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Published on September 10, 2014

Examining Annual Check-Ups:
The Differences Between Physicals & Wellness Visits  

Meghan Cooley, DNP with a patientDo you know the difference between an annual physical and a wellness visit? They sound similar and have very similar meanings, but the two are actually quite different from a medical perspective, as well as very different to your health insurance provider in terms of billing. To best suit you, your needs and your budget, it’s important to be clear about the differences between the two types of visits.

Appointment Differences

At first glance, a physical and a wellness visit seem very similar: both can occur annually at your primary care provider’s office. But, consider these differences:

Annual Physical

  • Occurs once yearly.
  • Make updates to your family and personal medical history.
  • Get a complete physical examination.
  • Receive any necessary vaccines or immunizations.
  • Take samples for any necessary lab tests – blood, urine, stool, etc.
  • Visit Radiology for any necessary testing.
  • Not covered under Medicare A or B.

Annual Wellness Visit

  • Occurs once yearly.
  • Review of family and personal medical history.
  • No physical examination.
  • Screen for depression.
  • Screen for safety.
  • Screen for cognitive impairment.
  • Create a testing schedule* – lab, radiology, vaccines, immunizations, etc.
    * Coverage for preventive services varies under Medicare. Ask your doctor for more details about the type of testing that is recommended.
  • Devise a list of risk factors and interventions.
  • Completely covered under Medicare A and B.

An easy way to remember the differences between an annual physical and a wellness visit is that you receive a physical examination, whereas you are not physically examined at a wellness visit.

Cost Differences for Medicare Patients

As a result of these differences, the two are billed to your insurance very differently as well, which will affect your total cost. If you are on Medicare, it is not advisable to get a physical because it is not covered; however, an annual wellness visit is covered by Medicare. It is also important to note that, if you do have a physical, each additional test beyond the physical examination is reported and charged individually to your insurance. This could result in a higher out-of-pocket cost beyond your copay.

If you are not on Medicare, contact your insurance provider if you have any questions about coverage.

When you need an annual check-up, be sure to know which of these you need so that you get the best care. Be specific when making your appointment with your provider’s office; if you have the wrong type of visit, you might not realize it until it is too late. To find a MercyCare primary care provider, call (319) 369-4444.

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