A memory check is a required part of the Medicare Annual Wellness Visit, and for most people it takes only a few minutes of the appointment. Medicare Part B covers the visit once every 12 months for anyone enrolled in Part B for more than a year, and Medicare's own coverage page lists "detection of any cognitive impairment" as one of the elements — with no copay and no deductible when the provider accepts assignment. What that element looks like in practice varies widely, because Medicare specifies the goal and not the method. Expect some combination of questions on a health questionnaire, a short three-to-five-minute test, and the doctor's own observation of how you answer and follow instructions.
Table of Contents
- What Medicare requires, and what it leaves open
- What a brief screen actually feels like
- Screening is required at the visit, but not recommended for everyone
- The most common outcome is that nothing happens
- What happens if the screen raises concern
- How to make the cognitive element actually happen
- Frequently Asked Questions
What Medicare requires, and what it leaves open
The Annual Wellness Visit is not a physical exam. It is a prevention-planning appointment: a health risk assessment, a medication review, a screening schedule, and a personalized prevention plan. Cognitive detection sits inside that structure. CMS deliberately named no required screening instrument.
According to the Alzheimer's Association's guidance for clinicians, that choice was made because no single brief test meets every detection need. Detection is expected to come from three sources instead: the memory questions on the health risk assessment, the clinician's direct observation during the visit, and concerns raised by the patient, a family member, or a caregiver. That third source matters more than most families realize. A caregiver's remark about repeated questions or a missed bill carries the same weight in the requirement as any printed test, and it is often the only thing that triggers one.
What a brief screen actually feels like
If a formal test is given, it is short. The Mini-Cog, one of the briefest validated options, takes about three minutes: the patient repeats and later recalls three unrelated words, and in between draws a clock face showing a specified time. Scoring is simple. Per the standardized Mini-Cog instructions, recall is worth 0 to 3 points and the clock drawing 0 to 2, for a total out of 5.
A score of 0 to 2 is a positive screen, and the instructions note that a cut point below 4 can be used when greater sensitivity is wanted. A positive screen is not a diagnosis. It is a signal that a fuller evaluation is warranted, and it can be affected by hearing loss, poor sleep, a new medication, depression, or an unfamiliar testing environment. Longer instruments exist — the Alzheimer's Association's 2025 primary-care guideline reviewed ten brief tests, including the MoCA, SLUMS, GPCOG, AD8 and MIS, for use in ambulatory adults 55 and older.
Screening is required at the visit, but not recommended for everyone
These two facts sit side by side and confuse a lot of people. Medicare requires the cognitive element as part of the covered visit. The U.S. Preventive Services Task Force, after reviewing 59 studies of 49 instruments, concluded on February 25, 2020 that the evidence is insufficient to weigh the benefits and harms of screening community-dwelling adults 65 and older who have no recognized symptoms.
That is an "I statement" — neither for nor against. It reflects uncertainty about whether finding impairment early in someone with no symptoms leads to better outcomes, not a judgment that testing is harmful. The practical reading for a family: if someone has noticed a change, pursue assessment, because that person is no longer in the asymptomatic group the Task Force was describing. If nobody has noticed anything, a brief screen at the wellness visit is reasonable and free, and a normal result is a useful baseline for comparison next year.
The most common outcome is that nothing happens
This is the gap that catches families off guard. A national survey published in Alzheimer's & Dementia in 2025 found that only 31% of Medicare beneficiaries received formal cognitive testing at their Annual Wellness Visit, and 35% were simply asked whether they had memory problems. People at higher risk of impairment were no more likely to be tested than anyone else. Raising a concern does not reliably fix it either.
A 2026 study by Wec and colleagues looked at 1,801 visits where patients reported memory concerns, with a mean patient age of 78. Roughly 8% had any documented follow-up — 5.4% received a cognitive assessment and 2.1% got a specialist referral. Patients often do not know to ask. The Alzheimer's Association's 2026 Facts and Figures reports that about half of older adults have ever discussed thinking or memory with a provider, under a third have ever been assessed, only 16% get regular assessments, and just one in three knew cognition is supposed to be part of the wellness visit at all.
What happens if the screen raises concern
Medicare pays for a separate, much fuller evaluation, billed under CPT code 99483. It is a different appointment, not an extension of the wellness visit, and it is substantial: CMS guidance describes roughly 50 minutes of face-to-face time and documentation of a defined set of clinical elements, including a care plan. One requirement shapes who needs to be in the room. The service requires an independent historian — a spouse, adult child, or another person who knows the patient well and can describe changes the patient may not report.
Booking that appointment without arranging for that person to attend can mean it cannot be completed as billed. Blood testing is now part of the diagnostic picture, but not at this stage. Fujirebio's Lumipulse G pTau217/β-Amyloid 1-42 plasma ratio received FDA clearance on May 16, 2025 as the first Alzheimer's blood test, and it is cleared only for symptomatic patients 55 and older seen in specialized care. It is not a screening test for an asymptomatic wellness visit, and a primary care office should not be ordering it as one.
How to make the cognitive element actually happen
The visit is scheduled, brief, and full of competing items. A little preparation moves the memory portion from optional to concrete. If the office declines to test and the concern is real, the 99483 evaluation is a separate covered service you can ask to be scheduled for on its own, with the independent historian present.
- Confirm you are booking the Annual Wellness Visit, not a routine physical or a problem visit — the cognitive element belongs to the wellness visit, and the cost protection applies to it.
- Bring one person who sees the patient regularly. Caregiver-reported concern is one of the three sources Medicare expects detection to come from.
- Write down two or three specific examples before you go: a missed medication dose, a repeated question, a wrong turn on a familiar route, a bill paid twice. Specifics get documented; "seems more forgetful" often does not.
- Ask directly for a brief validated test by name — the Mini-Cog or MoCA — rather than asking whether memory "looks okay."
- Ask that both the concern and the result be entered in the chart, and ask what the next step is if the screen is positive.
Frequently Asked Questions
Does the memory screening cost anything?
No, when the provider accepts assignment. Medicare.gov states the Annual Wellness Visit carries no copay and the Part B deductible does not apply, provided you have been enrolled in Part B for more than 12 months and have not had the visit in the past 12 months.
Can I refuse the cognitive portion?
Yes. It is a covered element of the visit, not a condition of receiving it. Declining is worth discussing first, though, since a normal result recorded this year becomes the comparison point for any concern raised later.
Is a low Mini-Cog score a dementia diagnosis?
No. The Mini-Cog is a screen scored out of 5, where 0 to 2 is positive. It indicates that a fuller evaluation is warranted, and scores can be lowered by hearing loss, depression, medication effects, or poor sleep.