existing complaint — one to establish a baseline in the first year of coverage, and one annually after that to update it. The gap most people fall into isn’t a lack of coverage; it’s not knowing the Wellness visit exists at all once the one-time Welcome visit is behind them, since nothing about turning 66 or 70 triggers a reminder the way an open enrollment mailing does.
This article was researched and drafted with the assistance of artificial intelligence.
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