Know The Difference Before You Schedule An Appointment
You probably know that having an annual check-up with your primary care doctor is a good idea for several reasons. A yearly appointment gives your doctor an opportunity to check on your general health, look for anything unusual and talk with you about your concerns.
However, the words annual check-up may not mean the same thing to everyone especially if you have a Medicare plan. Medicare Part B, part of Original Medicare, covers annual wellness visits that may include basic preventive services, but they are not full head-to-toe physical exams.
During a full physical exam, your doctor may listen to your heart and lungs, feel your neck and abdominal area, test your reflexes and more, says Shantu Patel, MD, an internal medicine physician at Scripps Coastal Medical Center Vista. If needed, we also may recommend lab work, such as a cholesterol screening or a thyroid test.
None of these are part of a Medicare wellness visit. Moreover, according to the Centers for Medicare & Medicaid Services, Medicare wellness visits cannot be used to directly treat an illness or chronic condition, such as diabetes or arthritis.
If your exam goes beyond the limitations of what Medicare covers, you may have to pay the full cost out of your own pocket unless you have a supplemental plan that covers what Medicare doesnt.
Read on to understand what Medicare Part B visits cover and when.
If youre new to Medicare Part B
The initial preventive physical exam includes:
Continuing preventive care
What Does It Include
The Welcome to Medicare physical is an initial visit that provides the doctor with baseline measurements for monitoring a persons health.
Healthcare professionals use these initial measurements for comparison in subsequent AWVs or other visits to assess someones ongoing health status.
During the visit, the doctor will take a range of measurements, including:
- respiration rate
The doctor will also assess the persons mental health and their ability to function safely in the home and wider community.
In addition to this basic examination, the doctor will also ask questions regarding the persons family history of certain conditions and their personal medical history.
These questions may cover:
- any previous illnesses, conditions, or surgical procedures
- diseases or conditions that family members have experienced
- lifestyle factors, such as diet, exercise, smoking, and alcohol use
- any medications and dietary supplements
This information allows the doctor to determine any risk factors for future illnesses or conditions. They can then recommend appropriate screening measures or further tests.
The doctor can also schedule appointments for routine preventive care, including:
- male and female health checks
Depending on the individuals needs, the doctor also may provide education and counseling for specific health conditions or referrals to other healthcare professionals.
Does Medicare Require A Wellness Exam
Medicare does not require a wellness exam however, its still important to take advantage of this important benefit. Thats because the wellness exam gives you an opportunity to get personalized health advice.
You can talk about any healthcare concerns you may have, ask questions about your medications, talk about changes to your diet or exercise routine and more.
You May Like: Does Medicare Medicaid Cover Dentures
Annual Wellness Visit Health Risk Assessment
The AWV includes a HRA. See summary below of the minimum elements in the HRA. Get more information in the CDCs A Framework for Patient-Centered Health Risk Assessments booklet, including:
- Evidence suggests HRA use and follow-up interventions can positively influence health behaviors
- Definition of the HRA framework and rationale for its use
- Guidance on HRA use, reduction of health disparities, and improving health outcomes through identifying modifiable health risks and providing behavior change interventions
- Sample HRA
Perform Health Risk Assessment
- Get patient self-reported information
- You or the patient complete the HRA before or during the AWV it shouldnt take more than 20 minutes
1.Establish patients medical and family history
At a minimum, document:
2.Establish list of current providers and suppliers
12. Screen for potential Substance Use Disorders
1. Review and update Health Risk Assessment
How Will The Exam Help Me
This “welcome to Medicare” exam is extremely comprehensive. When you have a very comprehensive examination, it allows your doctor and Medicare to detect any conditions that may be developing and recommend treatment immediately. It is not uncommon for you to feel perfectly healthy but have a potentially dangerous condition developing. The tests in this exam help to analyze your heart, your eyes, your ears and any other part of your body where a dangerous condition could be starting. If the tests come back that indicate a potential problem, your doctor will work with Medicare to get you further testing and treatment.
You May Like: What Is Medicare Open Enrollment
What Is An Annual Wellness Visit
Theres a common misconception in the medical industry that annual wellness visits are the same thing as an annual physical exam. This likely comes with most people being familiar with annual physical exams or checkups, and assuming that an annual wellness visit is the same thing. However, they are quite different.
Medicares Annual Wellness Visits are yearly preventive visits for Medicare patients to create or update a personalized prevention plan. These preventative visits are designed to give the patient the opportunity to explain to their provider how they feel about their health status by filling out a health risk assessment. The provider is then able to use the collected information to identify risk factors, suggest appropriate preventive services, and create a personalized prevention plan for the patient.
These visits are comprised of three main components:
Understanding Why Medicare Does Not Pay For Annual Physical Exams
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.”
You May Like: What Is A Medicare Special Needs Plan
What Can I Do To Prepare For The Medicare Annual Wellness Exam
There are several ways you can prepare for this exam. For example, you can write down all medications you take or put them in a bag to bring with you to the appointment. This includes prescriptions, non-prescriptions, vitamins, supplements and herbal medications. Also write down your family medical history so you dont forget anything.
Likewise, you can compile a list of all the healthcare providers you see, including their full names, addresses and phone numbers.
Another helpful way to prepare is to jot down any health-related questions or concerns in advance. You can hand the paper directly to your physician, or you can read the questions aloud. Bring a notebook with you to write down important information and advice.
If your appointment is via telehealth, be sure you know the steps to log onto the telehealth platform, and have your computer or mobile device fully charged and ready to go.
Make an appointment with your doctor today for your Medicare Annual Wellness Visit, or call a licensed insurance agent to learn about additional preventive care benefits that may be available in some Medicare Advantage plans.
Find Medicare Advantage plans in your area
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Lisa currently resides in Cranston, Rhode Island with her wife and two-year-old twin boys.
What To Expect During Your Medicare Wellness Exam
Your Medicare AWV is mostly a simple conversation with your doctor. Together, youll review your current health and talk about a personalized prevention plan. The wellness exam isnt a full physical exam, Dr. Solava says. The purpose of the visit is to prevent conditions we typically look for in the over-65 population.
Your physician will conduct routine measurements, such as height, weight, and blood pressure. If necessary, your doctor will address acute complaints, such as shortness of breath or chest pain, and perform additional physical assessments. Just know that if your physician adds a service or attends to an acute issue, you may be charged for that extra medical care.
However, if your doctor decides its in your best interest, the visit may include:
Recommended Reading: Does Medicare Cover Depends For Incontinence
Annual Wellness Visits: Not Required But Worth It
Medicare recipients are eligible for an annual wellness visit once theyve had Medicare Part B for 12 months or more. According to Medicare.gov, the goal of the visit is to develop or update a personalized prevention plan, designed to help prevent disease and disability based on your current health and risk factors.
Patients complete a health risk assessment, and providers typically complete a medical and family history review as well as take patients height, weight, blood pressure, and other routine measurements. Providers may also discuss recommended preventative services and screenings.
In an opinion piece for STAT, Does Medicares free annual wellness visit do any good?, Ishani Ganguili, MD, an instructor of medicine at Harvard Medicine School and primary care physician at Brigham and Womens Hospital, questions the utility of the annual wellness visits.
Dr. Ganguili says that while the exam requires clinicians to run through a lengthy list of tasks like screening for dementia and depression, discussing care preferences at the end of life, and asking patients if they can cook and clean independently. . .Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.
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. Medicare covers 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.
- 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.
Read Also: Does Humana Offer A Medicare Supplement Plan
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.
Invest In Preventive Services Technology
Investing in the right technology can help your practice reduce the time spent on preventive services, such as the annual wellness exam, while increasing reimbursements. One such technology is Prevounce. This customizable, holistic wellness platform improves eligibility verification, patient outreach and intake, billing and coding, documentation requirements, compliance , and much more. Schedule a demo today!
Read Also: When Do You Get Medicare When On Disability
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 Does The Physical Exam Include
The exam is a complete physical that is covered by Medicare. It includes standard examinations to check your blood pressure, your vision, your height and your weight. You are also either given an EKG to check your heart either on the spot or the doctor gives you a referral to have an EKG scheduled at a Medicare-approved facility. The doctor will make a full record of your current medical condition and will also review your history on inoculations. If you require any shots, then the doctor will provide them and make a note of it. The final part of the examination consists of the doctor introducing you to the preventative care services Medicare has to offer and then making suggestions on which services you would best benefit from.
You May Like: When Can I Start Collecting Medicare Benefits
Whats Included In A Physical Exam
An annual physical exam is an assessment of your bodys health. The primary purpose is to look for health problems.
During the exam, your doctor uses his or her senses mainly sight, touch and hearing to gauge how your body is performing. Based on whats learned, your doctor may ask you to have tests to discover or rule out possible health problems.
The list below shows some of the things your doctor may do during a physical exam.
- Visually check your body overall for signs of existing health issues
- Look into your eyes, ears, nose and throat for potential problems
- Listen to your heart and lungs to detect irregular sounds
- Touch parts of your body to feel for abnormalities
- Test your motor function and reflexes
- Perform pelvic and rectal exams
- Measure your height, weight and blood pressure
As a rule, Medicare does not cover an annual physical. The exam and any tests your doctor orders are separate services, and you may have costs related to each depending on your Medicare plan.
Annual Physical Exam: The Basics
The physical exam is an essential part of any doctor’s visit. Surprisingly, though, there are no absolutes in a routine physical. A good doctor may be thorough or brief, but they will spend time listening to your concerns and providing counseling for your particular complaints and risk factors.
Annual exams usually check your:
History. This is your chance to mention any complaints or concerns about your health. Your doctor will also likely quiz you about lifestyle behaviors like smoking, excessive alcohol use, sexual health, diet, and exercise. The doctor will also check on your vaccination status and update your personal and family medical history.
Vital Signs. These are some vital signs checked by your doctor:
- Blood pressure: Less than 120 over less than 80 is a normal blood pressure. Doctors define high blood pressure as 130 over 80 or higher.
- Heart rate: Values between 60 and 100 are considered normal. Many healthy people have heart rates slower than 60, however.
- Respiration rate: From 12 to 16 breaths per minute is normal for a healthy adult. Breathing more than 20 times per minute can suggest heart or lung problems.
- Temperature: 98.6 degrees Fahrenheit is the average, but healthy people can have resting temperatures slightly higher or lower.
Whats Included In The Medicare Annual Wellness Exam
First, your primary care doctor will ask you to fill out a questionnaire called a Health Risk Assessment that evaluates your health status, frailty and physical functioning.
It also assesses other aspects of your health, such as:
- Psychosocial risks
- Behavioral risks
- Activities of daily living
After reviewing this assessment, your primary care doctor will likely provide a variety of other services and talk to you about preventable health diseases.
In particular, they will:
- Review your medical and family history
- Develop or update a list of your current providers and prescriptions
- Take routine measurements such as height, weight and blood pressure
- Assess for any cognitive impairment
- Talk to you about screenings, vaccinations and other preventive services.
They may also provide advance care planning, which refers to planning for care you would receive if you became unable to speak for yourself.