Do wellness visits have to be 365 days apart?

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Whether wellness visits must be 365 days apart depends entirely on your specific insurance provider or Medicare plan type.

Insurance Rules and Spacing

  • Standard / Calendar Year Plans: Many commercial insurance plans and some Medicare Advantage plans allow one wellness visit per calendar year (meaning you could have one in December of one year and January or even September of the next).
  • Strict 12-Month / 365-Day Plans: Traditional Original Medicare and certain commercial or Medicare Advantage plans require 12 full months—or at least 365 days—to pass between visits, though some allow the appointment as early as the first day of the same calendar month in the following year.
  • Medicare Requirements: For traditional Medicare, 11 full months must pass after your previous annual wellness visit before you are eligible for the next one.

Do you have to wait 365 days for a Medicare annual wellness visit?

Yes, Original Medicare requires roughly 12 months (at least 365 days or 11 full months depending on exact billing rules) to pass between your yearly wellness visits.

Rules for Timing

  • Traditional Medicare: You generally need to wait at least 11 to 12 months between visits (often tracked as once every 365 days or starting in the same month of the following year).
  • Medicare Advantage: These plans often allow one visit per calendar year, meaning you could potentially have one late in one year and earlier in the next calendar year.
  • First Visit Rule: Your very first Annual Wellness Visit requires you to have had Medicare Part B for over 12 months, and it cannot occur within 12 months of a "Welcome to Medicare" visit.

You can check specific rules for your coverage through the official Medicare Yearly Wellness Visits page.

Does an AWV have to be 12 months apart?

Yes, subsequent Medicare Annual Wellness Visits (AWVs) must be at least 11 full months apart, meaning you do not have to wait a full 365 days or 12 calendar months.

Timing Rules for Medicare AWV

  • Initial AWV: Can only be done after you have been enrolled in Medicare Part B for at least 12 months, and you must not have received an Initial Preventive Physical Examination (IPPE / "Welcome to Medicare" visit) or a first AWV in that same timeframe.
  • Subsequent AWVs: Require a minimum interval of 11 full months and can typically be performed during the same calendar month of the following year (for example, if you had your visit on December 21 last year, you can have your next one as early as December 1 of this year).
  • Official Information: You can review further details directly through the Centers for Medicare & Medicaid Services or the official Medicare Coverage Guide.

How often can you get an annual wellness visit?

You can get a Medicare Annual Wellness Visit once every 12 months.

Timing and Rules

  • First visit: You must wait until you have been enrolled in Medicare Part B for at least 12 months.
  • Welcome to Medicare: Your first year includes an optional one-time "Welcome to Medicare" preventive visit instead.
  • Later visits: Following your first year, subsequent annual visits must be spaced 12 months apart (or according to your specific Medicare Advantage or fee-for-service calendar rules).

Does Blue Cross Blue Shield require 365 days before wellness visit?

No, most Blue Cross Blue Shield (BCBS) plans cover one wellness visit per calendar year rather than strictly requiring 365 days to pass between appointments.

Calendar Year vs. 365 Days

  • Calendar Year Plans: Many commercial and Independence Blue Cross plans allow one routine physical or annual exam per calendar year (e.g., any time between January 1 and December 31). You can have a visit in November one year and February the next without waiting a full 365 days.
  • 365-Day / 12-Month Rules: Certain specific plans or Medicare-related Annual Wellness Visits (such as those under Blue Cross and Blue Shield of Kansas or standard Medicare guidelines) may track coverage based on a 12-month interval or 365+1 days between dates of service.

Because BCBS operates through independent regional companies and offers many different employer or individual policy tiers, your exact rule depends on your specific policy.

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9 related questions found

Do United Healthcare wellness visits need to be 12 months apart?

No, UnitedHealthcare Medicare Advantage wellness visits and routine physical exams do not need to be 12 months apart; they are covered once per calendar year.

Coverage Rules

  • Calendar Year: You can have your annual wellness visit or routine physical once every calendar year, meaning you can do one in December and the next in January without waiting a full 12 months.
  • First-Year Exception: For original Medicare Part B or initial Welcome to Medicare visits, the very first wellness check has specific initial enrollment window rules (usually within the first 12 months of enrollment), but subsequent annual visits follow the calendar year guidelines.
  • Coding and Billing: Always confirm with your provider's office that the appointment is scheduled specifically as a preventive or annual wellness visit so it is billed correctly.

Can you refuse a Medicare wellness visit for seniors?

Yes, you can refuse a Medicare annual wellness visit without any penalty or impact on your Medicare benefits or coverage eligibility.

Key Facts About Refusing

  • 100% Optional: Participation in a Medicare wellness visit is completely voluntary and up to your personal discretion.
  • No Coverage Penalties: Skipping or declining this visit will not cause you to lose your Original Medicare or Medicare Advantage benefits.
  • Provider Relations: Your doctor cannot penalize you, drop you as a patient, or refuse other medically necessary care because you skip a wellness visit.
  • Changing Your Mind: You can choose to schedule a wellness visit later if you change your mind, with no retroactive penalties.

What the Visit Involves

  • Not a Physical Exam: The wellness visit is a conversation-based review of your medical history, current medications, and health risk assessments. It does not include a hands-on physical examination.
  • No Out-of-Pocket Cost: When using an in-network provider who accepts Medicare assignment, the visit is fully covered at $0.
  • Preventive Focus: It is designed to create a personalized prevention plan and screen for cognitive or safety risks. As noted in a discussion on Reddit, doctors' offices strongly encourage these visits for preventive tracking and practice workflow, but they remain entirely optional for the patient.

What are the CMS guidelines for annual wellness visits in 2026?

The Centers for Medicare & Medicaid Services (CMS) guidelines for a Medicare Annual Wellness Visit (AWV) in 2026 focus on personalized prevention planning, risk assessments, and health status updates rather than a head-to-toe physical examination.

Core HCPCS / CPT Codes & Eligibility

  • G0402 (IPPE / Welcome to Medicare): Covered once in a lifetime for new beneficiaries within their first 12 months of Part B enrollment (National average reimbursement: ~$175).
  • G0438 (Initial AWV): Available once in a lifetime for patients who have been enrolled in Part B for more than 12 months and have not received an initial AWV or IPPE (National average reimbursement: ~$174).
  • G0439 (Subsequent AWV): Billed annually, at least 11 full calendar months after the previous initial or subsequent AWV (National average reimbursement: ~$138).

Key 2026 Updates

  • Physical Activity & Nutrition Assessment (G0136): Effective in 2026, a standardized, evidence-based assessment of physical activity and nutrition (lasting 5 to 15 minutes) can be billed using code G0136 semi-annually as an optional element. Add modifier -33 on the claim alongside the AWV to waive the copayment and deductible for this specific code.
  • Cost Sharing: The AWV itself remains a $0 preventive service for beneficiaries if the provider accepts assignment. However, addressing acute or new medical issues during the same visit may trigger a separate Evaluation and Management (E/M) charge subject to deductibles and coinsurance (use modifier -25).

Required Documentation Elements

  • Health Risk Assessment (HRA): Completed by or on behalf of the beneficiary prior to or during the visit.
  • Medical and Family History: Documenting past medical events of parents, siblings, and children, along with hereditary risk factors.
  • Current Providers & Suppliers List: A list of regular medical and behavioral healthcare providers.
  • Routine Measurements: Height, weight, body mass index (BMI) or waist circumference, and blood pressure.
  • Cognitive Impairment Detection: Assessed via direct observation or formal screening instruments.
  • Depression & Functional Screening: Reviewing risk of depression, functional ability, fall risks, and home safety.
  • Personalized Prevention Plan (PPPS): A written schedule or checklist of recommended preventive services and screenings for the coming years.

What are the three words for Medicare Wellness Visit?

There is no single official set of three words mandated by Medicare, but commonly cited examples used in short-term recall tests include "banana, sunrise, and chair" or "apple, table, and penny".

About the 3-Word Memory Test

  • Purpose: Healthcare providers use a quick word-recall task during the cognitive screening portion of an Annual Wellness Visit to check short-term memory and detect early signs of cognitive impairment.
  • How it works: The clinician names three unrelated words, asks you to repeat them, moves on to other discussion or questions, and then asks you to recall the three words a few minutes later.
  • Flexibility: Because doctors use different validated screening tools or local clinic guidelines, the exact words chosen change from visit to visit and provider to provider.

What is the difference between a Medicare Annual Wellness Visit (AWV) and an annual physical?

A Medicare Annual Wellness Visit (AWV) is a prevention-planning session, while an annual physical is a hands-on, head-to-toe medical examination.

Key Differences at a Glance

  • Focus: An Annual Wellness Visit updates your personalized prevention plan and reviews risk factors. An annual physical evaluates your current overall health status and diagnoses or treats active issues.
  • Physical Exam: An AWV is a "hands-off" assessment with no physical touch other than routine basic measurements like height, weight, and blood pressure. A physical is a comprehensive, hands-on exam where a doctor listens to your heart and lungs, checks your abdomen, and tests reflexes.
  • Tests and Labs: Automatic lab work, blood tests, or X-rays are not included in an AWV. An annual physical frequently includes or leads to ordered lab tests, blood panels, and screenings.
  • Medicare Coverage: Original Medicare fully covers an annual wellness visit once every 12 months with no copay or deductible. Original Medicare does not cover routine annual physical exams.