Medicare AdvantageCoverageMedium impact
Reminder: Annual wellness visit covered by calendar year
Harvard Pilgrim Health Care·Geriatrics, Internal Medicine, Family Medicine +1 more·Provider Newsletter
We identified it
Jul 12, 2026
Summary
Tufts Health Plan clarifies that annual wellness visits for Medicare members are covered on a calendar year basis (Jan 1 - Dec 31), not a rolling 365-day basis. Members may receive two covered wellness visits in fewer than 365 days if the visits occur in different calendar years. Billing teams must ensure claims are adjudicated correctly based on calendar year rather than days elapsed since the previous visit.
Action Required
Immediately: Billing team must verify claim adjudication logic in billing software reflects calendar year coverage rules for annual wellness visits (not 365-day rolling period). Review any denied claims from late December 2026 through early January 2027 where a second wellness visit may have been incorrectly denied. Update internal billing guidelines and staff training materials to reflect that visits in different calendar years are separately covered. Providers should be educated to schedule overdue wellness visits strategically, noting that a visit on Dec 31 and Jan 1 of consecutive years are both covered. Failure to apply correct rules will result in inappropriate claim denials for Tufts Senior Care Options and Medicare Preferred members.