No, wellness visits don't always have to be exactly 365 days apart; it depends on your insurance, with Medicare often allowing visits once per calendar year (after the first 12 months) or every 366 days, while some private plans offer more flexibility, sometimes allowing a visit less than a full year from the last one if it's in a new calendar year, but it's generally covered once annually. Always check with your specific insurer, as rules vary, but the goal is usually one preventive visit per year, with flexibility around the 365-day mark.
Medicare covers a wellness visit once every 12 months (11 full months must have passed since your last visit), and you are eligible for this benefit after you have had Part B for at least 12 months.
They do not need to wait 365 days between visits. A member can schedule an annual well-care visit/physical exam at any time during each calendar year. Coverage for annual well-care visits is based on a calendar year regardless of the commercial member's benefit period.
An annual wellness visit will only be covered by Medicare once every 12 months. This doesn't mean you have to see a provider during the same month every year. But in order for a wellness visit to be covered by insurance, the appointment must take place 12 months after the last one.
The wellness exam should take roughly 30 minutes, and your provider may schedule additional tests or ask for a follow-up appointment.
Your visit may include:
You can have an annual wellness visit once every 12 months. For example: If you have your AWV on May 15, you can schedule your next AWV the following year anytime in the month of May (May 1 or later).
Starting in 2025, there is an annual limit on what you pay out-of-pocket for prescription medications through Medicare and Medicare Advantage prescription drug plans. All prescription medications, including specialty medications, covered by Part D plans are included under this cap.
A Medicare Wellness Visit (AWV) is for preventative planning, reviewing history, and creating a health plan (no hands-on exam), while a physical exam is a problem-focused, hands-on checkup including vitals, listening to heart/lungs, and potentially bloodwork, which Medicare doesn't cover but Medicare Advantage plans often do. Think of the AWV as "staying healthy," and the physical as "checking what's wrong," with the key difference being that the AWV doesn't include a full physical exam by default.
Medicare pays for only one first AWV per beneficiary per lifetime, and pays for one subsequent AWV per year thereafter. Additional information regarding Medicare coverage of the AWV is available in the CMS MLN Quick Reference Information: The ABCs of Providing the Annual Wellness Visit chart.
What not to do before a physical exam
Yes, you can absolutely refuse a Medicare Annual Wellness Visit (AWV); it is entirely optional and not mandatory, and declining it will not affect your Medicare coverage or eligibility, though you'll miss out on a free, personalized prevention plan and updates on screenings. These visits focus on health planning, not a physical exam, but you can opt-out if you don't find them helpful or feel they're intrusive.
Annual wellness visits can help spot potential problems before they get serious. Plus, it's important to keep track of key measurements over time.
Is a Medicare wellness visit mandatory? The short answer is no, you are not required to have a Medicare Wellness Visit.
There is a difference between an “annual wellness visit” and an “annual physical exam.” One is focused more on preventing disease and disability, while the other is more focused on checking your current overall health. We'd like to clear up any confusion you might have.
The prominence of laboratory testing has invariably led to a diminution in the skill of performing the physical examination. Numerous studies have documented reduced skills in cardiac auscultation among physicians at all levels, but more prominent among those who were trained more recently.
Medicare wellness visits are not mandatory, and skipping them won't affect your coverage or benefits.
The extra $144 added to Social Security usually comes from the Medicare Part B Giveback benefit, offered by some Medicare Advantage (Part C) plans, which pays back some or all your Part B premium, showing up as extra money in your check if it's deducted from your Social Security. To qualify, you need Original Medicare (Parts A & B), pay your own Part B premium, live in a plan's service area, and enroll in a specific Medicare Advantage plan that offers this "rebate," with the amount varying by plan and location.
The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185.00 in 2025. The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025.
Through 2024, if you spent a certain amount on prescription drugs, you'd enter the Part D "donut hole" or coverage gap. As of 2025, the Medicare Part D coverage gap is eliminated.
What Not to Do Before a Physical
Visits must be at least 11 months apart
“In order for Medicare to pay for annual wellness visits, at least 11 full months must have elapsed,” Dr. Candler said. “What the annual wellness visit does is it combines all the recommendations that doctors and other scientists have for how to stay healthy.