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Medicare Preventive Visit, the Annual Wellness Visit and Routine Physical Exams: Three Different Services, Only Two Are Covered by Medicare
When you go to the doctor for a once-a year examination, it’s important that both you and your doctor know what kind of exam you are there for.
Medicare pays for a one-time ‘Welcome to Medicare’ preventive visit within the first 12 months you have Part B coverage. During this visit (also called the ‘Initial Preventive Physical Exam’), your doctor will obtain information on your medical and social history related to your health. ‘Social history’ can mean any history of alcohol, tobacco or other drug use, and your diet and physical activities. Your doctor will measure your blood pressure, weight, height, body mass index, and screen your vision. Your doctor will also give you guidance or advice on preventive services you may wish to consider including certain screenings, shots, and referrals for other care, if needed. You should receive a brief written plan or checklist for the Medicare-covered screenings that you are eligible for.
For this visit, bring your medical records (if your doctor doesn’t have them), including immunization records. Also bring a record of the prescription drugs you are taking, as well as any over-the-counter medications and vitamins you use. If you are new to the doctor conducting this exam, he or she is going to want to know why you were prescribed these medications or take the over-the-counter medicines and vitamins.
When we say ‘doctor’ for the ‘Welcome to Medicare’ visit, we mean a physician (doctor of medicine or osteopathy) or a qualified non-physician (such as a physician assistant, nurse practitioner, or certified clinical nurse specialist).
While you are not required to have this examination, you pay nothing for this visit if your doctor accepts assignment, and the Part B deductible doesn’t apply. This is one preventive service that’s too good to pass up! When you make your appointment, let your doctor’s office know that you would like to schedule your “Welcome to Medicare” preventive visit.
Twelve months after the ‘Welcome to Medicare’ visit, you are eligible for an ‘Annual Wellness Visit’. Or, if you did not have the ‘Welcome to Medicare’ service, you can have the ‘Annual Wellness Visit’ once you have had Part B Medicare coverage for longer than 12 months.
The Annual Wellness Visit can be performed by a ‘health professional’, including a physician, physician assistant, nurse practitioner, clinical nurse specialist, or a health educator, registered dietician, nutrition professional, or other licensed practitioner. This would include a team of medical professionals working under the direct supervision of a physician.
During your first wellness visit, your provider will develop or update a personalized prevention plan based on your current health and risk factors. They will inquire or ask you to update your medical and family history. They will also check your blood pressure, measure your height and weight, and conduct other routine measurements.
They will review any potential risk factors for depression, your ability to function, as well as other mental attributes.
Other components of this visit: developing a written schedule or checklist for the next five to 10 years, discussing any risk factors and giving health advice or referrals for health education.
After your first Annual Wellness Visit, you are eligible for future wellness visits once every 12 months. You don’t need to wait until the exact date each year to have the exam; you only have to wait until the same month every year.
Like the ‘Welcome to Medicare’ visit, you pay nothing for the ‘Annual Wellness Visit’ if your doctor accepts assignment, and the Part B deductible doesn’t apply. When you make your appointment, let your doctor’s office know that you would like to schedule your “Annual Wellness” visit.
During both the ‘Welcome to Medicare’ visit and the “Annual Wellness” visit, your doctor may order tests or make referrals for other services based on your general health and medical history. Payments for other services you receive from your doctor or based on a referral from your doctor, including laboratory tests and EKGs, are not included in the payment for visit and will be billed separately. You may have to pay coinsurance, and the Part B deductible may apply, to those services.
While both the ‘Welcome to Medicare’ preventive visit and the ‘Annual Wellness Visit’ are covered by Medicare, routine physical examinations or yearly check-ups are not covered by Medicare. The Medicare-covered preventive visits include specific components that your doctor must perform to be able to bill for the covered service. That is why it is important that your doctor and your doctor’s staff know what type of visit you are scheduled for. If your doctor is not aware that you are there for one of the Medicare-covered preventive visits, he or she may conduct a routine physical exam instead.
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