Does an Annual Wellness Visit Include a Complete Physical Exam?

September 30, 2025 •

4 min read

Confusing a Medicare Annual Wellness Visit (AWV) with a complete physical exam is a common misunderstanding. Both are beneficial, but are distinct services, and an annual wellness visit does not include a complete physical exam.

Quick Summary

An annual wellness visit is a health assessment and planning session, not a hands-on physical exam. It focuses on health risk assessments and prevention plans, while a complete physical is a hands-on checkup covering current health concerns and diagnostics.

Key Points

Annual Wellness Visit is not a physical exam: Medicare states that the AWV is a personalized prevention plan, not a complete head-to-toe physical exam.
AWV is a "hands-off" assessment: The AWV involves a Health Risk Assessment and discussion, with basic measurements like height, weight, and blood pressure taken.
Physical exam is a "hands-on" diagnostic tool: A physical exam includes a comprehensive, hands-on check of the body, as well as necessary lab work and other diagnostic tests.
Insurance coverage differs for each visit: Medicare covers AWVs at no cost, but often does not cover routine physical exams, which may be covered by private insurance.
Combining visits may incur extra costs: If combining an AWV and a physical into one appointment, services related to the physical exam may result in a copay or other out-of-pocket expenses.
Both visits are valuable and complementary: For holistic health, both the preventive planning of an AWV and the hands-on diagnosis of a physical exam are important, serving different purposes.

The belief that an annual wellness visit includes a complete physical exam is a widespread misunderstanding, particularly among those with Medicare. However, these two appointments are fundamentally different in their purpose, procedure, and insurance coverage. Understanding the distinction is crucial for managing health proactively and avoiding unexpected billing surprises. An Annual Wellness Visit (AWV) is a planning-oriented, preventive discussion, whereas a complete physical exam is a diagnostic and hands-on assessment.

What an Annual Wellness Visit (AWV) Includes

An AWV is a no-cost Medicare-covered benefit for beneficiaries who have had Part B for at least 12 months. It is a "hands-off" appointment focused on creating or updating a personalized prevention plan to help stay healthy and avoid disease.

Key components of an AWV include:

Health Risk Assessment (HRA): A questionnaire about health status, behaviors, and risks.
Medical and Family History Review: The provider will go over medical and family health history.
Routine Measurements: Recording of height, weight, and blood pressure.
Cognitive Assessment: Screening for signs of dementia or other cognitive impairment.
Personalized Health Advice: Recommendations for preventive services like screenings and vaccinations, and referrals to health education or counseling programs.
Medication and Provider Review: Discussion of all medications, supplements, and other doctors involved in care.
Advance Care Planning: An optional discussion about wishes for future medical treatment.

The AWV is forward-looking and focuses on risk identification rather than diagnosing current symptoms. During this visit, the provider will not perform a head-to-toe physical examination or perform lab tests.

What a Complete Physical Exam Includes

In contrast to the AWV, a complete physical exam is a comprehensive, hands-on checkup that assesses current physical health. This is a more traditional doctor's visit where the provider physically examines the body and addresses any current health concerns.

Key components of a complete physical exam typically include:

Full Physical Assessment: A hands-on examination, which may involve listening to the heart and lungs with a stethoscope, checking reflexes, and palpating (touching) certain areas of the body.
Vital Signs: Recording blood pressure, heart rate, and temperature.
Lab Work: Ordering and reviewing blood work (e.g., cholesterol, blood sugar) and urine analysis.
Specific Screenings: Conducting sex-specific screenings, such as prostate exams for men or pelvic and breast exams for women.
Addressing Current Health Problems: This is the time to discuss any new symptoms or changes in health.

Coverage for physical exams varies, with many private insurance plans covering them annually, often with a copay. It's essential to check specific plan details, as Medicare does not cover routine physical exams.

Can You Combine Both Visits?

Some insurance providers and clinics allow scheduling an AWV and a physical exam during the same visit. However, this often requires careful communication with the provider and knowledge of how insurance will handle the billing. For Medicare, providers can bill for both preventive (AWV) and problem-focused (physical exam) services during the same appointment by using a special billing code, but the parts of the visit related to the physical exam may incur a separate charge, deductible, or copay. Therefore, combining visits might save time but could lead to unexpected out-of-pocket costs.

Annual Wellness Visit vs. Complete Physical Exam

To highlight the key differences, here is a comparison table:


Feature	Annual Wellness Visit (AWV)	Complete Physical Exam (CPE)
Purpose	Proactive, preventive planning to mitigate future health risks.	Comprehensive, hands-on assessment for diagnosing current health issues.
Scope	Hands-off assessment, review of history, risk factors, and prevention plan.	Hands-on examination, includes vital signs, physical assessment, and lab tests.
Key Deliverable	A personalized prevention plan for the next 5-10 years.	Diagnostic findings, treatment for existing issues, and overall health status review.
Patient Input	Completion of a Health Risk Assessment (HRA) questionnaire.	Discussion of specific symptoms and current health concerns.
Insurance Coverage	Covered 100% by Medicare (and most Advantage plans).	Not covered by traditional Medicare, but covered by most private and Advantage plans (sometimes with a copay).
Discussion Focus	Family and social history, lifestyle habits, advance directives.	Current health problems, illness management, and physical findings.
Billing	Free for eligible Medicare beneficiaries.	Potential for deductibles, coinsurance, and copays, especially with Medicare.

The Complementary Roles of Both Visits

Neither visit is a complete substitute for the other. The AWV provides a critical overview for long-term planning, while the physical exam offers a detailed snapshot of current bodily health. For a holistic approach to healthcare, it is beneficial to have a regular physical exam and engage fully in the AWV when eligible. The combination ensures addressing immediate concerns and planning for sustained wellness. Use the AWV as an opportunity to discuss long-term goals and review the overall health strategy, while reserving the physical exam for a hands-on assessment and discussion of more immediate health concerns.

Conclusion

The difference between an annual wellness visit and a complete physical exam is significant, and understanding it is key to navigating healthcare correctly. The AWV is a preventive, planning-focused discussion, particularly for Medicare beneficiaries, that helps identify health risks and create a long-term prevention strategy. In contrast, a complete physical is a hands-on, comprehensive examination that addresses current physical health and may involve separate billing. Instead of viewing them as interchangeable, recognizing their distinct purposes allows leveraging both for a complete picture of health. By communicating clearly with a doctor and understanding insurance coverage, ensure receiving the right care at the right time.

For more information on Medicare's annual wellness visits and coverage, visit the official Medicare website.

Frequently Asked Questions

No, a Medicare Annual Wellness Visit is not the same as a complete physical exam. The AWV is a preventive discussion to develop a health plan, while a physical exam is a hands-on, diagnostic checkup.

During an AWV, the provider will review medical and family history, take routine measurements like height and blood pressure, conduct a health risk assessment, and provide personalized health advice and a preventive screening schedule.

A complete physical exam is a hands-on assessment where the doctor checks the body, listens to the heart and lungs, checks vital signs, and may order lab work like blood tests and other screenings.

No, traditional Medicare typically does not cover routine physical exams. It does, however, cover the Annual Wellness Visit at no cost. Many Medicare Advantage plans and private insurance policies do cover annual physicals.

Yes, it is often possible to have both visits in one appointment, but a separate charge, copay, or deductible may be incurred for the physical exam portion, especially with Medicare.

To prepare for the AWV, bring a list of current medications and supplements, a detailed family health history, a list of other healthcare providers seen, and any questions or concerns.

Both visits are important because they serve different, complementary purposes. The AWV helps create a long-term prevention strategy, while a physical exam provides a hands-on checkup to diagnose and treat any current health issues.