Monday, February 26, 2024

Do Medicare Advantage Plans Cover Annual Physicals

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Understanding Why Medicare Does Not Pay For Annual Physical Exams

Does Medicare Cover An Annual Physical? | (Tips that can save you $$ !)

Now that we’ve summarized the different services provided during these annual exams and visits, we can examine why Medicare only covers annual wellness visits and not annual physical exams.

The reason becomes more apparent when we simplify the differences between an annual physical exam and an annual wellness visit. As the KHN article referenced earlier states, “An annual physical typically involves an exam by a doctor along with bloodwork or other tests. The annual wellness visit generally doesn’t include a physical exam, except to check routine measurements such as height, weight and blood pressure.” The UNC School of Medicine notes, “Medicare wellness visits are designed to improve your overall health care by providing a more detailed look at your health risks based on family history and health behaviors and more.”

Think of the annual physical exam as more of a “hands-on” experience, whereas the annual wellness visit takes a “hands-off” approach to evaluation. It would seem that when the federal government was debating what to cover within traditional Medicare, the decision was to cover the broader look at a beneficiary’s health. In discussing the annual wellness visits, AARP states, “The visit provides a snapshot of your current health as a baseline for future yearly visits, and is intended as a preventive service a way of catching potentially serious health issues early.”

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Many people believe that acupuncture can help with a variety of conditions, including vertigo. However, Medicare doesnt provide coverage for acupuncture treatments for these ailments.

If you have vertigo, you might see your doctor about getting other medical treatments that would be covered by Medicare. In many instances, you can do exercises at home that help vertigo go away without further medical care or need for treatment. However, you may also need medication or even surgery, depending on the cause.

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Medicare Annual Wellness Visit Eligibility

Youâre eligible for the Medicare Annual Wellness Visit as long as you are enrolled in Part B and itâs been 12 months since your last AWV. In addition, you cannot be in your first year of having Medicare Part B.

The list of Medicare-approved providers who can perform this screening includes:

  • Either a medical doctor or a doctor of osteopathy
  • Physician assistant
  • Certified clinical nurse specialist
  • Other licensed medical professional, such as registered dietician, health educator, or nutrition professional

Your AWV may also be performed by a team of medical professionals, under the guidance of your doctor.

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Ways That Physical Therapy Can Help Seniors

There are several reasons why a senior citizen might undergo physical therapy, such as:

  • Recovering from a fall, accident or strokeFalls are the most common type of accident for seniors, and they often result in broken bones and other injuries. Physical therapy can help you recover from a fall and regain strength in your affected body part.Seniors who suffer a stroke are also often left with one weaker hand or arm. As with recovering from a broken bone, physical therapy can help you rebuild strength and range of motion in your affected limbs.
  • Recovering from a surgeryMany older adults find themselves confined to bed for weeks after undergoing surgery. After an initial resting period, physical therapy helps many recovering seniors regain the strength and range of motion that they enjoyed before their procedure.
  • Avoiding surgeryA person may be able to avoid having surgery altogether by successfully rehabilitating an injury through physical therapy, if their doctor agrees to this treatment option.
  • Alleviating chronic painPhysical therapy can be an effective form of pain relief for chronic pain conditions such as arthritis and osteoporosis.
  • Reducing dependence on prescription medicationsFinding pain relief through physical therapy can reduce or eliminate ones dependency on pain killing medication.
  • Physical therapy can help seniors develop strength, flexibility and endurance, which are especially helpful in helping prevent falls and keeping seniors healthy and happy overall.

    Future Annual Wellness Visits

    Patient Resources

    Medicare covers an AWV every 12 months. During your subsequent Annual Wellness Visits, your provider will update all information as required, including healthcare providers, medical equipment suppliers, and medications you take. Theyâll also take routine measurements and update your screening schedule. Basically, theyâll do everything they did during that first visit. Only this time, theyâre updating those baseline findings and making alterations to planned preventive services as needed.

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    Whats The Difference Between The Two

    You may have been looking through your Medicare benefits and wondering how does an annual wellness exam compare to a physical? What are they and why do you need both? We can give you the details.

    During a Medicare annual wellness visit, your doctor doesnt give a physical exam, except for taking routine measurements. Theyll ask questions and give advice, too. The purpose of a wellness visit is to develop a plan just for you, based on your health and risk factors. Its a type of preventive care, meant to take care of any health issues before they get serious.

    Your doctor will have you fill out a series of questions called a Health Risk Assessment about your general health. They will ask for and look at:

    • Your medical history and family medical history
    • Your doctors and prescriptions
    • Your body measurements like height, weight and blood pressure

    Then theyll go over:

    • General health advice
    • Any risk factors you have and options for treating them
    • A schedule for health screenings, shots and other preventive services
    • Planning for advanced care

    Your doctor will test you for signs of dementia and Alzheimers, too. Theyll see if you have trouble making everyday decisions, remembering details, learning new things and concentrating. If they see signs of mental decline, theyll recommend you for further visits to check your brain health.

    Whats Included In A Medicare Wellness Visit

    A Medicare Wellness Visit, also called a wellness exam, is an assessment of your overall health and well-being. The primary purpose is prevention either to develop or update your personalized prevention plan. Medicarecovers a wellness visit once every 12 months , and you are eligible for this benefit after you have had Part B for at least 12 months.

    During the exam, your primary care provider combines information from the visit with your medical record to gauge your risk for common preventable health problems such as heart disease, cancer and type 2 diabetes. Based on whats learned, your doctor creates your personal prevention plan with a checklist of screenings you need to have.

    The list below shows some of the things your doctor may do during a wellness exam.

    • Review your health risk assessment

    • Confirm your medical and family history

    • Record your current prescriptions and providers

    • Measure and document your height, weight, and blood pressure

    • Look for signs of memory loss, dementia, or frailty

    • Document your health risk factors and treatment options

    • Provide personalized health advice

    • Develop a screening schedule for the preventive services recommended for you

    Medicare Part B covers an annual wellness exam and many preventive screenings with no copay or deductible. However, you may have to pay a share of the cost for certain recommended tests or services. And while its not mandatory, there are very good reasons to have a wellness exam every year.

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    Medicare Advantage Plan Members Can Now Get One Wellness Visit Per Calendar Year

    Beginning , Medicare Advantage plan members can now get their annual wellness visit once per calendar year instead of once every 366 days. This means even your patients who had their annual wellness visits late in the calendar year can be scheduled early in the next calendar year. This gives patients more time to focus on their health during the year.

    For language services, please call the number on your member ID card and request an operator. For other language services: | | | | | | | | | | | | | | |

    Medicare Advantage New And Established Patients:

    Medicare Annual Physical? Better WATCH OUT!

    InterMed participates with the following Medicare Advantage Plans:

    • Aetna Medicare Advantage HMO, PPO, and PFFS
    • Anthem Medicare Advantage HMO, PPO, and PFFS
    • Humana Medicaid Advantage PPO, POS, PFFS, and HMO Plans
    • Medicare Advantage HMO, HMO-POS, PPO, and HMO SNP Plans
    • WellCare Medicare Advantage PPO, and PFFS
    • UnitedHealthcare Medicare Advantage Benefit Plans

    InterMed does not accept any other Medicare Advantage Plans

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    Is The Medicare Wellness Exam Free

    Yes, the Medicare annual wellness exam is a Medicare-covered service as long as your primary care doctor accepts Medicare. It wont cost you anything unless your doctor performs additional tests or services during the same exam. If they do, you may owe a coinsurance or copayment depending on the service provided.

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    Costs Of Preventive Care Visits

    Braven Health Medicare Advantage Plan members pay $0 for both an in-network annual wellness visit and an in-network annual physical exam.

    But you may have additional cost-sharing if:

    • Your doctor or other health care provider performs further tests or services during the same visit.
    • These added tests or services aren’t covered under the preventive benefits.

    Medicare. Yearly Wellness visits. Retrieved March 28, 2022 from

    The material provided by Braven Health is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.


    Does Medicare Cover A Yearly Physical

    Wellness Physical For Medicare

    No, Medicare does not cover a yearly physical. This is because this is a more extensive exam and may also include additional services that are not covered. These could be head and neck, lung, and neurological exams, or blood or lab tests. Each may have different costs depending on your Medicare coverage.

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    Review Of Medical And Family History

    A review of your medical history will identify which conditions may be of increased risk to you. Reviewing your familys medical history can reveal any hereditary conditions worth monitoring, as some health conditions could become risks for you if they are prevalent in your family health history.

    This step is especially important during your very first wellness visit, as it will provide your doctor with a baseline of your overall health, create an opportunity for early detection and pinpoint any areas that need improvement.

    Does Medicare Cover Medical Physicals

    Medicare does not technically cover medical physical exams. They do, however, cover preventive wellness exams. Dont get caught up in the language of physical. Medicare covers an annual Medicare Wellness exam that will takes measurements, gives your scheduled screenings, and reviews other health issues, such as personal risk factors. This exam is at no cost to you, as long you dont require additional diagnostic testing or more frequent screenings than approved by Medicare. The important thing to remember that your wellness exam does not do every screening each year.

    For example:Cholesterol screenings are only scheduled once every 5 years under Medicare. If your doctor or other health care provider request that you have more frequent screenings, you may have to pay your Part B deductible, copays, and coinsurance.

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    Detection Of Cognitive Impairment

    Cognitive impairment can be a part of aging, and early detection is key. During your annual wellness visit, your doctor will screen you for Alzheimers and dementia along with mood disorders like depression. Additional tests may be ordered if your doctor feels they are warranted from the results of initial screening.

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    If you are eligible for Medicare, you may be eligible to join Plan G. American citizens are eligible for supplemental insurance, and they are eligible for the insurance. Working ten years & more is required under Part B without deductibles or supplementary benefits. If you didn’t work 10 years in US health care facilities or if they have not replaced you with Medicare you can continue with it. Most people are able to get a disability benefit from Social Security if they reach 65. There is only one exception to Medicare for patients with ALS.

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    What Is A Welcome To Medicare Preventive Visit

    A Welcome to Medicare preventive visit involves reviewing your medical history along with performing some basic measurements, screenings and services, which include:

    • Blood pressure measurement.

    • Height, weight and body mass index.

    • Basic vision test.

    • Some health screenings and referrals for necessary care.

    • Depression risk assessment.

    • Advance directives discussion, if desired.

    • A written plan detailing which screenings, vaccinations and other preventive services are appropriate for you.

    Be sure to let your doctors office know that the appointment is specifically for a Welcome to Medicare visit, so the staff will submit your claim properly and youll be covered.

    To prepare for your Welcome to Medicare visit, bring a list of any prescription medications, over-the-counter drugs, supplements and vitamins you use along with your medical and immunization records as well as your familys health history if you have access to that information.

    Welcome To Medicare Visits

    • Medicare Part B, as well as Medicare Advantage health plans, encourages you to schedule a one-time, Welcome to Medicare preventive visit with your provider within the first 12 months of becoming Medicare-eligible.
    • The visit includes a thorough review of your health, as well as education and counseling about preventive services you may need screenings, vaccines, and referrals for other care.
    • While not mandatory, this visit is useful for new Medicare beneficiaries to review your current healthcare status and to identify any services that may be necessary to keep you healthy.
    • This visit requires specific paperwork be completed before the visit so that you and your provider can review the details together. A limited hands-on examination may be performed, but the real focus of this visit is for you and your provider to discuss a comprehensive review of your health.

    For patients with Medicare Advantage health plans, both a traditional Physical Exam and the Welcome to Medicare Visit may be covered benefits. Check with your health plan for eligibility. If you wish to change your currently scheduled annual Physical Exam to a Welcome to Medicare Visit, or to combine visit types in a single appointment, please contact your doctors office as soon as possible. Please be aware that changing the appointment type could result in a date or time change of your upcoming appointment.

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    Providing Personalized Health Advice

    Based on the information you provide as well as their personal assessment, your medical provider should offer information and/or referrals for any relevant services of programs covered by Medicare. This may include:

    • Nutrition information
    • Tobacco use cessation assistance

    Medicareâs preventive services include a variety of programs, like personal and group counseling, designed to support a holistic approach to wellness. For example, if you are at risk of diabetes, your provider would likely suggest nutrition counseling to develop healthy eating habits and an exercise regimen. Both of these would help reduce your risk of developing diabetes. Or, if you already have diabetes, they will help you manage your condition.

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    Does Medicare Part B Cover Annual Physical Exams

    Medicare Annual Enrollment Period: What You Need To Know

    Medicare Part B does not cover traditional annual physical exams. However, Medicare does cover a yearly service called an annual wellness visit . At your first AWV, your doctor will cover many of the same components as your IPPE, including:

    • personal medical history
    • personal safety level
    • substance use disorder screening

    Using this information, your physician will recommend a preventive screening schedule and provide you with any other health advice or referrals you may need. You may also choose to speak with your doctor about advance care planning, which is an optional Medicare service in which you can discuss your health wishes for the future if you suddenly become unable to communicate them.

    Your AWV also includes a questionnaire called a health risk assessment, which helps your physician collect more information about lifestyle and health risks. Generally, the health risk assessment takes less than 30 minutes and covers a variety of topics, including:

    • depression, stress, anger, social activity, pain and fatigue levels
    • tobacco and alcohol use
    • ability to perform personal activities, such as getting dressed and eating food
    • daily living activities, such as laundry, grocery shopping and finances

    After your initial AWV, each follow-up AWV will include another quick physical exam, followed by an update on all the information your physician gathered at your previous AWV.

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    Medicares coverage of acupuncture for chronic lower back pain is a very recent development, and its one that shines a light on the effectiveness of naturopathic treatment in some cases.

    If you have more questions about Medicare and acupuncture, or youd like to compare Medicare plans to choose the right ones for your needs, talking to a licensed agent can help. Contact us today for more information!

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