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What to Know About Medicare Wellness Visits
The Medicare Annual Wellness visit is an included, preventive healthcare benefit with focus on staying healthy and preventing illness. It is not mandatory but rather a voluntary option available to take advantage of at no additional charge. Here's what to expect from this annual health care visit.
Things Included in Your Annual Wellness Visit
Your primary care provider will assess overall health and suggest a prevention plan with the intent of addressing any looming health issues and risk factors involved.
It can be a full-body physical, as well as a one on one time with your doctor, address any concerns and review any past concerns. Usually there is a written checklist the doctor will go through to check on a variety of areas.
Here are a few things your doctor might discuss during the Annual Wellness Visit:
- Routine measurements
- Height, weight and blood pressure check
- Health risk assessment consisting of questions about healthcare status, needs, and risks
- Review of medical history and family medical history
- Check list of current medications
- Assessment of functional ability and mobility – (ie, handling tasks of daily living like eating, transferring, bathing, and dressing)
- Screenings for hearing, dementia, and depression
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The Annual Wellness Visit is also an opportunity for the doctor to update your list of preferred providers, prescription drugs and provide some general health advice. It gives the doctor a chance to evaluate, connect, advise and make changes as needed.
If necessary, this visit will also provide an opportunity for the doctor to assess any specialty visits that may be helpful. They may also help you schedule appropriate appointments for immunizations, preventative health care services, like diabetes screenings or mammograms.
Medicare Pays for One Wellness Visit Every Year
Every year each Medicare beneficiary is eligible for one wellness visit. Any further appointments will be to address issues discussed during the wellness visit.
The whole cost of the annual wellness visit is covered by Medicare Part B as long as the provider accepts Medicare as the primary insurance. Some physicians will not accept Medicare as a primary insurance. Therefore, if Original Medicare is the only insurance plan in place, providers may charge an additional fee, called an excess charge, or may not be willing to accept it.
If the doctor diagnoses or treats something new or treats an existing condition during the wellness visit, it becomes part of diagnostic care. Medicare can bill separately for that. Medicare Part B will pay for 80% of the cost of the care, but only after your Part B deductible has been paid.
Most, but not all, Medigap plans will help cover this diagnostic care bill and it depends on which Medigap plan you're enrolled in. Medigap plans F and G will both cover the 20% coinsurance leftover.
A Wellness Visit Versus a Physical
A physical is generally more involved than a wellness visit. Physicals may involve lab test for blood and urine. A doctor may examine the head, neck, lungs, and abdomen during a physical, and may also perform a reflex or neurological test.
The Annual Wellness Visit generally doesn't include such extensive types of testing. If it does, the bill may fall under Part B for diagnostic tests.
That being said, the wellness visit has a great deal of value. It offers an opportunity to have some direct dialogue about your health with a primary health care provider and get ahead of any health care concerns before they become anything more serious.
How to Tell If You're Eligible for a Wellness Visit
As a beneficiary of Medicare Part B for at least twelve months, you are eligible for a wellness visit. If for some reason the initial “Welcome to Medicare” exam was missed, the wellness visit is still available.
Be aware: if someone is only enrolled in Medicare Part A, there is no eligibility for a wellness visit. Wellness visits are only available under Part B.
Who Can Perform the Annual Wellness Visit?
A primary doctor can if recognized by Medicare as a health care practitioner. Health care practitioners qualified to perform wellness visits include nurse practitioners, physicians assistants, clinical nurse specialists, and health care professionals working under the supervision of a Medicare physician.
Medicare Advantage Plans Cover the Wellness Visit
If opting for a Medicare Advantage plan, it is designed to cover all the same medical services as an Original Medicare plan that includes Parts A and B, and beyond. Medicare Advantage plans will cover annual wellness visits, and also cover a number of lab tests and more extensive services that arise during this visit.
For a more comprehensive physical exam, many Medicare Advantage plans cover those as well. Review your plan coverage and contact your agent to determine exact coverage.
What to Bring to Your Wellness Visit
Once the wellness visit is scheduled, the provider’s office might send out a list of questions to answer before the appointment. The purpose of the list of questions is a health risk assessment. It gives the doctor information to make best use of the wellness visit and time spent together. Be sure to fill that out, and write down any specific questions, to make this visit as productive as possible.
Plan to bring a list of your medications, including any vitamins, minerals, supplements, and over the counter medications you're taking. Record the dosage and frequency of each medication and whether they're brand name or generic.
It might be a valuable use of time to make a list of several medical concerns so that you can get useful information out of your doctor. Consider family history or chronic illness, and feel free to raise any concerns.
Bonus Tip
Sometimes we see billing errors regarding annual wellness visits. There is no reason this should happen because your wellness visit should be covered one hundred percent by Medicare Part B or most health plans. When calling to make an appointment, make sure to specify this for the Annual Wellness Visit. This will ensure that it pays for the visit in full and is billed correctly.
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