Your First Year on Medicare: The Welcome to Medicare Visit, the Annual Wellness Visit, and the Physical
Your card arrived. Part B starts January 1. Somewhere in the envelope was a mention of a Welcome to Medicare visit, and you set it aside with everything else.
Here is the part worth knowing now. That visit is available once in your lifetime, and only during the first 12 months you have Part B. According to Medicare.gov, you pay nothing for it when your provider accepts assignment. After month 12 the window closes permanently.
This article covers the three appointments people confuse constantly: the Welcome to Medicare visit, the yearly Annual Wellness Visit, and a traditional head-to-toe physical. They are not the same, they are not billed the same, and booking the wrong one is how people end up with a bill they did not expect.
The Three Visits, Side by Side
The confusion comes from the word "wellness," which Medicare uses for two different appointments, and from "physical," which Medicare largely does not cover.
| Welcome to Medicare visit (IPPE) | Annual Wellness Visit (AWV) | Comprehensive physical exam | |
|---|---|---|---|
| When you qualify | Once per lifetime, within your first 12 months of Part B | After you have had Part B for 12 months, then once a year | Any time you and your doctor schedule one |
| What it is | One-time review of your history and risks, plus a written prevention checklist | Yearly conversation that updates that plan | Hands-on examination, head to toe |
| Hands-on exam | Limited: height, weight, BMI, blood pressure, vision, balance and gait | Limited: routine measurements | Full: heart, lungs, abdomen, skin, reflexes |
| Blood work included | No, ordered separately | No, ordered separately | Usually yes |
| What you pay | Nothing, when your provider accepts assignment | Nothing, when your provider accepts assignment | Not a Medicare benefit, so cost-sharing usually applies |
Read the bottom row twice. Medicare's two wellness visits are free because they are prevention planning, not examination. A traditional physical is a different service with a different bill, which is why our guide to the annual physical exam stands on its own.
One practical note before you book. When you call any office in McAllen, use the exact words "Welcome to Medicare visit." Saying "I need my physical" gets you scheduled for something else.
What Actually Happens at the Welcome to Medicare Visit
This is the section nobody writes clearly, so here is the full list. Medicare.gov states plainly that "this visit isn't a comprehensive physical exam." Your provider works through these components:
- Your medical and social history. Past illnesses, surgeries, hospital stays, family history, and how you live day to day.
- Your current medications, including over-the-counter drugs, vitamins, and anything you take occasionally.
- A review of opioid prescriptions, if you have any, and a screening for substance use risk.
- Basic measurements. Height, weight, body mass index, and blood pressure.
- A simple vision test.
- A depression risk review.
- Functional ability and safety. Balance, gait, hearing, fall risk, and whether your home is safe to move around in.
- Advance directives. Who speaks for you if you cannot speak for yourself, and whether you want that in writing.
- A written preventive services plan. A checklist of the screenings, vaccines, and services you are due for.
Two items draw the most questions.
The EKG. Medicare allows a one-time screening electrocardiogram as a referral coming out of this visit. It is offered as part of the plan, not run automatically on everyone. Our office does EKGs on site, so when one is appropriate you are not sent to another building.
The labs. Here is the honest answer to a question search results get wrong constantly: no blood work is part of the Welcome to Medicare visit itself. Your provider instead orders the screening labs you qualify for separately, under their own coverage rules. Many of those, including the cardiovascular screening panel and diabetes screening, cost you nothing when your provider accepts assignment. We have an in-house phlebotomist, so the draw usually happens the same day.
The visit runs long. Plan on 45 minutes to an hour, and bring your list.
The Annual Wellness Visit After Your First Year
Once you have had Part B for 12 months, you move on to the Annual Wellness Visit, and you stay on it every year after. Our full guide to the Medicare Annual Wellness Visit has the complete component list and preparation checklist. Three points belong here instead.
The 12-month rule, answered precisely. This is the question people get burned by. Medicare.gov states that your first yearly wellness visit "can't take place within 12 months of your Part B enrollment." For every visit after that, the rule practices use is that 11 full months must have passed since your last Welcome to Medicare visit or Annual Wellness Visit. Count months, not dates. If your last one was in March, April of the following year is safe. Coming in early is the most common reason a patient gets billed for a visit they were told was free.
The cognitive assessment. Medicare.gov says the provider will "perform a cognitive assessment to look for signs of dementia, including Alzheimer's disease." This worries people, so let us be exact. It is not a pass-or-fail test, it is not a diagnosis, and a slow morning does not get recorded as dementia. Your provider watches how you follow the conversation and may ask you to remember a short list of words, name objects, or draw a clock face. It takes a few minutes. If something looks off, the next step is a longer evaluation, not a label. Several causes of memory change are treatable, including thyroid problems, vitamin deficiencies, sleep apnea, and medication side effects.
The personalized prevention plan. You leave with the written checklist again, updated. It shifts each year as your age and risks change. Ask for your copy before you walk out.
What Is Not Covered: The Part That Generates Bills
Search for this question and you get vague answers. Here is the direct one.
Neither the Welcome to Medicare visit nor the Annual Wellness Visit includes:
- A hands-on head-to-toe examination. No routine heart and lung exam, no abdominal exam, no full skin check.
- Management of a new or existing problem. These visits plan prevention. They do not treat your knee, adjust your blood pressure medication, or work up a cough.
- Blood work as part of the visit. Labs are ordered separately under their own rules.
- Most of what people picture when they say "physical."
Now the part that causes the surprise bill. You are in the room, the wellness visit is going well, and you say "and also, my knee has been bothering me for two months." Your provider will not ignore that. Evaluating it is a separate, medically necessary service on top of the preventive visit, billed separately with normal cost-sharing. The preventive visit stays free. The added service does not.
None of this means staying quiet about your knee. It means knowing which appointment you are in, so nothing on the statement is a mystery afterward. Two honest options: raise it and accept a possible second charge, or schedule a follow-up visit for the problem so the two stay separate. Ask the front desk how the office handles it. Any practice worth choosing will tell you straight.
How Much Medicare Pays
Short version: nothing comes out of your pocket for either wellness visit under the standard rules.
Medicare.gov states that for the Welcome to Medicare visit, "you pay nothing for the visit if your provider accepts assignment," and the same language applies to the yearly wellness visit. No copay. No coinsurance. The Part B deductible does not apply to the visit itself.
Two conditions sit behind that word "nothing."
Your provider has to accept assignment, meaning the practice takes Medicare's approved amount as full payment. Ask when you call. Our front desk answers that question every day at (956) 668-0974, along with whether your specific plan is in network.
The visit has to stay a preventive visit. Add a new problem and you add a separately billable service.
Medicare Advantage covers these visits too. Medicare.gov states that Advantage plans "must cover all medically necessary services that Original Medicare covers." The difference is the network. Advantage plans generally require in-network providers for non-emergency care, and some require a referral to see a specialist. We accept Medicare and most major insurance, and because plan participation changes, call to confirm your specific plan before your first appointment. That one phone call prevents most billing problems in year one, and it belongs with the rest of your preventive care planning.
Your First-Year Screening Calendar
The checklist you leave with is the reason the visit matters. Medicare covers a long list of screenings, each with its own eligibility rule and interval, and Medicare.gov notes that "you pay nothing for most preventive services" when your provider accepts assignment.
Here is what that list looks like in year one, drawn from Medicare.gov coverage pages.
| Screening | Who it applies to | How Medicare covers it |
|---|---|---|
| Cardiovascular disease screening (blood test for cholesterol and lipids) | Everyone with Part B | Once every 5 years, nothing to pay on assignment |
| Diabetes screening | People with risk factors such as high blood pressure, abnormal cholesterol, obesity, or past high blood sugar | Up to 2 each year, nothing to pay on assignment |
| Colorectal cancer screening (colonoscopy) | No minimum age requirement | Every 120 months at average risk, every 24 months at high risk. Nothing to pay, though a coinsurance applies if a polyp is removed |
| Screening mammogram | Women 40 and older | Once every 12 months, nothing to pay on assignment |
| Bone mass measurement | People meeting set conditions, such as estrogen deficiency with osteoporosis risk, X-ray findings, or steroid treatment | Every 24 months, or more often when medically necessary |
| Vaccines: flu, pneumococcal, COVID-19, hepatitis B | Varies by vaccine and risk | Covered under Part B |
| Shingles vaccine | Adults for whom it is recommended | Covered under Part D, nothing to pay if you have Part D |
Medicare's preventive list also covers abdominal aortic aneurysm screening, lung cancer screening with a qualifying smoking history, glaucoma, hepatitis C and HIV screening, depression screening, and obesity counseling. Your provider tells you which apply to you. Our page on health screenings lays out what we handle here.
Diabetes is more common in Hidalgo County than in Texas as a whole, according to Texas Department of State Health Services border health data. That screening column is the part of Medicare that matters most here, and it costs nothing.
Turning 65, Switching Plans, or Arriving for the Winter
Three different people read this in January, and each has a different first step.
You are turning 65. Your Part B start date is the clock that matters. Find it on your red, white, and blue card, count forward 12 months, and set a reminder at month nine. Book the visit in your first few months rather than your last few, because it produces the checklist that drives the rest of the year.
Your new plan takes effect January 1. If you changed coverage in the fall, confirm your doctor participates before you go. A new plan does not reset your wellness visit clock, since eligibility runs from your Part B start date and your last visit. Our article on how to choose a Medicare plan and keep your doctor covers the verification steps.
You spend the winter in the Valley. If your coverage works here for routine care, schedule the wellness visit during your stay along with any labs that come due. Establish care in your first two weeks, while you are well. January is when offices fill.
New Medicare Patients at Giraldo Internal Medicine in McAllen, TX
Dr. Alvaro Giraldo has practiced internal medicine for more than 38 years, and adult primary care is the whole of what this office does. Our team includes Sonia Reyna FNP-C, Alexa Giraldo Patterson MPAS PA-C, Amy Galvan MPAS PA-C, and Karen Baxter MPAS PA-C.
For a patient new to Medicare, that means your Welcome to Medicare visit, the labs that follow it, the EKG when one is indicated, and any chronic conditions found along the way are handled by one team in one place. We draw blood in house, run EKGs and pulmonary function testing on site, and offer telehealth follow-ups. For patients managing two or more chronic conditions, Chronic Care Management and remote patient monitoring add Medicare-covered support between visits.
Our staff is bilingual in English and Spanish, we see patients Saturdays from 9 to 1, and we are accepting new Medicare patients. We accept Medicare and most major insurance. Call to confirm your specific plan.
Giraldo Internal Medicine
1200 Savannah Ave STE 14, McAllen, TX 78503
Phone: (956) 668-0974
Website: giraldointernalmedicine.com
Call us today or visit our website to request an appointment.
Frequently Asked Questions
Q: Is the Welcome to Medicare visit required?
A: No. Nothing requires you to have it, and skipping it does not affect your coverage. It is a benefit you either use or lose, available once in your lifetime during your first 12 months of Part B. The reason to use it is the written prevention plan you leave with, which sets up your screenings for the years ahead.
Q: I have been on Medicare two years and never had one. Is it too late?
A: For the Welcome to Medicare visit, yes. That window closes 12 months after Part B starts and does not reopen. You still have the Annual Wellness Visit every year, at no cost when your provider accepts assignment, and it produces the same kind of written prevention plan. Book that instead.
Q: Can these visits be done by telehealth?
A: The Welcome to Medicare visit includes measurements taken in the room, including height, weight, blood pressure, a vision test, and your balance and gait, so it is normally an in-person appointment. Medicare's telehealth rules have changed several times in recent years. Call (956) 668-0974 and ask what applies right now under your plan.
Q: Is there a cognitive test at the wellness visit?
A: There is a cognitive assessment, which Medicare.gov describes as a check for signs of dementia including Alzheimer's disease. It is brief and not pass-or-fail. Your provider may ask you to recall a few words, name objects, or draw a clock. A concern leads to a fuller evaluation, never to an immediate diagnosis, and several causes of memory change are treatable.
Q: Does Medicare Advantage cover the Welcome to Medicare visit?
A: Yes. Medicare.gov states that Medicare Advantage plans must cover all medically necessary services Original Medicare covers, which includes both preventive visits. The practical difference is the network, since Advantage plans generally require in-network providers for non-emergency care. Confirm participation before you book, and we will check your plan with you.
Q: Can I have my physical and my wellness visit on the same day?
A: Often yes, and it is worth asking about directly. The wellness visit stays covered at no cost, while the comprehensive physical exam is a separate service with its own cost-sharing, since Original Medicare does not cover routine physicals. Ask the office to explain both charges beforehand.
Q: What should I bring to my first Medicare appointment?
A: Your Medicare card and any plan card, a photo ID, a written list of every medication and supplement with doses, your immunization record, contact information for your specialists, records or labs from a previous doctor, your family health history, and your questions. If someone helps manage your care, bring them.
Q: ¿Atienden a pacientes nuevos de Medicare en español?
A: Sí. Giraldo Internal Medicine is a bilingual practice, and the Welcome to Medicare visit, the Annual Wellness Visit, and the written prevention plan are all available in Spanish. A visit built almost entirely on conversation only works in the language you actually think in. Call (956) 668-0974 and ask for your appointment in Spanish.
References and Resources
- Medicare.gov. Welcome to Medicare Preventive Visit. Available at: medicare.gov/coverage/welcome-to-medicare-preventive-visit
- Medicare.gov. Yearly "Wellness" Visits. Available at: medicare.gov/coverage/yearly-wellness-visits
- Centers for Medicare & Medicaid Services (CMS). Medicare Wellness Visits, Initial Preventive Physical Exam (IPPE). Available at: cms.gov/medicare/coverage/preventive-services/medicare-wellness-visits/initial-preventive-physical-exam
- Centers for Medicare & Medicaid Services (CMS). Medicare Wellness Visits, Annual Wellness Visit (AWV). Available at: cms.gov/medicare/coverage/preventive-services/medicare-wellness-visits/annual-wellness-visit
- Medicare.gov. Preventive and Screening Services. Available at: medicare.gov/coverage/preventive-screening-services
- Medicare.gov. Compare Original Medicare and Medicare Advantage. Available at: medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage
- Medicare.gov. Coverage pages for Cardiovascular Disease Screenings, Diabetes Screenings, Colonoscopies, Mammograms, Bone Mass Measurements, and Shingles Shots. Available at: medicare.gov/coverage
- U.S. Preventive Services Task Force. A and B Recommendations. Available at: uspreventiveservicestaskforce.org/uspstf/recommendation-topics
- Texas Department of State Health Services. Texas Health Data, chronic disease indicators by county. Available at: healthdata.dshs.texas.gov
