Thursday, November 17, 2022

Do Medicare Advantage Plans Cover Annual Wellness Visits

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Is The Medicare Wellness Exam Free

Does Medicare cover an annual wellness visit?

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.

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: | | | | | | | | | | | | | | |

Does Medicare Cover Acupuncture For Lower Back Pain

Acupuncture is only covered by Original Medicare Part B if it is for the treatment of chronic low back pain, and the acupuncture treatment must be administered as part of a doctors care plan for your pain.

What does chronic lower back pain mean? It refers to pain that:

  • Lasts 12 weeks or longer.
  • Has no known cause .
  • Is not associated with surgery or pregnancy.

You can receive up to 12 acupuncture visits within 90 days, and up to eight more if you show improvement in your condition and pain has been reduced as a result. You cannot receive more than 20 treatments in a year. You also need to get acupuncture from a doctor or a medical professional with specific Masters or Doctorate level credentials.

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A Medicare Annual Wellness Visit Vs An Annual Physical Exam

Last year, an article ran in the Washington Post about a Medicare beneficiary who scheduled her annual checkup with her primary care doctor. To her, the appointment seemed like a routine physical, and she assumed that Medicare would pay for the visit until she received a large bill.

Why did this happen? There is a difference between an annual wellness visit and an annual physical exam. One is focused more on preventing disease and disability, while the other is more focused on checking your current overall health. Wed like to clear up any confusion you might have.

What Happens During The Medicare Annual Wellness Visit

Is the Medicare Annual Wellness Visit Mandatory?

The Annual Wellness Visit starts with a Health Risk Assessment . Your HRA includes self-reported information, often in the form of a questionnaire. It should include:

  • Personal medical history, including surgeries, illnesses, allergies, injuries, and medications
  • Family history, including the medical background of your parents, siblings, and children, to determine possible hereditary risks
  • Demographics, such as age, race, gender, and where you live, all of which may increase your risk for certain chronic conditions
  • Personal habits, such as smoking, drinking, and recreational drug use

Your provider may ask you to complete your part of this assessment ahead of time. It typically takes anywhere from 15 to 20 minutes. Be sure to bring a list of your current providers and any medications you take, including supplements and vitamins.

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Is The Annual Wellness Visit The Same As An Annual Physical Exam

Just remember that your annual wellness visit is not a physical exam. If youre confused, dont worry! An annual physical exam may be more extensive than an annual wellness visit. When thinking about the differences, think of the word physical. Your annual wellness visit includes assessments, but the provider doesnt physically touch you, unless you have a specific diagnosis or symptom. The idea is to paint a picture of your health and create a plan for your future care. Your annual physical includes a physical exam, and your provider will check your weight, height, and body mass index .

Be Transparent About Additional Services

Whether you perform an annual wellness exam, annual physical exam, or IPPE, you may determine that it is worthwhile to provide treatments or additional preventative services not necessarily covered under these routine exams. Before proceeding with these treatments or services, explain to patients why you recommend them, and what they are likely to cost patients. Doing so will help avoid the problems previously noted.

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How Much Do You Pay For The Medicare Annual Wellness Visit

Assuming you use a provider who accepts Medicare, Part B covers 100 percent of the cost for the Annual Wellness Visit. However, if you receive any diagnostic tests or have your yearly physical on the same day, charges for those services may include the Part B coinsurance . In addition, the Part B deductible applies.

There is also no out-of-pocket cost for the Annual Wellness Visit if you have a Medicare Advantage plan, assuming you use an in-network provider. This is because all Medicare Advantage plans must provide the same services and benefits that you get with Original Medicare .

Everything You Need To Know About Medicare Annual Wellness Visits

Take Advantage with 2022 UnitedHealthcare Medicare Plans

Did you know that youre eligible for whats known as a Welcome to Medicare preventive visit during the first 12 months of enrolling in Part B? This is a one-time preventive visit with $0 out-of-pocket costs when receiving the service from a provider in our network. Your primary care provider will review your medical history, establish the state of your health, and provide a plan for your future care.

Did you also know once youve had Medicare Part B for longer than 12 months, you may be eligible for an annual wellness visit? This visit provides a snapshot of your current health and is intended to serve as a preventive service. Both the Welcome to Medicare and annual wellness visit have a $0 out of pocket cost for you as long as you see an in-network provider and do not receive diagnostic care during your visit.

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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.

What Is A Medicare Annual Wellness Visit

If you choose standard Medicare coverage, you can opt to have an Annual Wellness Visit with the purpose of creating a personalized prevention plan. In addition, topics such as advance care planning are discussed. When making your appointment, let your doctors office know this is your Annual Wellness Visit. Like the Welcome to Medicare visit, it is not a head-to-toe physical exam. Your AWV is covered if you have been enrolled in standard Medicare coverage for more than 12 months and you have not received another AWV in 12 months. Over time, your personalized prevention plan will be updated based on our current health and risk factors.

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Learn More About Medicare Coverage For Acupuncture

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!

Medicare Annual Wellness Visit Eligibility

Medicare G0438

You’re eligible for the Medicare Annual Wellness Visit as long as you are enrolled in Part B and it’s 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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Do Medicare Advantage Plans Cover Your Annual Physical Exam

Remember that Medicare Advantage plans cover the same services as Medicare Part B. This means your plan will cover your Welcome to Medicare preventive visit and your annual wellness visit. Also, most of the time, a Medicare Advantage plan will cover your annual physical exam. ApexHealth Medicare Advantage Plans do cover an annual routine physical at $0 cost-share to you. Remember to check your Evidence of Coverage for more information about covered benefits that you can take advantage of.

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
  • Weight loss

Medicare’s 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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What Does A Medicare Wellness Visit Include

Routine medical care is important when youre sick or suffering from an ailment, but what about when youre feeling fine? The truth is, scheduling an annual doctors visit to assess your health, often referred to as a wellness visit, is just as important to do when youre feeling fine as it is when youre feeling under the weather. These visits provide your physician the chance to discuss any healthcare concerns you may have, and they also give you the opportunity to ask questions about any medications or supplements youre taking or about changes to your diet or exercise routine.

The Difference Between a Physical and a Wellness Visit

For many people, the terms physical and wellness visit are used interchangeably, but they are actually quite different. During a physical, your doctor carries out a physical exam of your major systems, takes measurements, documents any changes and reviews concerns. During a wellness visit, there is typically no examination that takes place other than a general inspection of the body. A wellness visit is more like checking in with your doctor while a physical is more like an in-depth examination to assess body systems and functions. During a wellness visit, you may bring up a medical concern which prompts a physical exam, and during a physical, you may discuss wellness concerns, but the two are billed as separate types of visits.

What Does a Medicare Wellness Visit Include?

Medicare Coverage Beyond Wellness Visits

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When Do Aetna Medicare Plans Pay For An Annual Wellness Visit

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During your first 12 months having Medicare Part B , you are eligible for a Welcome to Medicare preventive care visit. The Welcome to Medicare visit is similar to your annual wellness visit and provides your doctor with a baseline of your health that will be measured against during your future annual wellness visits.

After your 12th month of Part B enrollment, you are then eligible to receive annual wellness visits once every calendar year. With Aetna Medicare plans, when you undergo a wellness visit late in the year, you may have another covered wellness visit early the following year. There is no need to wait 12 months between visits as long as the visits are in different calendar years.

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Whats The Difference Between A Medicare Annual Wellness Exam And The Initial Preventive Physical Exam

The Initial Preventive Physical Exam is a one-time exam also focused on preventable health diseases that occurs within the first 12 months of your Medicare Part B coverage.

Many of the services you receive during the Welcome to Medicare visit are the same as ones you get during the annual wellness exam , and like the wellness exam, there is no cost to you if your doctor accepts Medicare.

Does Medicare Cover Acupuncture For Vertigo

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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Future Annual Wellness Visits

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. They’ll also take routine measurements and update your screening schedule. Basically, they’ll do everything they did during that first visit. Only this time, they’re updating those baseline findings and making alterations to planned preventive services as needed.

Planning For The Future

Medicare Annual Wellness Visit

Your Medicare Annual Wellness Visit also includes a variety of planning services.

  • A written schedule or checklist of recommended preventive screenings for the next 5 to 10 years
  • List of immunizations recommended by your doctor
  • Advance care planning services, including advance directives, identifying who you want to serve as caregiver should the need arise, the level of care you prefer, and how to have these conversations with your loved ones

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What Is The Medicare Annual Wellness Visit

Once youve been enrolled in Medicare Part B for 12 months, you are eligible for an annual wellness visit each year.

During your Medicare annual wellness visit, you and your doctor can develop and update your personalized prevention plan to help prevent disease and disability based on your risk factors.

As part of this visit, your doctor will ask you to fill out a questionnaire known as a Health Risk Assessment.

Typically, your Health Risk Assessment will include:

  • A review of your medical and family history
  • Height, weight, blood pressure and other routine measurements
  • A list of risk factors and treatment options for you
  • A screening schedule for appropriate preventive services
  • A list of current health care providers and prescriptions

If your doctor accepts Medicare assignment, you typically pay nothing for your Medicare annual wellness visit.

You may have to pay Part B coinsurance, and the Part B deductible may apply if your doctor performs additional services or tests during your Welcome to Medicare visit that arent covered under the preventive benefits of Medicare Part B.

If you have a Medicare Advantage plan, your plan will cover your Annual Wellness Visit, as long as you visit a health care provider who is in your plan network.

Coinsurance and deductible costs can vary based on your plan.

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Preventive Services Under Medicare Advantage Plans

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Preventative care services are important for everyone, especially seniors. The risk for health problems increases with age, and by preventing problems or identifying them early, seniors can enjoy longer, healthier lives. Some preventative services that are particularly important for older adults include annual wellness exams, influenza and pneumococcal vaccines, and screenings for diabetes, high blood pressure, cholesterol, osteoporosis and certain cancers.

Medicare Advantage plans provide coverage for preventative care services, though coverage details vary widely from one plan to another. Before enrolling in a plan, seniors should understand a plans preventative care coverage details, particularly if they are at an increased risk for developing conditions like high blood pressure or osteoporosis.

In this guide, weve outlined how Medicare Advantage plans work, how to know what a Medicare Advantage plan covers and some of seniors most frequently asked questions about their healthcare coverage through Medicare Advantage.

What Is Included In The Welcome To Medicare Visit

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Your Welcome to Medicare preventive visit is a one-time visit that is covered by Medicare Part B within first 12 months that you are enrolled in Medicare Part B.

During your Welcome to Medicare visit, you and your doctor will review your medical history, which may include:

  • Height, weight and blood pressure measurements
  • A simple vision test
  • Certain screenings
  • Flu and pneumococcal shots

If you doctor accepts Medicare assignment, you typically pay nothing for your Welcome to Medicare visit.

If your doctor performs additional services or tests during your Welcome to Medicare visit that arent covered under the preventive benefits of Medicare Part B, you may have to pay a 20 percent Part B coinsurance .

If you enrolled in a Medicare Advantage plan when you were first eligible for Medicare Part B, your Medicare Advantage plan will cover your Welcome to Medicare visit within the first 12 months that you have the plan.

You must visit a doctor who is in your plans provider network.

If you have a Medicare Advantage plan, your coinsurance and deductible costs may vary. If a service is fully covered by Medicare Part B, it will be fully covered by your Medicare Advantage plan.

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