Medicare annual wellness visit outreach: who is eligible, what to say about cost and how to invite patients

The Medicare annual wellness visit is a covered preventive visit that a practice can offer each eligible patient once every 12 months. Inviting patients to it is one of the plainest kinds of outreach a practice does, and it still has several places where the wording can go wrong: who is eligible on what date, what the patient may pay, what the visit is and is not, and how the screening parts of the visit are described. This guide works through each of those using the federal regulation, the CMS provider page and the Medicare.gov page patients see.

Several related topics have their own guides and are not repeated here. Why a wellness visit should not be called a free physical, gifts of nominal value and how to use the word Medicare are covered in our guide to marketing to Medicare patients. Building the recall list, the contact sequence and sample messages are in our patient recall system guide, and the wider picture for a primary care office is in our primary care marketing guide.

What the visit is, in the words Medicare uses

Medicare.gov describes the yearly wellness visit as a conversation-based visit with a doctor or other health care provider to develop or update a personalized plan to help prevent disease or disability, based on the patient’s current health and risk factors. The same page says it is not a routine physical exam, and that a patient with specific health concerns should schedule a separate appointment so the wellness visit stays focused on prevention.

The regulation at 42 CFR 410.15 lists what the visit includes. For a first annual wellness visit, the list includes:

• Review, and administration if needed, of a health risk assessment.
• Establishing the patient’s medical and family history and a list of current providers and suppliers regularly involved in their care.
• Measurement of height, weight, body mass index (or waist circumference, if appropriate), blood pressure and other routine measurements as deemed appropriate.
• Detection of any cognitive impairment, and a review of risk factors for depression and of functional ability and level of safety.
• A written screening schedule, such as a checklist for the next 5 to 10 years, and a list of risk factors and conditions for which interventions are recommended or underway.
• Personalized health advice and referrals, as appropriate, to health education or preventive counseling services.
• Advance care planning at the discretion of the patient, a review of any current opioid prescriptions, and screening for potential substance use disorders.
• At the discretion of the health professional and the patient, a physical activity and nutrition risk assessment.

A subsequent visit updates these items rather than starting over. That list is the honest content of an invitation. A message that says the visit is a chance to review medications, update the screening checklist and talk about prevention describes what the regulation provides. A message that promises lab work, a head-to-toe exam or a diagnosis describes something else.

For 2026, CMS changed the optional assessment element of the visit from a social determinants of health risk assessment to a physical activity and nutrition risk assessment. Our guide to social needs screening outreach explains what that change means for invitations and intake forms.

The Welcome to Medicare preventive visit is a separate, one-time benefit. Under 42 CFR 410.16 it is covered when it is received not more than one year after the effective date of the patient’s first Part B coverage, and Medicare.gov says it is not a comprehensive physical exam either. New Medicare patients should be invited to that visit first, not to the annual wellness visit.

Who is eligible, and on what date

42 CFR 410.15 defines an eligible beneficiary as someone who is no longer within 12 months after the effective date of their first Part B coverage period and who has not received either an initial preventive physical examination or an annual wellness visit within the past 12 months. Medicare.gov puts the same rule to patients: the first yearly wellness visit cannot take place within 12 months of Part B enrollment or the Welcome to Medicare visit, and the patient does not need to have had the Welcome to Medicare visit to qualify.

The window is 12 months from the last qualifying visit, not a calendar year. The CMS provider page says the visit can be billed only once in a 12-month period, and that claims billed within 12 months of a Welcome to Medicare visit for the same patient are denied with a message that the patient reached the benefit maximum. Two practical points follow for outreach:

• Build the invitation list from dates: the Part B effective date for new Medicare patients, and the date of the last annual wellness visit or Welcome to Medicare visit for everyone else.
• The patient may have had a wellness visit somewhere else. Ask at booking whether they have had a wellness visit or a Welcome to Medicare visit with any provider in the past 12 months, and have your billing team check before the appointment if your systems allow it.

An invitation that says “your yearly wellness visit is due” should go out only when your records support it. If you are not sure, say “you may be due” and let the scheduler confirm.

Cost wording for the invitation

Medicare.gov says the patient pays nothing for the yearly wellness visit if the provider accepts assignment, and that the Part B deductible does not apply. The same page says the patient may have to pay coinsurance, and the Part B deductible may apply, if the provider performs additional tests or services during the same visit that are not covered under this preventive benefit, and that if Medicare does not cover the additional tests or services, such as a routine physical exam, the patient may have to pay the full amount.

That gives an invitation two sentences it needs, not one. The first says Medicare Part B covers the yearly wellness visit with no cost to the patient when the practice accepts assignment. The second says other tests or services during the same appointment may have costs. Without the second sentence, the invitation leaves out a cost the patient may face. The Medicare.gov page describes Original Medicare Part B, so for a patient with other Medicare coverage, have the scheduler confirm with the plan before quoting a cost.

Two optional parts of the visit have their own cost rules. The CMS provider page says CMS waives the Part B coinsurance and deductible for advance care planning, and for the physical activity and nutrition risk assessment, when it is provided on the same day by the same provider and billed on the same claim as the annual wellness visit, once per year. Outside the covered wellness visit, the deductible and coinsurance apply. If your invitation mentions advance care planning, describe it as Medicare.gov does, as something the provider will offer to talk about, and do not describe later planning sessions as included.

Separate concerns on the same day

A patient may arrive at a wellness visit with a problem: a new pain, a refill question, a worry about a test result. The CMS provider page says that when a practitioner provides an annual wellness visit and a significant, separately identifiable, medically necessary evaluation and management service, CMS may pay for the additional service. Medicare.gov tells patients they may owe coinsurance and the deductible for additional services in the same visit.

For the front desk, that turns into one question at booking: is there anything specific you want to talk about at this visit? If the answer is yes, the scheduler can explain that the wellness visit is focused on prevention, that a specific problem may be handled as a separate visit or a separately billed service, and that it may have costs. Whether a separate service was medically necessary is a clinical and billing decision made at the visit, not something a booking script or a web page should promise either way.

The pre-visit message and the health risk assessment

Under 42 CFR 410.15 the health risk assessment collects self-reported information, can be completed by the patient on their own or by a health professional before or as part of the visit, takes no more than 20 minutes to complete, and is tailored to the communication needs of underserved populations, people with limited English proficiency and people with health literacy needs. At a minimum it covers demographic data, a self-assessment of health status, psychosocial risks, behavioral risks, activities of daily living and instrumental activities of daily living.

The CMS provider page also lists what to encourage patients to bring: medical records including immunization records, a detailed family health history, a full list of medications and supplements with the dose and frequency for each, and a list of current providers and suppliers involved in their care, including community-based providers and behavioral health specialists. A pre-visit message built from that list helps the patient and the visit.

Sending the questionnaire ahead of time raises a privacy question. The assessment asks about mood, loneliness, alcohol use, sexual health, falls and finances. If patients fill it in online, the form, the place its answers are stored and any tool that touches them handle protected health information, so set that up the way our guides to online patient intake forms and HIPAA and website contact forms describe. A paper copy at the front desk remains a valid option, and the regulation’s tailoring requirement is a reason to offer one.

Describing the cognitive and other screening parts

Medicare.gov tells patients that the provider will perform a cognitive assessment to look for signs of dementia, and that if the provider thinks the patient may have cognitive impairment, Medicare covers a separate visit for a more thorough review. Under 42 CFR 410.15, detection of cognitive impairment means assessment of cognitive function by direct observation, with consideration of information from the patient and from family members, friends, caretakers or others.

Those descriptions set the limits for an invitation. A line such as “your visit includes a check on memory and thinking, as part of Medicare’s yearly wellness visit” matches the sources. A headline such as “Free dementia screening, catch it early” turns an assessment into a promise of detection and a fear appeal, and it skips the fact that a fuller evaluation is a separate visit. The same applies to depression and substance use: the regulation describes a review of risk factors and referral as appropriate, so describe it that way.

Under 15 U.S.C. 45 and 52, advertising for health services must not be deceptive. The FTC Policy Statement on Deception looks at whether a representation or omission is likely to mislead a consumer acting reasonably and whether it is material, and the FTC Policy Statement Regarding Advertising Substantiation says advertisers need a reasonable basis for objective claims before they make them. Statements about what a wellness visit will find or prevent are objective claims about health.

If a patient chooses advance care planning as part of the visit, the invitation, cost and privacy wording for that conversation are covered in our advance care planning outreach guide.

Who sends the invitation, and how

Under 45 CFR 164.501, a communication made to describe a health-related product or service provided by the covered entity making the communication, or for treatment of an individual, is not marketing for HIPAA purposes unless the covered entity receives financial remuneration in exchange for making it, which the same section defines as payment from or on behalf of a third party. A practice inviting its own patients to a visit it provides fits that description. A message paid for by an outside company to promote that company’s product does not, and our HIPAA marketing rules guide covers what changes then.

Automated calls and texts are governed by 47 CFR 64.1200. Calls to cell phones using an automatic telephone dialing system or an artificial or prerecorded voice need prior express consent, and automated calls that include an advertisement need prior express written consent unless they deliver a health care message made by or on behalf of a HIPAA covered entity or its business associate. Whether a wellness visit invitation is a health care message depends on what it says, so settle that with counsel before you automate it. The condition-by-condition walk-through is in our appointment reminder texting guide.

If an outside company books wellness visits for you and is paid per visit booked, have a lawyer review the arrangement. The Anti-Kickback Statute at 42 U.S.C. 1320a-7b(b) makes it a felony to knowingly and willfully offer, pay, solicit or receive remuneration in return for referring an individual for, or arranging for or recommending, items or services paid for in whole or in part by a federal health care program.

Illustration: one invitation letter and one booking call

Illustration: a family practice sends a letter to patients whose last wellness visit was more than 12 months ago. It says the patient may be due for Medicare’s yearly wellness visit, a visit to update their prevention plan, review medications and update their screening checklist. It says Medicare Part B covers the visit with no cost to the patient when the practice accepts assignment, and that other tests or services during the same appointment may have costs. It asks the patient to bring their medication list and records, and offers the questionnaire on paper or through the practice’s secure form.

Illustration: when a patient calls to book, the scheduler confirms the date of the last wellness visit and asks whether they have had one elsewhere in the past 12 months. The patient mentions knee pain. The scheduler explains that the wellness visit is focused on prevention, that the knee may be handled as a separate visit or separately billed service with possible costs, and asks how the patient would like to schedule. Nothing in the letter or the call promises a diagnosis or describes the visit as a physical.

Checklist

• Invitations describe the visit as Medicare.gov does: a prevention planning visit, not a routine physical.
• New Medicare patients are invited to the Welcome to Medicare visit within their first 12 months of Part B, not the annual wellness visit.
• The invitation list is built from the Part B effective date and the date of the last wellness or Welcome to Medicare visit.
• Schedulers ask whether the patient had a wellness visit elsewhere in the past 12 months.
• Cost wording has both sentences: no cost when the practice accepts assignment, and other services during the same appointment may have costs.
• Patients with other Medicare coverage have their cost confirmed with the plan before a figure is quoted.
• The booking script asks about specific concerns and explains that they may be a separate, billed service.
• The pre-visit message lists what CMS suggests patients bring.
• An online health risk assessment runs on tools covered for protected health information, and a paper option exists.
• Cognitive, depression and substance use parts are described as reviews and assessments, with no promise of detection.
• Automated calls and texts have been checked against 47 CFR 64.1200 with counsel.
• Any outside company paid per booked visit has been reviewed by a lawyer.

For diabetes screening at or around the wellness visit, see our guide to prediabetes and diabetes screening outreach.

Bone density screening is one of the items to put on the written screening schedule. Our guide to osteoporosis screening outreach covers who the USPSTF recommends screening, the Medicare frequency rule and recall lists.

How we help

We build websites, local search, Google Ads and AI front desk tools for independent practices and health businesses. For a practice running wellness visit outreach, that means a website page that describes the visit and its costs the way Medicare.gov does, invitation letters and booking scripts that ask the eligibility and same-day questions, and inquiry flows that route scheduling and cost questions to the right person on your team. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. We do not sell lead lists and we do not pay for referrals. For the wider rules, see our healthcare marketing rules hub.

Sources

• 42 CFR 410.15: Annual wellness visits providing Personalized Prevention Plan Services
• 42 CFR 410.16: Initial preventive physical examination
• CMS: Annual Wellness Visit (page last modified April 9, 2026)
• Medicare.gov: Yearly Wellness visits
• Medicare.gov: Welcome to Medicare preventive visit
• 45 CFR 164.501: Definitions
• 47 CFR 64.1200: Delivery restrictions
• 42 U.S.C. 1320a-7b: Criminal penalties for acts involving Federal health care programs
• 15 U.S.C. 45: Unfair methods of competition and unfair or deceptive acts or practices
• 15 U.S.C. 52: Dissemination of false advertisements
• FTC Policy Statement on Deception
• FTC Policy Statement Regarding Advertising Substantiation

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