annual wellness visit lab tests

Medicare Wellness Visits Back to MLN Print November 2023 Updates

What’s Changed?

• Added information about monthly chronic pain management and treatment services
• Added information about checking for cognitive impairment during annual wellness visits
• Added information about Social Determinants of Health Risk Assessments as an optional element of annual wellness visits

Quick Start

The Annual Wellness Visits video helps you understand these exams, as well as their purpose and claim submission requirements.

Medicare Physical Exam Coverage

Initial Preventive Physical Exam (IPPE)

Review of medical and social health history and preventive services education.

✔ New Medicare patients within 12 months of starting Part B coverage

✔ Patients pay nothing (if provider accepts assignment)

Annual Wellness Visit (AWV)

Visit to develop or update a personalized prevention plan and perform a health risk assessment.

✔ Covered once every 12 months

Routine Physical Exam

Exam performed without relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury.

✘ Medicare doesn’t cover a routine physical

✘ Patients pay 100% out-of-pocket

Together we can advance health equity and help eliminate health disparities for all minority and underserved groups. Find resources and more from the CMS Office of Minority Health :

• Health Equity Technical Assistance Program
• Disparities Impact Statement

Communication Avoids Confusion

As a health care provider, you may recommend that patients get services more often than we cover or that we don’t cover. If this happens, help patients understand they may have to pay some or all costs. Communication is key to ensuring patients understand why you’re recommending certain services and whether we cover them.

Initial Preventive Physical Exam

The initial preventive physical exam (IPPE), also known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE per lifetime if it’s provided within the first 12 months after the patient’s Part B coverage starts.

1. Review the patient’s medical and social history

At a minimum, collect this information:

• Past medical and surgical history (illnesses, hospital stays, operations, allergies, injuries, and treatments)
• Current medications, supplements, and other substances the person may be using
• Family history (review the patient’s family and medical events, including hereditary conditions that place them at increased risk)
• Physical activities
• Social activities and engagement
• Alcohol, tobacco, and illegal drug use history

Learn information about Medicare’s substance use disorder (SUD) services coverage .

2. Review the patient’s potential depression risk factors

Depression risk factors include:

• Current or past experiences with depression
• Other mood disorders

Select from various standardized screening tools designed for this purpose and recognized by national professional medical organizations. APA’s Depression Assessment Instruments has more information.

3. Review the patient’s functional ability and safety level

Use direct patient observation, appropriate screening questions, or standardized questionnaires recognized by national professional medical organizations to review, at a minimum, the patient’s:

• Ability to perform activities of daily living (ADLs)
• Hearing impairment
• Home and community safety, including driving when appropriate

Medicare offers cognitive assessment and care plan services for patients who show signs of impairment.

• Height, weight, body mass index (BMI) (or waist circumference, if appropriate), blood pressure, balance, and gait
• Visual acuity screen
• Other factors deemed appropriate based on medical and social history and current clinical standards

5. End-of-life planning, upon patient agreement

End-of-life planning is verbal or written information you (their physician or practitioner) can offer the patient about:

• Their ability to prepare an advance directive in case an injury or illness prevents them from making their own health care decisions
• If you agree to follow their advance directive
• This includes psychiatric advance directives

6. Review current opioid prescriptions

For a patient with a current opioid prescription:

• Review any potential opioid use disorder (OUD) risk factors
• Evaluate their pain severity and current treatment plan
• Provide information about non-opiod treatment options
• Refer to a specialist, as appropriate

The HHS Pain Management Best Practices Inter-Agency Task Force Report has more information. Medicare now covers monthly chronic pain management and treatment services .

7. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them to treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

8. Educate, counsel, and refer based on previous components

Based on the results of the review and evaluation services from the previous components, provide the patient with appropriate education, counseling, and referrals.

9. Educate, counsel, and refer for other preventive services

Include a brief written plan, like a checklist, for the patient to get:

• A once-in-a-lifetime screening electrocardiogram (ECG), as appropriate
• Appropriate screenings and other covered preventive services

Use these HCPCS codes to file IPPE and ECG screening claims:

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment

Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv

* Section 60.2 of the Medicare Claims Processing Manual, Chapter 9 has more information on how to bill HCPCS code G0468.

Report a diagnosis code when submitting IPPE claims. We don’t require you to use a specific IPPE diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an IPPE when performed by a:

• Physician (doctor of medicine or osteopathy)
• Qualified non-physician practitioner (physician assistant, nurse practitioner, or certified clinical nurse specialist)

When you provide an IPPE and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

CPT only copyright 2022 American Medical Association. All rights reserved.

IPPE Resources

• 42 CFR 410.16
• Section 30.6.1.1 of the Medicare Claims Processing Manual, Chapter 12
• Section 80 of the Medicare Claims Processing Manual, Chapter 18
• U.S. Preventive Services Task Force Recommendations

No. The IPPE isn’t a routine physical that some patients may get periodically from their physician or other qualified non-physician practitioner (NPP). The IPPE is an introduction to Medicare and covered benefits, and it focuses on health promotion, disease prevention, and detection to help patients stay well. We encourage providers to inform patients about the AWV during their IPPE. The Social Security Act explicitly prohibits Medicare coverage of routine physical exams.

No. The IPPE and AWV don’t include clinical lab tests, but you may make appropriate referrals for these tests as part of the IPPE or AWV.

No. We waive the coinsurance, copayment, and Part B deductible for the IPPE (HCPCS code G0402). Neither is waived for the screening electrocardiogram (ECG) (HCPCS codes G0403, G0404, or G0405).

A patient who hasn’t had an IPPE and whose Part B enrollment began in 2023 can get an IPPE in 2024 if it’s within 12 months of the patient’s Part B enrollment effective date.

We suggest providers check with their MAC for available options to verify patient eligibility. If you have questions, find your MAC’s website .

Annual Wellness Visit Health Risk Assessment

The annual wellness visit (AWV) includes a health risk assessment (HRA). View the HRA minimum elements summary below. A Framework for Patient-Centered Health Risk Assessments has more information, including a sample HRA.

Perform an HRA

• You or the patient can update the HRA before or during the AWV
• Consider the best way to communicate with underserved populations, people who speak different languages, people with varying health literacy, and people with disabilities
• Demographic data
• Health status self-assessment
• Psychosocial risks, including, but not limited to, depression, life satisfaction, stress, anger, loneliness or social isolation, pain, suicidality, and fatigue
• Behavioral risks, including, but not limited to, tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety (for example, seat belt use), and home safety
• Activities of daily living (ADLs), including dressing, feeding, toileting, and grooming; physical ambulation, including balance or fall risks and bathing; and instrumental ADLs (IADLs), including using the phone, housekeeping, laundry, transportation, shopping, managing medications, and handling finances

1. Establish the patient’s medical and family history

At a minimum, document:

• Medical events of the patient’s parents, siblings, and children, including hereditary conditions that place them at increased risk
• Use of, or exposure to, medications, supplements, and other substances the person may be using

2. Establish a current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including behavioral health care.

• Height, weight, body mass index (BMI) (or waist circumference, if appropriate), and blood pressure
• Other routine measurements deemed appropriate based on medical and family history

4. Detect any cognitive impairments the patient may have

Check for cognitive impairment as part of the first AWV.

Assess cognitive function by direct observation or reported observations from the patient, family, friends, caregivers, and others. Consider using brief cognitive tests, health disparities, chronic conditions, and other factors that contribute to increased cognitive impairment risk. Alzheimer’s and Related Dementia Resources for Professionals has more information.

5. Review the patient’s potential depression risk factors

6. Review the patient’s functional ability and level of safety

• Ability to perform ADLs

7. Establish an appropriate patient written screening schedule

Base the written screening schedule on the:

• Checklist for the next 5–10 years
• United States Preventive Services Task Force and Advisory Committee on Immunization Practices (ACIP) recommendations
• Patient’s HRA, health status and screening history, and age-appropriate preventive services we cover

8. Establish the patient’s list of risk factors and conditions

• A recommendation for primary, secondary, or tertiary interventions or report whether they’re underway
• Mental health conditions, including depression, substance use disorders , suicidality, and cognitive impairments
• IPPE risk factors or identified conditions
• Treatment options and associated risks and benefits

9. Provide personalized patient health advice and appropriate referrals to health education or preventive counseling services or programs

Include referrals to educational and counseling services or programs aimed at:

• Fall prevention
• Physical activity
• Tobacco-use cessation
• Social engagement
• Weight loss

10. Provide advance care planning (ACP) services at the patient’s discretion

ACP is a discussion between you and the patient about:

• Preparing an advance directive in case an injury or illness prevents them from making their own health care decisions
• Future care decisions they might need or want to make
• How they can let others know about their care preferences
• Caregiver identification
• Advance directive elements, which may involve completing standard forms

Advance directive is a general term that refers to various documents, like a living will, instruction directive, health care proxy, psychiatric advance directive, or health care power of attorney. It’s a document that appoints an agent or records a person’s wishes about their medical treatment at a future time when the individual can’t communicate for themselves. The Advance Care Planning fact sheet has more information.

We don’t limit how many times the patient can revisit the ACP during the year, but cost sharing applies outside the AWV.

11. Review current opioid prescriptions

• Review any potential OUD risk factors
• Provide information about non-opioid treatment options

12. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them for treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

13. Social Determinants of Health (SDOH) Risk Assessment

Starting in 2024, Medicare includes an optional SDOH Risk Assessment as part of the AWV. This assessment must follow standardized, evidence-based practices and ensure communication aligns with the patient’s educational, developmental, and health literacy level, as well as being culturally and linguistically appropriate.

1. Review and update the HRA

2. Update the patient’s medical and family history

At a minimum, document updates to:

3. Update current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including those added because of the first AWV personalized prevention plan services (PPPS), and any behavioral health providers.

• Weight (or waist circumference, if appropriate) and blood pressure

5. Detect any cognitive impairments patients may have

Check for cognitive impairment as part of the subsequent AWV.

6. Update the patient’s written screening schedule

Base written screening schedule on the:

7. Update the patient’s list of risk factors and conditions

• Mental health conditions, including depression, substance use disorders , and cognitive impairments
• Risk factors or identified conditions

8. As necessary, provide and update patient PPPS, including personalized health advice and appropriate referrals to health education or preventive counseling services or programs

9. Provide advance care planning (ACP) services at the patient’s discretion

10. Review current opioid prescriptions

11. Screen for potential substance use disorders (SUDs)

12. Social Determinants of Health (SDOH) Risk Assessment

Preparing Eligible Patients for their AWV

Help eligible patients prepare for their AWV by encouraging them to bring this information to their appointment:

• Medical records, including immunization records
• Detailed family health history
• Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
• Full list of current providers and suppliers involved in their care, including community-based providers (for example, personal care, adult day care, and home-delivered meals), and behavioral health specialists

Use these HCPCS codes to file AWV claims:

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Report a diagnosis code when submitting AWV claims. We don’t require you to use a specific AWV diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an AWV if performed by a:

• Medical professional (including health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of medical professionals directly supervised by a physician

When you provide an AWV and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV, and G0439 is for subsequent AWVs. Don’t bill G0438 or G0439 within 12 months of a previous G0402 (IPPE) billing for the same patient. We deny these claims with messages indicating the patient reached the benefit maximum for the time period.

Medicare telehealth includes HCPCS codes G0438 and G0439.

ACP is the face-to-face conversation between a physician (or other qualified health care professional) and a patient to discuss their health care wishes and medical treatment preferences if they become unable to communicate or make decisions about their care. At the patient’s discretion, you can provide the ACP during the AWV.

Use these CPT codes to file ACP claims as an optional AWV element:

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

Report a diagnosis code when submitting an ACP claim as an optional AWV element. We don’t require you to use a specific ACP diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

We waive both the Part B ACP coinsurance and deductible when it’s:

• Provided on the same day as the covered AWV
• Provided by the same provider as the covered AWV
• Billed with modifier 33 (Preventive Service)
• Billed on the same claim as the AWV

We waive the ACP deductible and coinsurance once per year when billed with the AWV. If we deny the AWV billed with ACP for exceeding the once-per-year limit, we’ll apply the ACP deductible and coinsurance .

We apply the deductible and coinsurance when you deliver the ACP outside the covered AWV. There are no limits on the number of times you can report ACP for a certain patient in a certain period. When billing this service multiple times, document changes in the patient’s health status or wishes about their end-of-life care.

SDOH is important in assessing patient histories; in assessing patient risk; and in guiding medical decision making, prevention, diagnosis, care, and treatment. In the CY 2024 Medicare Physician Fee Schedule final rule , we added a new SDOH Risk Assessment as an optional, additional element of the AWV. At both yours and the patient’s discretion, you may conduct the SDOH Risk Assessment during the AWV.

Use this HCPCS code to file SDOH Risk Assessment claims as an optional AWV element:

Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes

Report a diagnosis code when submitting an SDOH Risk Assessment claim as an optional AWV element. We don’t require you to use a specific SDOH Risk Assessment diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

The implementation date for SDOH Risk Assessment claims is January 1, 2024. We waive both the Part B SDOH Risk Assessment coinsurance and deductible when it’s:

We waive the SDOH Risk Assessment deductible and coinsurance once per year when billed with the AWV.

If we deny the AWV billed with SDOH Risk Assessment for exceeding the once-per-year limit, we’ll apply the deductible and coinsurance. We also apply the deductible and coinsurance when you deliver the SDOH Risk Assessment outside the covered AWV.

AWV Resources

• 42 CFR 410.15
• Section 140 of the Medicare Claims Processing Manual, Chapter 18

No. The AWV isn’t a routine physical some patients may get periodically from their physician or other qualified NPP. We don’t cover routine physical exams.

No. We waive the coinsurance, copayment, and Part B deductible for the AWV.

We cover an AWV for all patients who’ve had Medicare coverage for longer than 12 months after their first Part B eligibility date and who didn’t have an IPPE or AWV within those past 12 months. We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient’s last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.

Generally, you may provide other medically necessary services on the same date as an AWV. The deductible and coinsurance or copayment applies for these other medically necessary and reasonable services.

You have different options for accessing AWV eligibility information depending on where you practice. Check eligibility to find when a patient is eligible for their next preventive service. Find your MAC’s website if you have specific patient eligibility questions.

Know the Differences

An IPPE is a review of a patient’s medical and social health history and includes education about other preventive services .

• We cover 1 IPPE per lifetime for patients within the first 12 months after their Part B benefits eligibility date
• We pay IPPE costs if the provider accepts assignment

An AWV is a review of a patient’s personalized prevention plan of services and includes a health risk assessment.

• We cover an annual AWV for patients who aren’t within the first 12 months after their Part B benefits eligibility date
• We cover an annual AWV 12 months after the last AWV’s (or IPPE’s) date of service
• We pay AWV costs if the provider accepts assignment

A routine physical is an exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury.

• We don’t cover routine physical exams, but the IPPE, AWV, or other Medicare benefits cover some routine physical elements
• Patients pay 100% out of pocket

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CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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7 blood tests to ask for at your annual physical + how to get them covered by insurance.

If you're remotely health-conscious, you probably get an annual physical during which your doctor asks how you've been feeling, does a brief exam, and occasionally (but not always) orders some blood work. Maybe she spouts off the names of a couple of lab tests she's ordering, like a CBC or CMP—but rarely does anyone explain what exactly these tests are looking for. So you get your blood drawn, get a call a few days later that things came back "normal," and you don't really think much about it until next year. 

And again, that's if your doctor calls for any blood work at all. I actually went from age 25 to 30 with zero labs from my general practitioner, even though I have a family history of heart disease and high cholesterol. 

On the other end of the spectrum, though, you know there are functional and integrative docs out there who tout all sorts of medical tests (from inflammatory markers to food sensitivities) that supposedly help spot problems early on and offer intel on how you might tweak your diet and lifestyle to optimize your health. But not everyone has access to this type of practitioner, and not all of these tests are covered by insurance. 

So then the question becomes: What's a happy medium between bare-bones and borderline excessive lab testing? If you're seriously proactive about optimizing your health and preventing issues, what are the key tests to consider getting done semi-regularly that pretty much any doctor can order and that will most likely be covered by insurance? 

It's important to note that everyone's health insurance coverage is different. This article will make a note of which tests are very likely, pretty likely, and less likely to be covered, but you can increase your chances of getting the tests you need (and getting them paid for) if you take the following steps before/during your next appointment: 

• Write down your family history of diseases and illnesses, which relative had them, and at what age. This could qualify you for certain medical tests you may not otherwise be qualified for. "If I have certain verbiage from you, I can get away with ordering more tests," says Bindiya Gandhi, M.D. , a family medicine physician trained in functional medicine. "If you have fatigue and a family history of hypothyroidism, by me adding that diagnostic code, I could probably run a more extensive thyroid panel."
• Keep a symptom journal, noting any changes to your health since your last visit, including new aches and pains, increased fatigue, hair loss, weight gain or loss, etc. 
• If you're seeing a new doctor, have all your recent lab work sent over. This will help them compare test results over time and determine what testing may be justified now.
• If there's ever a question, call your specific insurance company to confirm coverage. 

These are the medical tests most adults (particularly women) should consider getting annually.

Here, with guidance from top docs, is a rundown of the lab tests you may want to consider getting on an annual, or at least semi-regular basis. We start with some of the most basic tests that will almost definitely be covered by insurance, then dive into some that are often warranted based on common symptoms and/or if you have a family history. 

Complete Blood Count (CBC)

A complete blood count (CBC) is one of those basic tests that's often included as part of an annual checkup—or that will be if you ask for it. It measures different features of your blood, including red blood cells, white blood cells, platelets, hemoglobin, and hematocrit. 

"A CBC will find anemia, which is common among menstruating women, and it's also a screening test for immune system issues and different types of cancer—blood cancers that can happen in young people," says Chloe Godwin-Gorga, M.D. , an integrative primary care physician. "So if you get a wonky CBC, it's a reason to be more thoroughly evaluated. That's why it's a really good basic test." 

Who should get it? All adults.

Coverage: A CBC is very likely to be covered by insurance as part of your annual physical.

Comprehensive Metabolic Panel (CMP)

Another basic but goody is a comprehensive metabolic panel (CMP), which reveals information about your overall metabolism, including kidney and liver function and type 2 diabetes risk.

It typically includes a measure of your fasting blood glucose , which may not be the best test for predicting diabetes risk or blood sugar imbalances but gives you a general idea (pro tip: A fasting blood glucose of less than 100 mg/dL is considered "normal," but most functional docs would like to see that number at around 70 or 80 mg/dL, says Heinz). It also looks at electrolytes like sodium, calcium, and potassium, which can indicate whether you're dehydrated, and it's a screening test for your liver and kidney function.

Coverage: A CMP is very likely to be covered by insurance as part of your annual physical.

Hemoglobin A1C (HbA1C)

As mentioned above, a fasting blood glucose test (which is typically part of a CMP) isn't always the best indicator of blood sugar dysregulation. According to all of the doctors I spoke with, one of the best ways to get a heads-up about blood sugar issues, insulin resistance, and prediabetes before they manifest as serious health problems is with a hemoglobin A1C test 1 (HbA1C). 

An HbA1c test measures the percentage of red blood cells saturated with glucose. The higher your A1C, the higher the estimated average blood glucose. Your HbA1c number is generally considered to correlate to your average blood glucose over two to three months—not just a single day. In addition to diabetes, a high HbA1C marker may also increase your risk of Alzheimer's disease and cancer—potentially making the test a good predictor of overall longevity. 

"Interestingly, in young women, having a high HbA1c is also associated with having polycystic ovaries (or PCOS ), which can make it really hard to conceive," says Godwin-Gorga. "So if you're headed in that direction and your periods are a bit irregular, finding out that number can provide the motivation to make changes to your eating and exercise habits that benefit overall fertility and metabolism." Then, you can retest in three to six months to see if you've moved the needle. Ideally, you'll want your HbA1C to be 4 to 5.3, though lower is better.

Who should get it? Preferably all adults, particularly if you're overweight, at increased risk of diabetes, struggling with fertility or symptoms of PCOS , or over age 45.

Coverage: An HbA1C test is pretty likely to be covered by insurance, but check first.

Lipid Panel (ideally with particle size)

For a broad picture of heart health, you at least want a standard lipid panel , which is a measure of your HDL ("good") cholesterol, LDL ("bad") cholesterol, and triglycerides. But while this is certainly a good baseline test, especially if you have no heart disease risk factors, many functional and integrative doctors don't believe it goes far enough. That's because, even though high LDL cholesterol has consistently been linked to heart disease, there are still some people with normal or even low LDL levels 2 that develop heart disease—so there's more to the story.

Increasingly, integrative doctors, including Gandhi, Amy Shah, M.D. , and Kristann Heinz, M.D., R.D. , are calling for more advanced lipid panels, like those that include a breakdown of lipoprotein size (cholesterol particle size). Research suggests that looking at numbers of specific particles is more indicative of your risk than simply zeroing in on total or LDL cholesterol. Basically, you want your particles to be big and buoyant, not small and heavy, because then they tend to lodge in the walls of arteries more easily, which can increase your risk of heart attack and stroke.

If your insurance doesn't cover a more advanced lipid panel, you shouldn't stress—but you should look at the numbers on your standard lipid panel more closely. "One of the strongest predictors for preventing heart disease is having a good HDL-to-triglycerides ratio," says Steven Gundry, M.D. , cardiologist and functional primary care physician. "So your HDL should be higher than or equal to triglycerides." 

Who should get it? All adults, especially if you have a family history of heart disease or other risk factors.

Coverage: A standard lipid panel is very likely to be covered by insurance as part of your annual physical, while more advanced lipid testing may depend on your risk or family history.

Thyroid Panel (or at least a TSH test) 

Thyroid disorders are incredibly common , affecting one in 10 women, and about 60% of people with a thyroid problem are unaware of their condition—and thus, unable to manage it appropriately. Hypothyroidism (or low thyroid function), especially the common autoimmune type called Hashimoto's thyroiditis , is often missed as a hidden cause of fertility problems and pregnancy loss.

This is why nearly every doctor I spoke with recommended some degree of thyroid testing for women (at least a thyroid-stimulating hormone, or TSH, test), and a more comprehensive thyroid panel for women experiencing unexplainable weight gain or loss, chronic fatigue, cold intolerance, hair loss, forgetfulness, constipation, and feeling generally depressed. For these women, Godwin-Gorga likes to run a panel of five tests: TSH, free T4, free T3, reverse T3, and two types of thyroid antibody levels called anti-TPO and anti-thyroglobulin.

TSH alone can miss many cases of Hashimoto's. That's because thyroid function is very erratic (or up and down) in the early stages of this condition—so TSH levels may actually be normal at the time of your test, even if thyroid function is compromised. A more comprehensive panel can spot issues early while they can still be addressed with lifestyle changes.

Who should get it? Monitoring your TSH levels over time is a good idea for most women, and a more extensive thyroid panel may be warranted for women with the symptoms above and/or a family history. 

Coverage: Thyroid testing is often covered by insurance if you're experiencing symptoms like fatigue. In some cases, you may need to start with a TSH test first and go from there. 

Another go-to test among functional docs, particularly if you're experiencing fatigue, is a 25-hydroxy vitamin D blood test. "The majority of my patients are actually vitamin D deficient 3 ; that's why it's part of my standard panel of tests," says Gandhi. This can occur for a number of reasons. "Geographically, many of us aren't exposed to enough sun year-round, some people have a genetic mutation so they can't synthesize vitamin D from sunlight, and we're also taught to wear sunscreen." 

Shah echoes this sentiment: "I check vitamin D levels on almost every woman," she says, adding that this vitamin and hormone-precursor plays a key role in immune function and mood. Deficiencies in vitamin D can also be a factor in autoimmune disease and certain cancers.

When it comes to vitamin D levels, keep in mind that a "normal" test result, which is anywhere from 30 to 80 ng/mL, does not necessarily indicate "optimal"—ideally, you want it above 50 ng/mL, says Gandhi. If you're below that, supplementation will likely be necessary.

Who should get it? Most adults, particularly women and those experiencing fatigue and poor mood.

Coverage: Vitamin D testing is typically covered if you're experiencing symptoms.

Anemia Panel (or iron, ferritin, folate, and vitamin B12)

So far, this piece has referenced fatigue and low energy a lot—because, unfortunately, these are pretty common symptoms among U.S. adults, especially women. In addition to thyroid issues and low vitamin D, another potential cause of waning energy levels is low levels of a few key nutrients: iron, ferritin (the stored form of iron), folate, and vitamin B12. Your doctor can test for these separately or all at once on an anemia panel, says Godwin-Gorga.

Low vitamin B12 is common among vegetarians and vegans but can also exist among omnivores due to nutrient malabsorption issues caused by antibiotic overuse, or celiac or Crohn's disease. Folate plays a crucial role in healthy pregnancy and preventing birth defects but often is not screened. And pretty much any menstruating woman has the potential to be low in iron. So, this combo of tests can be pretty revealing—and low levels can be easily remedied. 

"Iron is an interesting one," says Godwin-Gorga. "It affects your thyroid, and if your iron is low, it can present as hypothyroidism. It's so common for women to feel normal once we replenish their iron." And interestingly, even if you're not anemic (which can be tested for with a CBC), you can still be iron deficient—which is why testing for iron and ferritin separately is important. 

Who should get it? People experiencing fatigue, particularly if you're a menstruating woman, or if you follow a plant-based diet. 

Coverage: Pretty much everyone with a period who's experiencing fatigue can get an anemia panel covered by insurance, says Godwin-Gorga. 

After your labs are completed.

One of the biggest issues with medical testing—even if you do manage to get some good tests ordered by your primary care physician—is that you may not know what to do with the results. "I think one of the big lapses in primary care right now is that no doctor is really giving you good feedback on what the numbers mean," says Godwin-Gorga. "It takes them getting abnormal before anyone even says something to you. But there's a lot of room to say, 'Hey, this is not optimal ; let’s talk about that.'"

So, what's the solution?

• First, schedule a call or follow-up appointment to discuss your labs and what they mean. Often doctors won't explain your results in detail (especially if they're "normal") because they simply don't have time. If you want guidance on whether your TSH test result, which was on the high end of normal, is actually optimal for someone like you, ask them. If you do your homework and ask targeted questions, you're more likely to get some opinions, says Godwin-Gorga.
• If you're not getting the guidance you need, consider getting a second opinion from a functional or integrative doc. "If you feel like your doctor's not being responsive to you, then always seek another set of eyes," says Godwin-Gorga. "I have people bring me their labs from other doctors all the time, and I'll say, here's what I think they mean, and here are some other tests I'd consider adding." Heinz echoes this sentiment: "Taking your bloodwork to someone who feels comfortable looking at your results in terms of optimal ranges versus standard/normal ranges can give you a world of information about how to start making changes," she says. Of course, not all functional/integrative doctors take insurance, but since you already have your bloodwork done, an office visit or a virtual visit probably won't break the bank.

Bottom line: Getting the right tests (for you) can be empowering.

In most cases, you don't need to run a bazillion tests to get a good picture of your health and what you can do to optimize it. Start by doing your homework. Write down any ongoing or new symptoms and a complete family history—then, ask your doctor what tests they think you should get based on this, and have a discussion about some of the specific tests mentioned above if you feel they may be warranted. Also remember, how your labs are interpreted is just as important as getting them done in the first place—and if you want more guidance on what you should do based on your results (in terms of lifestyle changes or further testing), probe your doctor for more details or get a second opinion. And remember, always call your insurance company to ask about coverage! 

*Keep in mind: This article does not cover every single medical test or screening that you may need. Always consult with your doctor—getting second opinions when necessary—to come up with the testing regimen that's best suited for you.

• https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597070/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/

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Your Medicare annual wellness visit: Preventive care, health planning at no extra cost

Most of us know that it’s important to see a doctor for an annual checkup. During your working years, that annual checkup typically means a full physical. But once you become eligible for Medicare, you’ll likely start hearing about something called an  annual wellness visit .

Unlike a standard head-to-toe physical, an annual wellness visit is primarily focused on preventive care, health screenings and wellness planning. It gives you an opportunity to have a conversation with your doctor about your health status and goals – then create a long-term plan to help you meet those goals and maximize your well-being.

While Original Medicare doesn’t cover an annual physical, some Medicare Advantage plans do. However, everyone enrolled in Original Medicare or Medicare Advantage is eligible for an annual wellness visit at no additional cost.  If your Medicare Advantage plan includes coverage for an annual comprehensive physical exam, ask your provider if the annual wellness visit and the physical can be scheduled during the same visit.

Below you’ll find an overview of what to expect from your annual wellness visit – and hopefully the motivation to schedule one.

Taking stock of your medical history

Your primary care provider , whether in person or virtually , will review your relevant medical history, including major illnesses, surgeries, plus any current medical conditions and medications you’re taking.

Your doctor’s office may send you a form ahead of your appointment that includes a list of questions. 

To-do : Fill out this form in advance to help ensure your doctor has a thorough understanding of your health history. It may also remind you of questions you might want to raise at the appointment.

If you don’t get a form before your visit, you should still be prepared to be as detailed as possible when describing any past medical procedures and illnesses. Knowing specific diagnoses and dates will certainly help, but even giving a rough description of any major medical events in your life will help your physician understand both your past and current medical issues.

The who’s who of your health care team

Keeping you healthy is a group effort, and the primary care provider you see for your wellness visit will want to know who’s part of your health care team. He or she may also want to work closely with other health care professionals involved in your care.

To-do : Be prepared to give the person conducting your visit a list of your current health care providers, including contact information and fields of specialty.

If you see several specialists to help you manage chronic conditions or haven’t seen some of your doctors in the past year, it can be easy to forget their names. That’s why it’s a good idea to create a list of your doctors and bring it with you to your wellness visit.

You may have chosen a health care surrogate or a proxy who will speak on your behalf should you ever become too sick to speak for yourself. If so, bring a copy of your completed forms to your appointment. If you haven’t made your choices yet, this is a good time to get your physician’s advice on your personal advance care planning .

An Rx for a productive medication review

Getting a full rundown of all your vitamins, minerals, herbal supplements and prescription medications can help the doctor spot potential drug interactions that could be harmful to your health. He or she will also want to ensure you have a complete understanding   of each medication, its purpose and any potential side effects.

To-do: Make a list, including how often you take each medication and the dosage. Or, bring all your pill bottles with you to your appointment and show them to the provider.

Stats and screenings

A clinician will check your height, weight and blood pressure, and then your provider will likely ask you some questions, including how you have been feeling recently. These questions are designed to test your cognitive function and screen you for depression. Answer them as honestly as possible and come to the appointment well-rested so you can perform your best on the tests.

Creating a wellness plan

After completing all tests and assessments, your provider will be ready to assess your current health status and work with you to develop a plan to meet your health goals. That plan will address how to treat your current conditions and how to help prevent future health problems. If you have any risk factors for developing new conditions, your provider will give you some options for managing those risks.

You can also set up a schedule for preventive care or screening tests and discuss treatment options for any newly diagnosed conditions.

To-do : Be prepared to get the most out of this planning by developing a list of questions you would like to ask at the appointment. And don’t be shy with your questions. During the annual wellness visit, your provider may have more time than usual to listen to your concerns and answer your questions.

It’s also important to be honest about your health goals. Not everyone sets out to exercise daily or lose 10 pounds in the next year – and that’s OK. Maybe your goal is to ride a bike with your grandkids around the neighborhood or to cut back on your alcohol consumption. Whatever your health goals are, your provider can’t help you reach them if he or she doesn’t know about them. So be as open and honest as possible during your visit.

Things to keep in mind

To avoid surprises, pay attention to these details as you get your visit on the calendar:

• Make sure the appointment is scheduled specifically as an annual wellness visit, or the provider may bill it as a normal office visit, which could be subject to a copay, depending on your plan. If you’re a UnitedHealthcare member, our dedicated customer service advocates can even help schedule your appointment for you.
• If your provider orders a test during the annual wellness visit, you may be charged any applicable lab or diagnostic copay for the recommended services.

When you are prepared, your annual wellness visit is more than just an office visit. It is your opportunity to take charge of your health and help ensure you’re on the right path to living the life you want. If you haven’t scheduled yours yet, use this as the push you need to get it on your calendar. It could be one of the most important conversations you have all year.

To learn more about how your how your UnitedHealthcare Medicare plan can help you access the care you need, visit UHCMedicareHealthPlans.com .

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Yearly "Wellness" visits

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.

Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.

Your costs in Original Medicare

You pay nothing for this visit if your doctor or other health care provider accepts assignment .

The Part B deductible  doesn’t apply. 

However, you may have to pay coinsurance , and the Part B deductible may apply if your doctor or other health care provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit.

If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Your health care provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your doctor develop or update a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include:

• Routine measurements (like height, weight, and blood pressure).
• A review of your medical and family history.
• A review of your current prescriptions.
• Personalized health advice.
• Advance care planning .
• A screening schedule (like a checklist) for appropriate preventive services.
• An optional “ Social Determinants of Health Risk Assessment ” to help your provider understand your social needs and their impact on your treatment.  

Your health care provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your health care provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium and design a care plan.

If you have a current prescription for opioids, your doctor or other health care provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your doctor or other health care provider will also review your potential risk factors for substance use disorder, like alcohol and tobacco use , and refer you for treatment, if needed. 

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The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical. Also, this service is similar to but separate from the one-time Welcome to Medicare preventive visit .

Eligibility

Medicare Part B covers the Annual Wellness Visit if:

• You have had Part B for over 12 months
• And, you have not received an AWV in the past 12 months

Additionally, you cannot receive your AWV within the same year as your Welcome to Medicare preventive visit.

Covered services

During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:

• Check your height, weight, blood pressure, and other routine measurements
• This may include a questionnaire that you complete before or during the visit. The questionnaire asks about your health status, injury risks, behavioral risks, and urgent health needs.
• This includes screening for hearing impairments and your risk of falling.
• Your doctor must also assess your ability to perform activities of daily living (such as bathing and dressing), and your level of safety at home.
• Learn about your medical and family history
• Medications include prescription medications, as well as vitamins and supplements you may take
• Your PCP should keep in mind your health status, screening history, and eligibility for age-appropriate, Medicare-covered preventive services
• Medicare does not require that doctors use a test to screen you. Instead, doctors are asked to rely on their observations and/or on reports by you and others.
• Screen for depression
• Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.

AWVs after your first visit may be different. At subsequent AWVs, your doctor should:

• Check your weight and blood pressure
• Update the health risk assessment you completed
• Update your medical and family history
• Update your list of current medical providers and suppliers
• Update your written screening schedule
• Screen for cognitive issues
• Provide health advice and referrals to health education and/or preventive counseling services

If you qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider . This means you pay nothing (no deductible or coinsurance ). Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.

During the course of your AWV, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.

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Staying healthy as you age: Medicare Annual Wellness Visits explained

• Family Medicine

Getting older has many advantages. You have the wisdom that comes with experience, plenty of stories to share and are usually more comfortable with who you are. If you have Medicare Part B coverage, another benefit is that you qualify for an Annual Wellness Visit.

This visit aims to keep you healthy and give you the tools to have a good quality of life as you age. The Medicare Annual Wellness Visit allows your health care team to review your health status, design a personalized prevention plan and connect you with critical preventive services covered by Medicare Part B.

Medicare Annual Wellness Visits create a snapshot of your health and provide a reference point for future visits. This improves the chances that a potentially serious health issue is caught early.

It's important to understand that Medicare Annual Wellness Visits differ from a physical exam conducted by your primary care provider.

Here are three major differences between these types of appointments:

1. provider seen.

A nurse or nurse practitioner typically conducts a Medicare Annual Wellness Visit. In most cases, you will not see your primary doctor or health care provider during this appointment.

A physical exam is conducted by your primary care provider, who may be a doctor, nurse practitioner or physician assistant.

2. What's included

A Medicare Annual Wellness Visit is meant to enhance your health and focuses on your well-being through interviews and assessments of your lifestyle factors. You will also be asked to fill out a health risk assessment before your appointment.

During a Medicare Annual Wellness Visit, the nurse will:

• Evaluate your fall risk.
• Measure your height, weight and blood pressure.
• Offer referrals to other health education or preventive services.
• Provide information related to voluntary advance care planning.
• Screen for cognitive impairments like dementia.
• Screen for depression.
• Update your medical and family history.

A physical exam includes an age and gender-appropriate comprehensive head-to-toe checkup. This exam is completed to detect and prevent illnesses or injuries.

During a physical exam, your primary care provider may:

• Check your vital signs.
• Discuss acute or urgent health issues.
• Review chronic health conditions.
• Review your medications.
• Perform a physical exam.
• Ask about your activity level, relationships and home environment.

3. Frequency and cost

A Medicare Annual Wellness Visit can be scheduled after you have Medicare Part B coverage for at least 12 months and each year after that. Subsequent visits must be at least 365 days, or one full year, after your previous year's visit. Medicare offers the Annual Wellness Visit at no cost for those who have Medicare Part B coverage.

A physical exam can be scheduled at any time. You or your insurance carrier will be responsible for the cost of this exam. The total will vary based on what tests and services are completed during the visit. Ask your insurance carrier for coverage details.

Medicare Annual Wellness Visits and physical exams are best scheduled for the same day, with the wellness visit occurring first. Contact your health care team and ask if you qualify for a Medicare Annual Wellness Visit.

Robert Stroebel, M.D. , is a Community Internal Medicine, Geriatric and Palliative Care physician at Mayo Clinic Primary Care in Rochester and Kasson, Minnesota.

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What to Expect at Your Annual Wellness Visit

Once a year, you make an appointment with your primary care physician to make sure your health is in good working order and detect potential concerns early, before symptoms are noticeable.

To schedule your annual wellness or follow-up office visit with a provider in Primary Care, please visit here or login to Connect .

Most insurance plans cover your annual wellness exam — no copay required. However, you may find the actual components of a wellness visit a bit confusing.

Review the FAQs below to learn what to expect during your next annual wellness visit.

Frequently Asked Questions

What is included in a wellness visit.

Your annual wellness visit includes the following:

• A review of your medical and surgical history
• Screenings - we generally follow screening recommendations of the USPSTF
• Blood tests
• Immunizations - we follow the vaccine schedules published by the CDC
• A physical exam
• Counseling to prevent future health problems 

How should I prepare for my visit?

Please check in via Connect up to 5 days before your visit to make sure we have your most up-to-date information, including your medications, medical history and insurance. You will be able to update these, along with your preferred pharmacy. You can also review and update your responses to your health questionnaire.

Please fast for at least 4 hours prior to your visit. You may drink water or black coffee, and take your maintenance medications.  Pediatric and Gynecology patients should not fast.

On the day of your appointment, please arrive on time and bring your insurance card and ID.

What if I need to ask my doctor about a specific medical issue?

Specific issues are considered part of a follow-up or “sick” visit. These aspects of your visit will be billed to your insurance, and you may be responsible for copayments, coinsurance or deductible payments, based on the terms of your policy.

If you would like to address non-routine concerns during your wellness visit, you can let your doctor know about these issues when you schedule your appointment. Depending on their complexity, the questions may need to be dealt with at a later time.

What does a follow-up or “sick” visit include?

• Treatment of a chronic condition such as diabetes, asthma or high blood pressure
• Any new problems or complaints
• Your need for new medications or tests
• Referrals to a specialist
• Additional treatment options

What is a Medicare annual wellness visit and what does it include?

The Medicare annual wellness visit, covered by Medicare, allows your health-care provider to conduct a health risk assessment and propose screenings and prevention strategies. As well, your provider will make sure all your immunizations, cancer screenings and other screenings are discussed and scheduled.

Your Medicare wellness visit does not include a detailed physical exam or management of chronic or new medical problems . Your physician may be able to perform a complete physical and address new or existing medical issues during your Medicare annual wellness visit, but you could incur additional charges.

What to expect during your Medicare annual wellness visit

At your Medicare annual wellness visit, your health care provider will:

• Review your blood pressure, heart rate, height, weight and body mass index (BMI).
• Review your current health problems, as well as your medical, surgical, family and social histories.
• Review your current medications.
• Conduct a health risk assessment.
• Provide nutrition counseling.
• Discuss an exercise plan to fit your lifestyle.
• Discuss smoking cessation and arrange for counseling, if needed.
• Discuss fall prevention.
• Discuss advance care planning.
• Discuss preventive screenings recommended by evidence-based practice guidelines that are indicated for you based upon your age, risk factors and family history

How to prepare for your Medicare wellness visit

Bring these items to your visit:

• Immunization records
• A list of current prescribed medicines, supplements and over-the-counter medications
• A list of your patient care team—any specialists you see for various types of care
• Be prepared to review your family medical history.

Can I combine a Medicare or non-Medicare wellness visit with a follow up visit?

Combining a wellness visit with a follow-up office visit will save you time by eliminating an extra appointment, but doing so may affect your costs. Additional concerns beyond a wellness visit may be billed to your insurance, which can  result in unplanned out-of-pocket costs to you. For these reasons, Weill Cornell Primary Care recommends that you schedule your annual wellness visit and any follow-up or sick office visits separately.

What are the most important points I need to keep in mind?

• Review your insurance plan’s summary of benefits before your appointment to understand what your insurance company will or will not cover.
• When scheduling a wellness visit, clearly state that you would like to make an appointment for your annual wellness or preventive care exam. That will help the practice prepare for your visit and bill your insurance company appropriately.
• When you speak with your doctor or other practitioner, let them know you are there for a wellness exam. Or, if you need to discuss a specific concern that may require treatment, make sure to bring their attention to any non-routine concerns at the start of your appointment.

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What blood tests should I get at my annual physical, and what do they mean?

In most instances, an annual exam is usually uneventful. Your doctor will ask how you’re feeling, perform a brief exam and may order some blood work. The results are posted in your electronic health records a few days later, or you may get a phone call to inform you that everything is normal. Many patients don’t give it another thought until the next physical rolls around.

But should you be paying more attention to the results of these tests?  And what blood tests should you be getting? There are some basic tests that most doctors will order annually or semiannually. Other more specialized tests depend on your family history, personal medical history and current health.

“That’s why it’s so important to have a relationship with a primary care provider,” says nurse practitioner Thomas Strawmier, APRN-NP .

“A provider that you see on a regular basis is going to have a good read on you and will be able to be more proactive in helping you stay healthy and preventing future health issues.”

Either way, it’s important to have a good conversation with your primary care provider about any new symptoms or health issues you’ve been having, in addition to any new insights about your family history. “These conversations will help your provider determine if there are tests above and beyond the basics that should be ordered,” notes Strawmier.

The following is a rundown of common lab tests your provider may order or tests you may want to request annually or at least every few years. 

Complete blood count (CBC)

A complete blood count is a standard blood test done at your annual physical that provides a picture of your blood. This includes a breakdown of your red blood cells, white blood cells, platelets, hemoglobin and hematocrit. High or low levels can provide insight into whether you are having issues with your bone marrow, immune system or if you’ve been affected by a virus or other environmental issues, says Strawmier.

Comprehensive metabolic panel (CMP)

This test reveals information about how your liver and kidneys are functioning and details about your electrolytes, potassium, sodium and calcium, which are indicators of whether you are dehydrated. It includes fasting blood glucose, which can be an indicator for predicting diabetes risk or blood sugar imbalances.

Hemoglobin A1C (HbA1C)

This is one of the best tests for getting information about blood sugar issues, insulin resistance and prediabetes. The higher your A1C, the higher the estimated blood glucose. An elevated A1C may indicate your body is not producing enough insulin (or your insulin isn’t working effectively) to move the glucose from the blood into your cells, a sign of prediabetes or diabetes.

Standard lipid panel

This measures your HDL (good) cholesterol, LDL (bad) cholesterol and triglycerides. A baseline should be done between the ages of 35 and 40 unless you have a family history of obesity or heart disease. Optimal levels include total cholesterol under 200, triglycerides under 150, an HDL of 39 to 60 and an LDL of 130 or below.

“A high LDL level increases your risk for heart disease,” says Strawmier. “If your HDL is elevated, you and your provider should discuss lifestyle changes to reduce your level and help prevent future heart disease.”

An advanced lipid panel is a test that might be considered for someone with an elevated cholesterol level or a genetic cholesterol issue.

Thyroid test

Your provider may want to order this test if you have high blood pressure or have complained of tiredness, lack of energy, focus or heart palpitations. Thyroid issues are fairly common, affecting 1 in 10 women. “This is a test I usually don’t order unless a patient complains of some of these symptoms or has a family history of thyroid disease,” says Strawmier.

Prostate screening (PSA)

A prostate-specific antigen test is recommended for all men by age 50 to check PSA levels. PSA is a protein made by the prostate gland. An elevated PSA may indicate prostate cancer, benign prostatic hyperplasia or BPH, or inflammation of the prostate.

 “If you are taking a vitamin D supplement, you probably don’t need your calcium levels checked,” says Strawmier. “This is not a common test I would order unless there are indications for it, such as chronic fatigue or depression.”

Individuals with long-term problems like rheumatoid arthritis should have their levels monitored because low vitamin D can reduce the effectiveness of treatment, he says.  

Anemia panel

This is a test you may want to consider if you have chronic fatigue, lack of energy, heavy menstrual cycles, or if you have had any stomach issues such as gastric bypass or absorption difficulties, notes Strawmier.

An anemia panel tests for key nutrients such as iron, ferritin, folate and vitamin B12. Low vitamin B12 is more common among vegans and vegetarians. People with malabsorption issues due to antibiotic overuse, celiac or Crohn’s disease may also have low B12 levels. Folate is important in women who are pregnant or trying to conceive as it helps protect against congenital disabilities. Menstruating women, especially those with heavy periods, may be at risk for low iron levels. It’s also interesting to note that you can still have low iron levels even if you're not anemic.

After your labs are completed

When your labs come back, your provider will review them and look for potential issues. If they see a red flag, an additional test may be needed. If there are no issues, you may receive a phone call from your provider’s office, or the lab results will be posted in your One|Chart Patient portal with corresponding notes for you to review at your convenience.

Before you leave your annual physical, it is important to discuss with your provider how you would like to do a follow up on your labs. This might include a phone call from office staff, a telehealth visit or posting them to your electronic records.

“Maintaining a regular primary care provider, staying current on your annual physicals and having an open and honest relationship with your provider will go a long way in helping you stay healthy and be proactive in your health,” says Strawmier. 

Need a primary care provider? Use the online scheduling tool or call 800.922.0000 to schedule an appointment with a primary care provider that fits your needs and is close to home.

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PAUL F. SWENSON, MD, El Rio Community Health Center, Tucson, Arizona

MARK H. EBELL, MD, MS, University of Georgia College of Public Health, Athens, Georgia

Am Fam Physician. 2016;93(9):738-740

An updated version of the adult preventive health care schedule is available.

The U.S. Preventive Services Task Force (USPSTF) is an independent voluntary panel of experts in primary care, prevention, and evidence-based practice. As of April 2016, the USPSTF has recommendation statements for more than 80 active topics, most of which are endorsed by the American Academy of Family Physicians. 1 Its process has been recognized by the Institute of Medicine as a model for development of evidence-based practice guidelines. 2

However, numerous barriers exist to implementing these guidelines, including knowledge, time, insurance, and social barriers. 3 For example, knowledge of USPSTF colorectal cancer screening components ranged from 22% to 53% in first- through third-year medical residents. 4 One recent survey from the Centers for Disease Control and Prevention (CDC) found significant gaps in physicians' knowledge regarding the value of screening tests for ovarian and colorectal cancer. 5 Another survey found significant levels of nonadherence to USPSTF recommendations, including beginning cervical cancer screening too early, continuing it too long, and performing it annually rather than every three years as recommended. 6

In addition, recommendations for behavioral counseling are often not implemented. For example, counseling for tobacco cessation was documented in only 21% of visits in which tobacco use was documented. 7 This gap between guideline recommendations and actual practice has the potential to worsen as recommendations become more complex, vary by age group, and increasingly require risk assessment, as with recommendations for mammography, breast cancer chemoprevention, screening for the BRCA gene mutation, and screening for hepatitis B and C virus infections.

With the passage of the Affordable Care Act in 2010, the USPSTF guidelines have taken on new significance. Specifically, grade A and B recommendations must be covered without cost-sharing requirements for patients in nongrandfathered insurance plans. 8 Currently, several resources are available to help physicians understand and implement recommendations:

Electronic Preventive Services Selector ( http://www.epss.ahrq.gov/PDA/index.jsp ): an electronic resource allowing physicians to input a patient's characteristics to find applicable USPSTF preventive health care recommendations.

USPSTF website ( http://www.uspreventiveservicestaskforce.org ): a web-based resource of all active and inactive recommendations, as well as those referring to another organization, such as the CDC.

Guide to Clinical Preventive Services, 2014 9 : an 85-page document (excluding appendices) providing summaries of USPSTF recommendations.

Although these resources are helpful, there has been no concise visual representation of USPSTF recommendations as there is for immunization recommendations ( http://www.cdc.gov/vaccines/schedules/hcp/adult.html#print ). The goals of such a schedule are the following:

Simplicity (excludes childhood and pregnancy-related topics)

Familiarity (such as a visual format similar to the CDC vaccine schedule)

Concise presentation

Informative

Easily disseminated

The Adult Preventive Health Care Schedule meets these criteria. Although it is not everything a family physician needs to know about screening and prevention, it provides a practical clinical aid. We hope this helps physicians bridge some of the knowledge gaps of USPSTF recommendations and apply them to their practice.

editor's note: The authors will periodically update the online version of this table and supporting documents throughout the year to make it as current a resource as possible. We plan to run an updated version of this table once a year, similar to the annual immunization schedules. In the online PDF, note that there are links in the main table's risk factors to mini-tables showing what those risk factors are.

Dr. Ebell is Deputy Editor for Evidence-Based Medicine for AFP , and a member of the USPSTF. This editorial and accompanying figure were produced independently of the USPSTF and do not necessarily represent the views and policies of the USPSTF.

Dr. Swenson developed the original version of the preventive schedule with coauthors Coya Lindberg, Cynthia Carillo, MD, and Joshua Clutter, MD, as a resident at the University of Arizona.

Address correspondence to Paul F. Swenson, MD, at [email protected] . Reprints are not available from the authors .

Author disclosure: No relevant financial affiliations.

U.S. Preventive Services Task Force. Published recommendations. http://www.uspreventiveservicestaskforce.org/BrowseRec/Index . Accessed January 30, 2016.

Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E, eds.; Committee on Standards for Developing Trustworthy Clinical Practice Guidelines; Institute of Medicine. Clinical Practice Guidelines We Can Trust . Washington, DC: National Academies Press; 2011

Yarnall KS, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention?. Am J Public Health. 2003;93(4):635-641.

Akerman S, Aronson SL, Cerulli MA, Akerman M, Sultan K. Resident knowledge of colorectal cancer screening assessed by web-based survey. J Clin Med Res. 2014;6(2):120-126.

Miller null, et al. Physicians' beliefs about effectiveness of cancer screening tests: a national survey of family physicians, general internists, and obstetrician-gynecologists. Prev Med. 2014;69:37-42.

Centers for Disease Control and Prevention (CDC). Cancer screening—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(3):41-45.

Jamal A, Dube SR, Malarcher AM, et al. Tobacco use screening and counseling during physician office visits among adults—National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005–2009. MMWR Morb Mortal Wkly Rep. 2012;61 suppl:38-45.

Centers for Medicare and Medicaid Services. Affordable Care Act implementation FAQs—set 12. https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.html . Accessed June 28, 2015.

U.S. Preventive Services Task Force. Information for health professionals. August 2014. http://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care . Accessed June 28, 2015.

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This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions  for copyright questions and/or permission requests.

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Medicare for Older Adults

The medicare annual wellness visit: what older adults should know.

Jul 28, 2022

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Kathleen Cameron

Senior Director of NCOA's Center for Healthy Aging

Ann Kayrish

Senior Program Manager, for Medicare

Key Takeaways

Introduced in 2011, the Medicare Annual Wellness Visit is a free benefit focused on health promotion and preventive care.

During your visit, you and your provider will create a personalized prevention plan that can help you avoid injury, illness, and disease.

The Medicare Annual Wellness Visit is 100% covered by Medicare Part B and can be scheduled once every 12 months.

Making the most of your Medicare coverage means understanding all the benefits and services available to you. One important benefit that many older adults don’t know about is the Medicare Annual Wellness Visit.

What is a Medicare Annual Wellness Visit?

Introduced in 2011 as part of the Affordable Care Act, the Medicare Annual Wellness Visit focuses on health promotion and preventive care . It allows you and your provider to create a personalized prevention plan that can help you stay healthy and avoid injury, illness, and disease. This visit is also an opportunity to address a range of issues that may be affecting your quality of life—such as depression , memory loss, and dementia .

The Annual Wellness Visit is only for preventive care and not for the diagnosis and treatment of an illness. If you want to discuss a specific health problem with your doctor, you’ll need to schedule a separate appointment.

Who can get a Medicare Annual Wellness Visit?

You can get an Annual Wellness Visit if you’ve been receiving Medicare Part B benefits for at least one year (12 months). Also, you must not have had an initial preventive physical exam (“Welcome to Medicare” exam) or a previous Wellness Visit within the past year.

When you call your provider’s office for an appointment, be sure to ask to schedule an “ Annual Wellness Visit ” by name. This will help ensure that Medicare covers the appointment as a preventive service.

Are Medicare Annual Wellness Visits free?

Medicare Annual Wellness Visits are 100% covered under Medicare Part B . This means that if you have Part B, you pay nothing if you go to a health care professional who accepts Medicare assignment. Assignment is an agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance. You won’t have to worry about out-of-pocket costs such as coinsurance and copayments , and the Part B deductible does not apply to this visit.

However, you can expect to pay a copayment or coinsurance and any unmet portion of your Part B deductible if:

• Your provider performs tests or services to treat an existing illness or health problem.
• You get any follow-up screenings or other preventive services recommended by your provider during your Wellness Visit.

How often can you have a Medicare Annual Wellness Visit?

Medicare covers one Wellness Visit per calendar year (12 months).

What happens during a Medicare Annual Wellness Visit?

During your visit, you will be asked to fill out a questionnaire called a Health Risk Assessment . Your responses will help your provider gain a better understanding of your current health and your risk factors. The appointment may also include:

• Recording of height, weight, body mass index (BMI), blood pressure, and other routine measurements
• Review of your medical and family history
• Review of your current health care providers and any prescriptions, vitamins, and/or supplements you’re taking
• Creation of a health screening schedule for the next 5-10 years based on your age, family history, and unique risk factors
• Review of functional ability (your ability to perform everyday tasks on your own) and safety (first visit only)
• Creation of a list of risk factors/conditions along with recommendations/treatment options
• Discussion of advance care planning (care you would receive if you could not speak for yourself)
• Personalized health advice and referrals for issues such as weight management , falls prevention , diet and nutrition , and smoking cessation

During your Annual Wellness Visit, you’ll also receive a cognitive assessment to check for dementia, memory loss, depression, anxiety, and other conditions. If your provider spots any issues, they will likely recommend a separate visit to perform a more thorough review of your cognitive function.

Additionally, if you're currently taking any prescription opioid medications, your provider will talk to you about the risks involved with taking opioids (including substance use disorder). They'll evaluate the severity of pain you're experiencing, review your existing treatment plan, and explain your non-opioid treatment options.

What is the difference between a Medicare Wellness Visit and a physical?

The Annual Wellness Visit may be like a routine physical in some ways, but it is not a comprehensive physical exam. This visit does not typically include:

• Physical examination
• Diagnosis of illness
• Lab tests (such as bloodwork and x-rays)
• Treatments for current conditions

While the goal of a physical exam is to identify any health issues, the goal of a Medicare Annual Wellness Visit is to help you maintain your current health and prevent problems down the road. In many cases, this visit doesn't need to be completed in an exam room.

Who can perform the Medicare Annual Wellness Visit?

This visit can be performed by different types of health care professionals who are recognized by Medicare, including:

• Nurse practitioner (NP)
• Physician assistant (PA)
• Clinical nurse specialist
• Registered dietitian
• Health educator

You may want to do your Medicare Wellness Visit with your primary care doctor or other provider in your doctor’s office. They know you best and will be able to monitor any changes in your health over time.

What should I bring to my Medicare Annual Wellness Visit appointment?

Bring your completed Health Risk Assessment to your visit along with a list of any medications, vitamins, and/or supplements you're taking (both prescription and over the counter). It’s a good idea to have your immunization records handy if the provider does not already have this information. You should also write down any questions or concerns you have about your medications or your health in general. This visit is a great opportunity to get all your questions answered.

Does Medicare require a Wellness Visit every year?

Medicare does not require that you have a Medicare Wellness Visit every year. But it’s important to take advantage of all the Medicare benefits available to you. This free yearly visit is an extra tool in your health care toolbox. It can help you prevent disability, illness, and chronic disease , so you can stay well and live your best life possible. You may want to set a reminder for yourself every year to schedule your Annual Wellness Visit.

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Doctor Visits

Get Your Medicare Wellness Visit Every Year

Take Action

If you have Medicare, be sure to schedule a yearly wellness visit with your doctor or nurse. A yearly wellness visit is a great way to help you stay healthy.

What happens during a yearly wellness visit?

First, the doctor or nurse will ask you to fill out a questionnaire called a health risk assessment. Answering these questions will help you get the most from your yearly wellness visit.

During your visit, the doctor or nurse will:

• Go over your health risk assessment with you
• Measure your height and weight and check your blood pressure
• Ask about your health history and conditions that run in your family 
• Ask about other doctors you see and any medicines you take
• Give advice to help you prevent disease, improve your health, and stay well
• Look for any changes in your ability to think, learn, or remember
• Ask about any risk factors for substance use disorder and talk with you about treatment options, if needed

If you take opioids to treat pain, the doctor or nurse may talk with you about your risk factors for opioid use disorder, review your treatment plan, and tell you about non-opioid treatment options. They may also refer you to a specialist. 

Finally, the doctor or nurse may give you a short, written plan to take home. This plan will include any screening tests and other preventive services that you’ll need in the next several years. Preventive services are health care services that keep you from getting sick. 

Learn more about yearly wellness visits .

Plan Your Visit

When can i go for a yearly wellness visit.

You can start getting Medicare wellness visits after you’ve had Medicare Part B for at least 12 months. Keep in mind you’ll need to wait 12 months in between Medicare wellness visits.

Do I need to have a “Welcome to Medicare” visit first?

You don’t need to have a “Welcome to Medicare” preventive visit before getting a yearly wellness visit.

If you choose to get the “Welcome to Medicare” visit during the first 12 months you have Medicare Part B, you’ll have to wait 12 months before you can get your first yearly wellness visit. 

Learn more about the “Welcome to Medicare” visit .

What about cost?

With Medicare Part B, you can get a wellness visit once a year at no cost to you. Check to make sure the doctor or nurse accepts Medicare when you schedule your appointment.

If you get any tests or services that aren’t included in the yearly wellness visit (like an extra blood test), you may have to pay some of those costs.

Who Can Get Medicare?

Medicare is a federal health insurance program. You may be able to get Medicare if you:

• Are age 65 or older
• Are under age 65 and have a disability
• Have amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease
• Have permanent kidney failure (called end-stage renal disease)

You must be living in the United States legally for at least 5 years to qualify for Medicare.  Answer these questions to find out when you can sign up for Medicare .

Make an Appointment

Take these steps to help you get the most out of your Medicare yearly wellness visit.

Schedule your Medicare yearly wellness visit.

Call your doctor’s office and ask to schedule your Medicare yearly wellness visit. Make sure it’s been at least 12 months since your last wellness visit.

If you're looking for a new doctor,  check out these tips on choosing a doctor you can trust .  

To find a doctor who accepts Medicare:

• Search for a doctor on the Medicare website
• Call 1-800-MEDICARE (1-800-633-4227)
• If you use a TTY, call Medicare at 1-877-486-2048

Gather important information.

Take any medical records or information you have to the appointment. Make sure you have important information like:

• The name and phone number of a friend or relative to call if there’s an emergency
• Dates and results of checkups and screening tests
• A list of vaccines (shots) you’ve gotten and the dates you got them
• Medicines you take (including over-the-counter medicines and vitamins), how much you take, and why you take them
• Phone numbers and addresses of other places you go to for health care, including your pharmacy

Make a list of any important changes in your life or health.

Your doctor or nurse will want to know about any big changes since your last visit. For example, write down things like:

• Losing your job
• A death in the family
• A serious illness or injury
• A change in your living situation

Know your family health history.

Your family's health history is an important part of your personal health record.  Use this family health history tool  to keep track of conditions that run in your family. Take this information to your yearly wellness visit.

Ask Questions

Make a list of questions you want to ask the doctor..

This visit is a great time to ask the doctor or nurse any questions about:

• A health condition
• Changes in sleeping or eating habits
• Pain or discomfort
• Prescription medicines, over-the-counter medicines, or supplements

Some important questions include:

• Do I need to get any vaccines to protect my health?
• How can I get more physical activity?
• Am I at a healthy weight?
• Do I need to make any changes to my eating habits?

Use this question builder tool  to make a list of things to ask your doctor or nurse.

It can be helpful to write down the answers so you remember them later. You may also want to take a friend or relative with you for support — they can take notes, too.

What to Expect

Know what to expect at your visit..

The doctor or nurse will ask you questions about your health and safety, like:

• Do you have stairs in your home?
• What do you do to stay active?
• Have you lost interest in doing things you usually enjoy?
• Do you have a hard time hearing people on the phone?
• What medicines, vitamins, or supplements do you take regularly?

The doctor or nurse will also do things like:

• Measure your height and weight
• Check your blood pressure
• Ask about your medical and family history

Make a wellness plan with your doctor.

During the yearly wellness visit, the doctor or nurse may give you a short, written plan — like a checklist — to take home with you. This written plan will include a list of preventive services that you’ll need over the next 5 to 10 years.

Your plan may include:

• Getting important screenings for cancer or other diseases
• Making healthy changes, like getting more physical activity

Follow up after your visit.

During your yearly wellness visit, the doctor or nurse may recommend that you see a specialist or get certain tests. Try to schedule these follow-up appointments before you leave your wellness visit.

If that’s not possible, put a reminder note on your calendar to schedule your follow-up appointments.

Add any new health information to your personal health documents.

Make your next wellness visit easier by updating your medical information in the personal health documents you keep at home. Write down any vaccines you got and the results of any screening tests.

Medicare offers an online tool called  MyMedicare  to help you track your personal health information and Medicare claims. If you have your Medicare number, you can  sign up for your MyMedicare account now .

Healthy Habits

Take care of yourself all year long..

After your visit, follow the plan you made with your doctor or nurse to stay healthy. Your plan may include:

• Getting important screenings
• Getting vaccines for older adults
• Keeping your heart healthy
• Preventing type 2 diabetes
• Lowering your risk of falling

Your plan could also include:

• Getting active
• Eating healthy
• Quitting smoking
• Watching your weight

Content last updated February 9, 2023

Reviewer Information

This information on Medicare wellness visits was adapted from materials from the Centers for Medicare and Medicaid Services

Reviewed by: Rachel Katonak Centers for Medicare and Medicaid Services Division of Policy and Evidence Review Coverage and Analysis Group

November 2022

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The Ultimate Guide to Medicare Annual Wellness Visits

The Medicare  Annual Wellness Visit (AWV)  is a valuable but often underutilized resource. This annual checkup, specifically designed for Medicare beneficiaries, encourages proactive health management, creates customized preventive care plans, and promotes improved quality of life for the recipients. 

Studies  have demonstrated the enormous opportunity for AWVs to facilitate healthy aging among the elderly populace and encourage participants to take advantage of preventive services and mitigate their health risks. AWVs also correlate to a significant reduction in acute hospitalizations and outpatient services, as Medicare patients average  a 5.7% reduction  in healthcare expenditures if they receive an AWV. 

However,  81% of eligible participants  fail to receive the service despite its potential to enhance overall well-being. Patients and providers are often confused about the distinction between AWVs and annual physicals. Furthermore, AWVs can be perceived as disruptive to a practice’s workflow without proper implementation. If practices cannot verify patient eligibility in real-time, they also risk providing a service that does not qualify for reimbursement. 

In this article, we delve into the vital aspects of AWVs, defining the specifics of what an AWV entails, what makes them distinct from other routine annual visits, and how to seamlessly integrate them into your practice through ChartSpan’s RapidAWV™ software. 

What is a Medicare Annual Wellness Visit?

A  Medicare Annual Wellness Visit (AWV)  is a yearly appointment where healthcare providers assess a patient’s health risks, develop personalized prevention plans, recommend screenings, and educate patients on managing their health. AWVs provide customized preventive care , detect potential health risks early on, actively engage patients in their wellness journey, and improve patients’ overall quality of life. 

First introduced in 2011 as part of the Affordable Care Act, Annual Wellness Visits are entirely covered by Medicare and scheduled every 12 months once a patient has been enrolled in Medicare Part B for over a year. 

What happens at an Annual Wellness Visit?

During an Annual Wellness Visit, physicians will review a patient’s medical history and prescription medications and document vital signs like height, weight, body mass index (BMI), and blood pressure. Before the physician’s consultation, patients complete a  Health Risk Assessment (HRA) , a self-guided questionnaire that ascertains details about the patient’s health, medical history, and lifestyle. AWVs also address various factors that influence a patient’s health, like behavioral risks, cognitive ability, depression, nutrition, and  Social Determinants of Health (SDOHs) . 

Annual Wellness Visits are intentionally proactive and designed to promote positive clinical outcomes and quality of life by holistically observing a patient’s health and risk factors. Suppose a patient is living with a chronic illness like diabetes. In that case, the focus of many office visits and yearly examinations may be tied to the patient’s symptoms and concerns about their condition and medications.

The AWV should not also be devoted to discussing the patient's diabetes. The provider will review how the patient's diabetes affects their overall health and long-term clinical prospects, but they will not use the AWV to address treatment for the chronic illness specifically.

Other risk factors may go undetected during sick-care visits, leading to the patient developing additional chronic conditions that further complicate their healthcare journey. Through HRAs and AWVs, physicians can observe a patient’s unique medical history, risk factors, and lifestyle and gain a better understanding of what conditions patients may struggle with in the future. 

Physicians then craft an individualized wellness plan that mitigates health risks and emphasizes preventive action, rather than solely treating the existing symptoms and concerns. 

These preventive health plans promote optimal quality of life for the patient by avoiding injury and disease, minimizing functional decline, and eliminating any outstanding  gaps in care . 

Learn more:  Why Do So Many Providers Fail to Capture AWVs?

What is included in a Medicare Annual Wellness Visit?

A Medicare Annual Wellness Visit may consist of: 

• Providing a patient with a Health Risk Assessment (HRA)
• Measuring a patient’s height, weight, BMI, blood pressure, and other relevant metrics
• Documenting a patient’s personal and family medical history 
• Reviewing a patient’s current medications, healthcare providers, vitamins, and supplements
• Evaluating a patient’s cognitive function and risk for impairments like dementia or Alzheimer’s
• Checking a patient’s functional abilities (dressing, bathing, using the bathroom, etc.) 
• Identifying risk factors, including fall risk assessments, behavioral risks like smoking, sedentary lifestyle, poor nutrition, and other limitations or lifestyle factors that may complicate a patient’s long-term health
• Administering a behavioral health screening for depression
• Discussing Social Determinants of Health (SDOHs) with a patient 
• Providing a patient with personalized health advice for identified risk factors, including resources for exercise, weight management, substance abuse, or smoking cessation
• Discussing  Advance Care Planning  
• Reviewing any opioid medications a patient may be taking 
• Creating a personalized schedule of health screenings and recommended tests based on a patient’s age, medical history, and unique risk factors

Some of the information obtained during an AWV may lead to additional appointments where more robust examinations occur. For example, suppose a physician notices a patient is exhibiting worrisome cognitive issues. In that case, they may schedule a follow-up appointment where they perform more thorough tests for dementia, Alzheimer’s, memory loss, and related behavioral health concerns like anxiety and depression. 

Similarly, a physician may recommend follow-up immunizations, cancer screenings, and lab tests based on information obtained through the HRA and subsequent patient dialogue. These follow-up appointments are a part of the preventive care plan presented to the patient after the AWV. The AWV does not cover these services, and this information should be clearly communicated to patients to minimize confusion.

However, AWVs can be billed concurrently with  problem visits , which is one of the most effective ways to integrate AWVs smoothly into a practice’s pre-existing workflow. When practices can efficiently combine sick visits with the administration of AWVs, they maximize revenue for the visit without sacrificing additional practice resources, demanding additional appointments from the patient, or running the risk of patients skipping the preventive care appointment. (This last point is a particular concern, as studies have shown up to  41%  of preventive care appointments result in patient no-shows.)

Learn more:  The Ultimate Annual Wellness Checklist for Providers

What is not included in an Annual Wellness Visit?

Medicare’s Annual Wellness Visits aim to develop preventive care plans rather than address pre-existing health concerns or be used for routine examinations. Therefore, AWVs do  not  include:  

• Any physical examination of the patient (beyond collecting standard metrics like weight and height) 
• Any blood work, x-rays, or lab tests 
• Treatment of chronic conditions like high blood pressure, diabetes, or arthritis 
• Evaluating, diagnosing, or creating a treatment plan for any new illness or symptom
• Prescription of new medications or adjusting existing medications 
• Performing immunizations

AWVs are not intended to diagnose conditions, treat pre-existing chronic illnesses, or include a hands-on physical examination of the patient. If patients have specific concerns related to their physical health, like new or worsening symptoms, a separate appointment will be necessary to analyze and address these issues thoroughly.

If a provider administers any of these services or other diagnostic care during the appointment, patients should expect a coinsurance or copayment, as these services are explicitly not covered under Medicare’s provisions for preventive AWVs. 

Learn more about what's not covered at a Medicare AWV .

How is the AWV distinct from an Annual Physical?

While an AWV is similar to an annual physical exam and the Initial Preventive Physical Exam (IPPE), also known as the  Welcome to Medicare preventive visit , an AWV is a separate service. AWVs have unique billing codes, Medicare-determined criteria, and a distinct purpose. 

Annual Wellness Visits are focused on creating preventive health plans for patients and do not include physical examination, lab work, or immunization. An Annual Wellness Visit’s primary purpose is for the patient to complete a Health Risk Assessment and for the physician to develop or update a Personalized Prevention Plan (PPP),  according to  the Centers for Medicare & Medicaid Services (CMS) documentation. 

An annual physical exam obtains a clear assessment of the overall state of a patient’s health, observes organ functionality, screens for common types of cancer, and keeps patients up-to-date on recommended vaccinations. Medicare does not cover annual physical exams, but they do cover 100% of AWVs for eligible participants. If a patient is treated for concerns that extend beyond the scope of an AWV, these services will be billed to a patient’s insurance, which may result in unplanned out-of-pocket costs. Patients often need to be made aware of the distinction between AWVs and annual physical exams. If patients do not understand the intention of an AWV, it can lead to confusion, frustration, and dissatisfaction. Physicians must communicate with patients about what to expect during an AWV and the intended outcomes of the appointment. 

Likewise, physicians are often unsure about what an AWV covers and what requires a distinct appointment, which may discourage them from promoting the service to their patients. The low utilization of AWVs, despite  their marked impact  on patients’ engagement with preventive services, indicates that the perceived value of AWVs may be misaligned or that practices cannot effectively integrate them into their office workflow.

Learn more:  The Difference Between Annual Physicals and Annual Wellness Visits

How to educate patients on Annual Wellness Visits

Properly educating patients on the purpose of a Medicare AWV is integral to maintaining patient satisfaction and the overall success of the preventive care plan. A patient who is not interested in preventive care is less likely to follow through on the measures proposed by their physician. A patient expecting to talk with their doctor about their chronic illness or medications may be frustrated by the appointment’s emphasis on medical history, lifestyle, and behavioral risk factors. 

Consider using outreach to inform your patients about the purpose and benefits of receiving AWVs. Your practice can distribute mailed material or electronic communication that tells patients what to expect during an AWV and how receiving AWVs can contribute to increased quality of life. These communications can be timed with holidays or patient birthdays or scheduled annually to ensure the patient gets a yearly reminder. 

Additionally, staff members can educate patients about the differences between physicals and AWVs when they come into the office for a routine visit, differentiating the services and offering to schedule the patient for their initial AWV. Combining AWVs with sick or Evaluation and Management (E/M) visits is also a strategic way to maximize the time spent with the patient and the reimbursements available for providing high-quality and thorough care. 

Who is eligible for an Annual Wellness Visit?

Medicare beneficiaries enrolled in Medicare Part B for over 12 months are eligible for Annual Wellness Visits. Patients cannot receive more than one AWV in a 12-month timeframe. Additionally, patients cannot receive an AWV in the same year as their initial Welcome to Medicare preventive visit (also known as an IPPE). Medicare Advantage plans (Medicare Part C) are also required to cover AWVs when a patient visits an in-network provider and meets the eligibility criteria outlined by Medicare.

Patients looking to schedule an AWV with their healthcare provider should ensure they ask for an “Annual Wellness Visit” by name when setting up the appointment. This will help clarify the intention of the appointment and ensure that Medicare fully covers the service.

Multiple healthcare practitioners, including primary care providers, certain specialty providers, and urgent care providers, can administer AWVs. Medicare will only reimburse practices for one AWV per patient per 12-month cycle, so it is crucial to access accurate patient eligibility data before administering the service. 

Some AWV software,  like ChartSpan’s RapidAWV , syncs with the HETS (HIPAA Eligibility Transaction System) database, allowing front desk personnel to check Medicare beneficiary data in real time. If they discover a patient is indeed eligible for an AWV, they can easily provide the patient with an HRA to complete within the same application. 

Learn more:  How to Identify Eligible Medicare Beneficiaries for Annual Wellness Visits

What is the reimbursement for Medicare Annual Wellness Visits?

Annual Wellness Visits offer between  $118-174 in reimbursements  per visit. The exact amount will differ based on the details of the individual AWV. The Medicare reimbursements may be increased by pairing them with other relevant preventive services, like smoking cessation consultations, advance care planning, or obesity counseling. These additional services have separate CPT billing codes that may be used with the AWV billing codes to maximize practice revenue* further. 

AWVs are an invaluable asset for any practice, as they can add a streamlined revenue channel while encouraging patients to utilize preventive resources and reduce patient healthcare expenses. 

*Results may vary by provider. 

What are the billing codes for Annual Wellness Visits?

There are three primary CPT codes used to bill AWVs to Medicare:

• G0402 (Welcome to Medicare / Initial Preventive Physical Exam):  The IPPE is a one-time, face-to-face service offered to newly enrolled patients in Medicare Part B and is a precursor to subsequent Annual Wellness Visits. This service is only offered in the initial 12-month window after a patient enrolls and will be rejected after that timeframe elapses.
• G0438 (Initial Annual Wellness Visit):  CPT code G0438 is used to bill for a patient’s first Annual Wellness Visit. If patients complete an IPPE, they are eligible for their initial AWV on the first day of the same calendar month a year later. If they do not take advantage of the IPPE, they are eligible for their first AWV twelve months after enrollment in Medicare. The reimbursement for the initial AWV is  higher than subsequent AWVs , so it is critical to correctly bill the service to ensure your practice receives maximum reimbursement for the services rendered. 
• G0439 (Subsequent Annual Wellness Visits):  This billing code is used for every AWV a patient receives after completing their IPPE and initial AWV. They will become eligible for AWVs once every 12 months. This is the only CPT billing code for AWVs that is used more than once.

Apart from the three standard billing codes, multiple codes are relevant to AWVs or often billed in tandem with AWVs. These include: 

• G0468 (FQHC IPPE or AWV) : CPT code G0469 is used by Federally Qualified Health Centers (FQHCs) to bill for visits that include IPPEs or AWVs as part of their bundle of services. Other practices cannot use this code. 
• 99497 (Advance Care Planning):  Advance Care Planning includes discussing and explaining advance directives if a patient becomes debilitatingly ill or otherwise unable to make medical decisions for themselves in the future. When this discussion is provided on the same day as an AWV by the same healthcare provider, it is considered preventive and covered by Medicare. It must be reported with modifier -33 and billed on the same claim as the AWV to waive co-payment. This service can be performed annually. 
• G0444 (Depression Screening):  Depression screenings are often coupled with AWVs and covered by Medicare. They can be performed annually. G0444 cannot be billed with a patient’s initial AWV (CPT code G0438).
• 99406 and 99407 (Counseling to Prevent Tobacco Use):  Medicare covers up to two smoking cessation counseling sessions per patient per year. These are often billed in conjunction with AWVs. 99406 is used for consultations that last between 3 and 10 minutes. Code 99407 is used for consultations that exceed 10 minutes in length. 
• G0442 and G0443 (Alcohol Misuse Screening & Counseling):  G0442 is a screening to detect the risk of alcohol misuse and can be performed once annually. If a patient is identified to be at risk, G0443 is used to bill the subsequent 15-minute behavioral consultation. This service can be performed up to four times per year.
• G0447 (IBT for Obesity):  Patients with a BMI that exceeds 30.0 qualify for obesity consultation services. These can be performed with IPPEs or AWVs and billed up to 22 times in 12 months, depending on the patient’s adherence to the physician’s recommendations and subsequent weight loss. 

Learn more:  CPT Billing Codes for Annual Wellness Visits       

Who can perform a Medicare Annual Wellness Visit?

Any of the following practitioners can  perform  Annual Wellness Visits:

• A physician (doctor of medicine or osteopathy)
• A qualified, non-physician practitioner, including a physician assistant (PA), a nurse practitioner (NP), or a certified clinical nurse specialist (CCNS)
• A medical professional like a registered dietitian, nutrition professional, or health educator, or a team of medical professionals directly supervised by a physician or another licensed healthcare practitioner

It is integral to remember that AWVs can be performed and billed by practices other than primary care facilities. Specialists like cardiologists or neurologists may also submit claims for AWV reimbursement. CMS has intentionally sought to  reduce barriers  to administering AWVs and HRAs to facilitate greater use and easier workflow implementation. 

However, without eligibility verification, this can lead to multiple practices attempting to bill Medicare for the same service and risks patients receiving poorly optimized, duplicated care. Medicare will only reimburse one AWV per patient within a 12-month timeframe. This is why checking patient eligibility in real-time is crucial before practice resources and patient time are devoted to redundant and non-reimbursable services.   

Implement AWVs into your workflow easily with ChartSpan’s RapidAWV™ software

The challenge:  Only  19%  of eligible Medicare patients receive AWVs. When properly implemented into a practice’s workflow, AWVs have the dual benefit of creating an additional revenue stream and facilitating positive patient clinical outcomes by encouraging targeted preventive care. However, many physicians view AWVs as overly time-consuming, staff may struggle to confirm patient eligibility, and many patients do not see the value in an appointment that does not address their current conditions, medications, and physical health. 

Our solution:  ChartSpan’s proprietary RapidAWV™ software  provides healthcare providers with an innovative solution to maximize revenue while significantly minimizing the time and resources required to implement AWVs. 

Real-time eligibility checks

When patients arrive for their scheduled sick visit, clinical staff can use the RapidAWV™ program to check their AWV eligibility via CMS’s HETS database in real time. If the patient is determined eligible for an AWV, your clinical staff can provide an HRA for the patient to complete on a desktop, tablet, or mobile device. These customizable, senior-friendly questionnaires are iOS and Android compatible and  optimized  for access across any device and screen size. 

Accessible and customizable HRAs

The patient can complete their HRA from the comfort of your practice’s waiting room while they await their regularly scheduled appointment, seamlessly integrating the AWV into their pre-existing appointment without causing any disruption to standard  practice workflow . 

These HRAs can be customized by the practice to include questions about medical history, lifestyle, risk factors, and whatever additional information you wish to gather. Upon completion, the software will then deliver a comprehensive, robust report to the attending physician, outlining risk factors and recommended screenings and flagging pertinent factors like nutrition, tobacco use, medication adherence, and vaccinations. 

Personalized preventive care plans

By analyzing the data provided by patients, ChartSpan’s AWV software generates 5- to 10-year preventive care plans with actionable goals, deliberate interventions, and timely follow-ups. It also gives patients clear summaries of their health risks and preventive care plans. 

This automated, data-driven AWV technology dramatically reduces the time required to administer an AWV. This ensures an AWV can be neatly combined with the scheduled appointment yet still deliver a tailor-made preventive care program for the individual patient. 

Partner with ChartSpan to maximize AWVs

With the ease of ChartSpan’s RapidAWV™ software, physicians at your practice can incorporate AWVs into any previously scheduled patient sick visit. Any inconvenience to the patient is minimized by attaching the AWV to a pre-existing appointment, encouraging higher participation. 

Our software checks eligibility instantly, eliminating the risk of your practice providing a non-reimbursable service. Furthermore, the software collects, analyzes, and synthesizes the information provided by the patient into an actionable preventive care plan unique to them, allowing you to maximize every appointment and elevate the quality and scope of care your practice provides. 

To ensure your team’s success with RapidAWV™, ChartSpan provides comprehensive onsite or remote training in our software and a dedicated Client Success Director to help your AWV enterprise flourish. 

Contact us  to learn how ChartSpan can elevate your practice’s care delivery and operational excellence with our industry-leading AWV software.     

You may also like: 

• Top 10 Chronic Disease Risk Factors
• 5 Examples of Patient-Centered Care
• A Healthcare Provider’s Guide to Value-Based Care

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Essential Yearly Blood Tests

Your blood is an incredible substance. Not only does it carry oxygen to every last inch of your body, it also transports hormones, removes waste, kills pathogens and much, much more. But maybe the most powerful thing you can do with your blood is examine the massive amount of information carried in every drop.

Monitoring the progression of your health with blood work each year is extremely easy and vitally important — regular blood health screening can highlight potential problems while they’re still simple to treat.

However, the typical yearly physical is NOT a comprehensive look at your health and it rarely prevents chronic illness, so it’s important for you to take matters into your own hands.

In this article, you’ll find everything you need to request from your doctor each year to make sure you have the best blood test package possible.

Your Annual Wellness Blood Test Should Include…

1. red blood cells (for oxygen distribution and anemia screening) and white blood cells (for immune function).

Red blood cells (RBCs) are produced in the bone marrow and circulate in the bloodstream to deliver oxygen to your cells. Oxygen molecules attach to a protein called hemoglobin within the RBC. The lifespan of most RBCs is around 120 days, and healthy RBC production requires iron, copper, B12, and folate.

Mean cell volume (MCV) is the size of your RBCs. If your RBCs need iron, they will shrink (low MCV), reducing their ability to effectively deliver oxygen around the body. If your RBCs need B12 or folate they increase in size (high MCV). A deficiency of iron, B12, and folate all lead to the reduced production of RBCs. The size of your red blood cells helps you to determine which nutrients are lacking. This test is key for understanding whether your RBCs are getting the support they need for their critical role in the body.

White blood cells (WBCs) exist in the blood, lymph, and tissues as your body’s natural defense system. They help to protect you against infections and have a role in inflammation and allergies. There are five different types of WBCs, each with a different function: neutrophils, lymphocytes, basophils, eosinophils, and monocytes.

The numbers of each type are relatively stable until a response is needed from your immune system, in which case the relevant WBC will increase in number. Imbalances in the types of WBCs may indicate infection, inflammation, or allergies, and so this test can highlight if your immune system is actively fighting a recent insult or a long-standing health issue.

The lab test that includes your RBCs and WBCs is called the Complete Blood Count (CBC) + Differential .

2. Liver and kidney function (removal of waste, detoxification, and regulation of body fluids)

The liver is responsible for more than 500 vital functions in the body and at any moment it contains about 13% of your total blood volume. All of the blood leaving your stomach and intestines passes through the liver where components are broken down, balanced, recreated, and stored. Chemicals and drugs are broken down into nontoxic forms, and can then be safely excreted by the body.

Bile and cholesterol are manufactured in the liver, and proteins are created to balance your blood volume and the distribution of fluid in your body. These proteins also help to regulate blood clotting and serve to carry hormones, cholesterol, and your immune system around the body. Iron and glucose are stored in the liver to make future red blood cells and energy.

Your kidneys are efficient filters and rid the body of wastes and toxins while preserving vitamins, electrolytes, hormones, and other vital substances. Your kidneys also play an important role in maintaining your blood pressure, promoting red blood cell production, activating vitamin D to promote healthy bones, and balancing body fluids.

Elevated liver enzymes indicate liver disease or dysfunction. Diseased liver cells means that they no longer can carry out their basic functions of detoxification, etc. An example of this is a common condition called fatty liver or non-alcoholic fatty liver disease (NAFLD). This occurs when healthy liver cells are replaced by fat cells due to high triglycerides and the amount of fat surrounding your abdominal organs (visceral fat).

Elevated kidney markers may indicate impaired kidney function or disease. You can not live without the continuous filtration and fluid balancing act of the kidneys. When the kidneys fail to function artificial means of filtration are required such as dialysis.

In the US liver and kidney function is part of the larger test called the Comprehensive Metabolic , which also includes electrolytes, proteins, and glucose. Outside of the US, you would ask for kidney (BUN, creatinine) and liver function tests (alkaline phosphatase, ALT, AST, bilirubin, albumin, total protein).

3. Electrolytes (body pH and enzyme function)

Electrolytes are essential minerals with an electrical charge — sodium, calcium, potassium, chloride, phosphate, and magnesium — that you must get from the food you eat and fluids you drink. They are key to vital processes in the body such as muscle contraction and hydration.

Another one of the main jobs of your kidneys is to maintain the delicate pH balance in the body. The ‘Anion Gap’ is a calculation using sodium, potassium, chloride, bicarbonate and it reflects the balance of acidity and alkalinity within your body. The higher your pH, the more acidic your body, and the lower the pH, the more alkaline.

A pH outside of the range, whether high or low, impacts the speed at which your enzymes can function. This slows down the tens of thousands of chemical reactions that take place every second of every day, which can cause a cascade of problems.

Your pH is impacted by your diet, breathing patterns, stress, medications, and kidney function. The pH in different body tissues impacts the function of your enzymes, which are vital for life and speed up the rate of virtually all of the chemical reactions that take place within your cells.

Measuring the Anion Gap requires each of the electrolytes involved to be measured: sodium, calcium, potassium, chloride, phosphate, magnesium, bicarbonate. Some labs may group them together in various ways. In the US, the electrolytes are included in the above liver and kidney function test called the Comprehensive Metabolic .

4. Blood sugar (glucose, insulin, and hemoglobin A1c levels)

Blood sugar, or glucose, is the sugar found in your blood that comes mainly from the food you eat. Whenever you eat something, your digestive system breaks it down into smaller components, and one of the major components is glucose.

Glucose is our bodies’ primary energy source. It’s a necessary ingredient for maintaining the optimal function of your organs, muscles, and nervous system. If you just ate a meal high in carbohydrates, starch and/or sugar, your blood sugar will rise high over a normal fasting level. If you just had a meal of healthy fats and proteins, your blood sugar will not rise as high.

Blood sugar after meals that is continuously outside of the normal range can lead to major blood vessel and body tissue damage. This damage creates toxic compounds called advanced glycation end products (AGEs), which are biomarkers implicated in aging and the development, or worsening, of many degenerative diseases, such as diabetes, atherosclerosis, chronic kidney disease, and Alzheimer’s disease.

Blood sugar stability and insulin levels throughout the day all impact your overall sense of well-being, ability to heal from illness, future risk of chronic disease, and your longevity. What you eat, how much you move and sleep, and the amount of stress that you are under all impact your daily blood sugar control.

Glucose testing is part of the Comprehensive Metabolic test in the US. In addition, I recommend that you test your insulin and hemoglobin A1c . Outside of the US, you would ask for glucose, insulin, and hemoglobin A1c levels separately.

5. Cardiovascular health screening (Cholesterol/Lipids + Apolipoprotein B)

Your cardiovascular system is made up of your heart and blood vessels and its main job is to transport oxygen, nutrients, and hormones throughout the body. The pattern of blood test results that indicate a healthy cardiovascular system include: healthy levels of both types of cholesterol (not too high or too low), low inflammation, and balanced blood sugar levels.

Your family history, smoking history, blood pressure, diet, fitness, sleep, and response to stress also contribute to your overall cardiovascular risk. In spite of the bad rap for playing a role in heart disease, a healthy balance of cholesterol is also vital to your health and well-being.

These tests are called lipid or cholesterol tests which include total cholesterol, HDL cholesterol, LDL cholesterol, VLDL, and triglycerides. You would also request an Apolipoprotein B test.

6. Inflammation (hs-CRP, homocysteine)

Inflammation is a vital part of your immune system’s response to injury and infection. It is the signal to your immune system that healing and repair are needed, or that defense against things like viruses and bacteria is required.

Inflammation that goes on too long or in the wrong place can lead to certain chronic diseases such as heart disease, diabetes, chronic pain, obesity, dementia, cancer, and autoimmune disease. Your diet choices, a lack of daily movement, inadequate sleep, and a poor response to mental and physical stress all contribute to increased inflammation.

When there is chronic inflammation, hs-CRP and homocysteine levels rise in the bloodstream. These tests indicate whether the concentration of those proteins is within an optimal range or whether the concentration is high enough that inflammation must be present.

Ask for the individual tests for homocysteine and c-reactive protein hs .

7: Thyroid (metabolism)

Your thyroid gland is a bowtie-shaped gland located just below your voicebox. It secretes hormones that affect the speed of your body’s chemical functions, also known as your metabolism or metabolic rate.

Metabolism is the rate that your body expends energy and burns calories, and your thyroid gland creates a whole cascade of hormones that go on to impact every tissue in the body. These include many vital functions such as your heart rate, the rate at which calories are burned, skin maintenance, tissue growth, heat production, fertility, and digestion.

To produce thyroid hormones, your body uses iodine and selenium. Symptoms of underactive thyroid function (hypothyroidism) include low energy, weight gain, cold hands and feet, dry skin, constipation, and low mood. Symptoms of elevated thyroid function (hyperthyroidism) include nervousness, anxiety, irritability, increased sweating, difficulty sleeping, hand tremors, high or low energy, heat intolerance, and heart racing.

This test is the Thyroid stimulating hormone (TSH), Free T3, Free T4 .

8. Nutrition blood tests

One of the most common requests I get from new clients is for a nutrition blood test. Sadly there’s no single test that will tell you how good your current nutrition is, and so we need a range of tests that will indicate your dietary intake of macro and micronutrients (vitamin D, iron/ferritin, B12/folate, and magnesium).

If your kidney tests show that creatinine and BUN are low, this may indicate that you are not eating enough dietary protein. Your body needs proteins and amino acids for cellular growth and repair and to produce important molecules in our body – such as enzymes, hormones, neurotransmitters, and antibodies.

Protein is essential for managing fat loss, muscle mass, bone strength, immune system function, and athletic performance and recovery. The basic recommendation for protein intake is 1.2 to 2.4 g/kg (around 0.54-1.1 g/lb) of body mass in generally healthy adults.

Common signs of low protein intake include loss of muscle mass, poor bone health and wound healing, swelling, low mood, frequent illness, weakness and fatigue, frequent hunger, and poor quality hair, skin, and nails.

Dietary Fat and Carbohydrates

If your triglycerides are low, this may indicate that you are not eating enough dietary fat. Healthy fats include olive oil, avocado, coconut, nuts and seeds, eggs, organic butter or ghee, and meat and seafood.

You use fat to support your mood, brain function, metabolism, cell communication, immune system, hormone production, and the absorption of many nutrients (such as vitamins A and D). Eating enough fat helps you to feel full between meals.

If your triglycerides are high this may indicate that your dietary carbohydrates are too high. Foods that contain carbohydrates are grains, vegetables, legumes, fruit, nuts, dairy, and sugars.

All carbs that we eat are broken down at various speeds into sugars and eventually glucose. Simple carbs like baked goods made from refined flour are broken down quickly and lead to a fast blood spike in blood sugar, while complex carbs such as vegetables and beans contain fiber and are broken down more slowly.

Vitamins and Minerals

Vitamins and minerals are needed for normal cell function, growth, and development. If you take supplements with fat-soluble vitamins — vitamins A, D, E, and K — these are best absorbed when taken with food. Fat-soluble vitamins are stored in fat for future use and this is why they can build up to toxic levels. It is important to test your levels of fat-soluble vitamins if you are taking high doses for prolonged periods of time.

There are 9 water-soluble B vitamins and these are not stored in the body (apart from B12 which can be stored for 3 to 5 years in the liver). If you take more B vitamins than the body can use you will get rid of them in urine (resulting in a fluorescent yellow tinge).

Some critical vitamins and minerals to test for include:

• Iron/ferritin

To do a basic nutrition blood test you will need all of the following: Vitamin D , iron, ferritin , B12, folate , magnesium , electrolytes , BUN and creatine , and triglycerides .

A good annual physical should help you to catch the disease process early.

But a great annual physical should help you to identify these areas of imbalance and give you the lifestyle and diet recommendations to reverse poor health and prevent the disease process from starting in the first place.

If you would like to order the blood health screening I use with all my clients at a lab near you, just click here . All these tests are included.

Remember that lab reference ranges take their data from the population that visits that particular lab, not from the research that indicates what’s optimal. I rely exclusively on research data, rather than a population’s averages, to assess your blood health, so if you want to take your analysis beyond the information the lab sends back — to see if your results reflect optimal health rather than just a lack of disease —  click here to book a consultation .

6 replies to "Essential Yearly Blood Tests"

This post about labs is so true! I’m one of Alexis’ clients, and the lab work I did with her FINALLY showed all of the issues that I was having–on paper! It made it so much easier for me to address my medical concerns. Previously, Western doctors had only told me that there was nothing that could be done for my medical problems, that they were “chronic” and therefore permanent and unchangeable.

In the last 6 months that I have been working with Alexis, I have seen marked improvement in my levels via blood work as well as felt worlds better on a day to day basis. Thanks to Alexis I feel in control of my health and body in a way that I hadn’t for years. The blood work holds the truth 🙂

So should I be cynically blaming pharmaceutical and insurance lobbyists for the differences between the U.S. recommended intakes/deficiency standards and those favored by you/other countries? Or is there some other reason that you differ from the ADA re: blood glucose levels and why you and Japan/Europe differ re: B12 deficiency levels?

Well, in part. However the answer is a bit more complicated in that it also involves how “normal” ranges are determined and what “normal” actually means. So each range is derived from tests done on 95% of a healthy, a.k.a. normal, target population for that specific lab. Which is why ranges differ slightly from lab to lab given differences in testing equipment, procedures, and the health of the target population itself. So you have to ask yourself, when the majority of people going into a lab to get blood work done are sick, do these people truly represent a healthy target population? Another problem lies with the interpretation of the results. For example, if someone has a Total cholesterol of 200mg/dL. This is considered normal for some labs. However, a cholesterol of 201mg/dL is all the sudden not normal and could lead to the recommendation of a drug. So you can literally be told “you are normal, come back next year” or “this is abnormal, you need drugs”, over 1 point. So- within most lab ranges there are healthy “optimal” ranges. And when you are outside of these optimal ranges, measures should be taken with diet & lifestyle to prevent worsening. Essentially, the blood work is a window into the inner workings of your body, and it shows imbalances WAY before you are outside of most lab ranges. However, most doctors are not taught how to see these patterns in blood work, or the lifestyle modifications that work to reverse them. It’s all about drugs. If it doesn’t yet require a drug, well then you are just fine. Come back when it does. It is not necessarily that the current lab ranges are wrong, they are just focused on something different. Disease. And disease processes. Whereas, I am more concerned with health. And maintaining health for that individual. So it requires looking at the blood in a different way. I have not done extensive research into these claims, but it has also been said that lab ranges have been changed slightly over time (with a push from drug companies), so that more people qualify for a particular medication (aka cholesterol lowering drugs). I’ll have to look more in to the roots of this claim. However, if it true then… ugh.

Thanks dude.

That was really interesting and informative. Thanks, Alexis!

I am 46 years old now. My previous family Dr was checking glucose level for the last 14 years. I moved to different city and my primary Dr also changed. Now this new Dr refused to check my glucose level for this year. He is saying my glucose number is stable for the last 2 years. Is this correct?. When I ask him to test it again, he is threatening that I have psychiatric issues and he will me to psychiatric . What should I do now?. Please advise me. Thank you!.

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Health First Fitness: Wellness is no secret. Learn how to make choices you know are right

Grandma was right: daylight, home-cooked meals, family and friends can improve heart health..

I see heart patients. I see many with severe cardiac conditions requiring intensive monitoring and, eventually, intervention, but I also see patients for their first electrocardiograms (ECGs).

Heart health is a lifelong thing that people take as a gauge of overall health, and they’re not wrong. Poor nutrition, inactivity, drinking and smoking are all generally unhealthy, and in medicine, conventional risk factors for heart disease.

Every now and then someone asks me, “So, what’s the secret to heart health?” I don’t have the answer to that! Genes? If your parents or grandparents weren’t on ACE inhibitors or statins, maintaining a healthy heart may be easier for you.

But the secret is no secret at all. You know the decisions that are heart healthy. What you should be asking is, what’s the secret to doing the things I know I should be doing?

I want to propose an answer to that question. The answer is, make more joy – and borrow a bit from our grandmothers’ old ideas.

Eat the rainbow, but 80/20

Any turn toward healthier habits should begin with nutrition. There are so many things at the grocery store that are highly processed and unhealthy, but there are just as many choices that are whole and nutritious.

I tell people to consume colorful foods – eat the rainbow. Start in the produce section and move over to fresh meats and then on to dairy and you’ll stay clear of the shades of brown common to frozen meats, boxed starches, snacks and sweets cramming the inside aisles.

My grandmother loved to cook with fresh, whole foods. But she also loved a treat!

So try to eat 80/20. That’s 80% “clean” (whole unprocessed foods with little or no additional oils or dressings) and 20% fun. Strict diets set people up for failure.

Eat in like Grandma

My Grandma loved to cook for us. She seemed happier preparing a big meal for all of us than she was when we’d occasionally all go out to eat and give her a night off.

Not every home cooked meal is heart healthy, but just about all restaurant meals have added sodium and sugar, oils and grease that aren’t a part of homecooked meals.

I tell my patients to have more meals at home. That is a key to eating more nutritionally. My patients who do this tend to maintain healthier weights.

Get out in the daylight

I played soccer throughout high school and into college. (I also played college rugby!) As an adult, I’ve run, coached soccer, practiced yoga and am learning to surf. When it comes to exercise and activity outdoors, everyone is different, but I’m a believer in the joy of getting out in the natural light.

Getting the kind of activity that raises your heart rate is just so beneficial to cardiovascular health. Doing so outside gives me added joy and that dose of daylight that’s important for Vitamin D and sleep later. Remember to apply UV protection and wear a hat.

My grandmother was not an exerciser, but she did like walks. Especially with a friend. Get out, walk on our beautiful beaches. Walk your beautiful dog. I make time to do this nearly every day.

Get lab work yearly

I don’t know if my grandmother got her blood work done annually, but I do advise grandmothers I see, and all my patients, to do it!

Blood work monitors our sugar levels (A1C), our lipids (cholesterol) and kidney function among other markers. It’s a snapshot of how our bodies are doing managing our nutritional choices. It’s good for setting goals and creating a health plan going forward, and many insurances, even those with a copay for a standard doctor’s visit, cover the yearly checkup.

Visit like Grandma

Finally, make time for family, close friends and neighbors. That connectivity and social support has been linked in the literature to joy and longevity . Maybe it’s the happiness itself. Or maybe having people in our lives leaves us more likely to hear the words, “You don’t look so good – I’m taking you to the hospital.”

So stay after church for fellowship. Stop to make small talk with a neighbor. Call old friends.

There’s a ton of joy in feeling connected and available to others. Go ask your grandmother.

Wendy Fiumano is a certified Advanced Practice Registered Nurse and Family Nurse Practitioner who sees heart patients at Health First’s Medical Group Gateway office location. She came to Health First from Orlando Health in Ocoee, Florida where she was a Cardiology Heart Failure Nurse Practitioner. She earned her Bachelor of Science in Nursing, summa cum laude from Northern Arizona University where she was a member of Sigma Theta Tau International Honor Society of Nursing.

To take a quick quiz online to begin assessing your heart health, visit Heart Risk Assessment | Health First .

Health First Fitness: Maintain balance today, rather than regain it after a fall