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Does Medicare Cover An Annual Wellness Visit

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Does Medicare cover an annual wellness visit?

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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What Preventive Medical Visits Does Medicare Cover

Medicare pays for two types of wellness visits: a one-time Welcome to Medicare Visit and an Annual Wellness Visit.

Within the first 12 months you have Medicare Part B, Medicare covers the one-time Welcome to Medicare Visit. It includes a review of your medical and social history related to your health, and education and counseling about preventive services such as certain screenings, shots and referrals for other care that is needed. The visit is a great way to get up-to-date with your doctor about how to stay healthy.

You are eligible for your first Annual Wellness Visit if you have been enrolled in Medicare for more than 12 months and have not had a Welcome to Medicare Visit in the last 12 months.

An official government booklet called Your Guide to Medicares Preventive Servicesexplains in detail all of the preventive services Medicare covers and how often.

What Is An Annual Wellness Visit

It is an opportunity for you and your provider to discuss your current risk for illness and injury and develop a preventive plan of action that includes your choices for future medical care.

During your visit, your provider will:

  • Take your vital signs, such as height, weight and blood pressure
  • Ask questions about your current health status, level of safety and any future health risks
  • Screen for depression, dementia, Alzheimers and other cognitive issues
  • Update your medical history, current medications, and discuss other providers who are contributing to your care

You will have the option to discuss advance care planning with your provider, so that your choices about your future medical care can be documented.

Based on your discussion with your provider:

  • You will work together to develop a written preventive care screening schedule
  • Your provider may offer health advice, education and/or referrals to other providers to reduce risk factors

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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.

What Is An Annual Physical Exam And Does Medicare Advantage Cover This

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An annual physical exam is more extensive than an AWV. It involves a physical exam by a doctor and includes bloodwork and other tests. The annual wellness visit will just include checking routine measurements such as height, weight, and blood pressure. A simple way to remember the difference is that a Medicare wellness exam will include assessments, but wont include physical tests where the doctor has to physically touch you, unless you have a specific diagnosis or symptom. A Medicare Advantage plan will give you access to both the Welcome to Medicare preventive visit and the Medicare AWV. Most of the time, a Medicare Advantage plan will cover annual physicals free of charge.

Aspire Health Plan now pays the doctor so they do not charge the patient a co-pay when the scope of the visit goes outside the AWV. No matter what, wed like to emphasize the importance of scheduling and attending your AWV every year. Its a good idea to see your primary care doctor annually. And as an added perk for Aspire Health Plan members, this helps you earn Aspire Rewards.


  • November 17, 2021 at 11:14 pm, Marva Laymansays:

    Wellness check is a waste of time for patients and doctors office alot of questions are ask and alot of paper work which patient can tell or write down anything a visit that should be eliminated and go back to physical exam

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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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    Can My Annual Wellness Visits Be Done Via Telehealth

    It is best to come into the office for an annual wellness visit. To ensure our practices are safe, we have instituted the following measures:

    • Applying guidance from the Centers for Disease Control and Prevention
    • Expanded cleaning of patient areas
    • Screening patients and their companions
    • Practicing social distancing
    • Applying CDC guidance
    • Constantly evaluating procedures

    In certain cases, you may be eligible to receive your Annual Wellness via a telehealth appointment. Your providers office can help determine if you are eligible.

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    What Should I Expect During My Visit

    A personalized prevention plan will be developed or updated with your healthcare provider to help you stay healthy and well all year long, based on your health needs at the time of the visit. Your Annual Wellness visit may include:

    • A health risk assessment
    • A review or update of your medical and family history
    • Development or update of current providers and medications
    • Documentation of height, weight, blood pressure, and other routine measurements
    • Screening for cognitive impairment such as dementia, memory loss, or Alzheimers disease
    • Health advice and referrals aimed at reducing identified risk factors and promoting wellness
    • A list of risk factors and treatment options for various health conditions
    • A long-term screening checklist for recommended preventive services

    You may be asked to bring a list of medications, medical records, family health history, or other information that may help your healthcare provider develop or update your personalized care plan.

    Posted October 2020

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

    Medicare Annual Physical? Better WATCH OUT!

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

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    What Is A Kaiser Medicare Annual Wellness Visit

    While the Medicare annual wellness visit thats covered by Kaiser Medicare plans is similar to a routine physical, its important to note that the annual wellness visit is not the same thing as a general routine physical. Your annual wellness visit does not actually include a physical examination or lab work.

    The following services are some of the important health steps you can expect as part of your annual wellness visit covered by a Kaiser Medicare plan.

    Ippe Awv & Routine Physical: Know The Differences

    Medicare Preventive Services educational tool has more information.

    No. The IPPE isnt a routine physical that some older adults may get periodically from their physician or other qualified non-physician practitioner . The IPPE is an introduction to Medicare and covered benefits, and focuses on health promotion, disease prevention, and detection to help patients stay well. We encourage providers to inform patients about the AWV and perform such visits. The Social Security Act explicitly prohibits Medicare coverage of routine physical exams.

    No. The AWV isnt a routine physical that some older adults may get periodically from their physician or other qualified NPP. We dont cover routine physical exams.

    No. The IPPE and AWV dont include clinical lab tests, but you may make appropriate referrals for these tests as part of the IPPE or AWV.

    No. We waive the coinsurance, copayment, and Part B deductible for the IPPE . Neither is waived for the screening electrocardiogram .

    No. We waive the coinsurance, copayment, and Part B deductible for the AWV.

    An eligible 2022 patient who hasnt had an IPPE and whose initial enrollment in Part B began in 2022, can get an IPPE in 2023 if its within 12 months of the patients first Part B enrollment effective date.

    We suggest providers check with their MAC for available options to verify patient eligibility. If you have questions, find your MACs website.

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    How Do You Qualify For An Annual Wellness Visit

    If you have Medicare Part B , you qualify for an annual wellness visit if you:

    • Did not have your Welcome to Medicare preventive visit in the past 12 months
    • Have had Part B for more than 12 months
    • Have not had an annual wellness visit in the past 12 months

    You can and should complete a wellness visit once every year. So long as 11 full months pass between appointments, Medicare Part B covers the full cost. That means, if you had your prior wellness visit in January, you do not have to wait until February of the following year for the next one.

    What Happens During The Welcome To Medicare Visit

    Medicare Annual Wellness Visit

    During the visit, your doctor will:

    • record your medical history
    • check your height, weight, and blood pressure
    • calculate your body mass index
    • give you a simple vision test
    • You also can talk with your provider about end-of-life planning, including advance directives. Advance directives are legal documents that allow you to put in writing what kind of health care you would want if you were too ill to speak for yourself. Talking to your family, friends, and health care providers about your wishes is important, but these legal documents make sure your wishes are followed.
    • Depending on your general health and medical history, further tests may be ordered. You will get advice to help you prevent disease, improve your health, and stay well. You will also get a written plan letting you know which screenings and other preventive services you need.

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    Im 72 Years Old And Plan To Schedule An Annual Wellness Visit With My Doctor Will That Include A Check

    AnAnnual Wellness Visit will include a screening blood pressure check, but your doctor will address the memory loss and your hypertension by ordering tests or prescribing medications during an extended part of the visit. This additional treatment will be billed as an office visit, with Medicare paying 80% of the allowed charges and the rest being applied to your deductible or copay.

    Document Code And Bill Correctly

    Once the service is delivered, proper documentation is key. Providers should ensure they document the correct service that’s being delivered, without any ambiguity. This will help ensure the service is coded correctly, which should then allow billers to bill the correct insurance and collect the appropriate amount from patients.

    Education is critical to completing these steps consistently and adequately. Staff should be trained on the differences between a Medicare annual wellness visit vs. annual physical exam vs. IPPE and why those differences matter from a coding, billing, and reimbursement perspective. Consider creating a cheat sheet to help remind staff of the differences when they are completing documentation.

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    How Much Does It Cost

    Your Medicare Annual Wellness Visit will fall under Medicare Part B. Since its considered a Medicare preventive service, there are no out-of-pocket costs. The Medicare Part B deductible does not apply. There is no copay or coinsurance. Medicare covers 100% of the Medicare-approved amount if your healthcare provider is a participating Medicare provider.

    What Is A Medicare Health Risk Assessment

    Annual Wellness Visits (AWV) Video

    All newly enrolled Security Health Plan Medicare Advantage members are encouraged to complete a Health Risk Assessment within 90 days of enrollment. The HRA process is intended to identify members who may have high-risk health care needs and provide baseline health status for care management programs.

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    What Questions Are Asked

    The health risk assessment is a comprehensive health questionnaire designed to help your physician come up with the best prevention plan for you. It will include questions about your lifestyle, medical history, and medications. There are also special Annual Wellness Visit questions that may be relevant in order to identify a list of risk factors or symptoms of certain conditions.

    Examples of some questions include:

    Are Annual Physicals Covered By Medicare Advantage

    Medicare Advantage plans are required to provide the same level of coverage as Original Medicare, so youll be covered for an introductory welcome visit and annual wellness visits. Because Medicare Advantage plans are offered through private health insurance companies, any additional coverage as well as specific copays, deductibles and coinsurance will vary.

    A number of Medicare Advantage plans do cover yearly physical exams, some with a $0 copay. Always read plan and provider network details carefully, and compare benefits to make sure you select the Medicare Advantage plan thats best for you.

    If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE .

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    Everything You Need To Know About Medicare Annual Wellness Visits

    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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    Review Of Medical And Family History

    Medicare Wellness Physical Guidelines

    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.

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    What To Expect At Your Welcome To Medicare Visit

    During the visit your provider will:

    • Record and evaluate your medical and family history, current health conditions and prescriptions.

    • Check your blood pressure, vision, weight and height to get a baseline for your care.

    • Make sure you are up-to-date with preventive screenings and services, such as cancer screenings and shots.

    • Order further tests, depending on your general health and medical history.

    You do not pay a copayment for your “Welcome to Medicare” visit. The Part B deductible does not apply to the cost of the visit either.

    After the visit, your provider will give you a personalized prevention plan or checklist with the screenings and preventive services recommended for you. These services are not part of the “Welcome to Medicare” visit. You may have to pay a co-payment for the recommended services when you get them. Your Part B deductible may also apply.

    Learn more about what to expect at your Medicare wellness visit.

    What Happens At Next Years Wellness Visit

    After your or Welcome to Medicare screening, the appointment changes somewhat. Your doctor measures your weight and blood pressure and updates your Health Assessment Risk. He or she also updates your personal and family medical histories and asks for an updated list of your medications and healthcare providers.

    Your physician performs another cognitive screening and updates your preventive services schedule. Finally, he or she offers advice on current and potential risks, including referrals for preventive counseling and health education.

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