Whether you are new to Medicare or you are just trying to keep up with all the changes surrounding the health insurance industry, it is important to know what is included in your Medicare coverage. Medicare, run by the Federal Centers for Medicare & Medicaid Services (CMS), includes coverage for hospital care under Medicare Part A and medical services under Part B.
Medicare Part B coverage includes several benefits that CMS now covers due to the Affordable Care Act (ACA). The ACA sometimes referred to as Obamacare, put a strong emphasis on preventive care. This means your Medicare Part B coverage includes a one time “Welcome to Medicare” preventive screening, and your Medicare annual wellness visit. The initial preventive screen must occur within the first 12 months of your enrollment in Part B coverage, after that point the Medicare annual wellness visit kicks in.
The Medicare wellness visit is a free, annual appointment with your primary care doctor to develop or revise a personalized plan to prevent health conditions from starting or progressing. Your doctor will review your overall health and any risk factors for disease, including a family history of disease, and help you develop a plan to prevent future illness and disability.
Everyone with original Medicare Part B coverage, including those with Medigap supplemental plans, is eligible for an annual wellness visit. As long as you are a Part B beneficiary you can have this preventive appointment once a year.
The Medicare wellness visit is a covered service under original Medicare Part B insurance. This means the annual visit comes with no out-of-pocket costs for you. There is no copay and your Part B deductible does not apply to this visit. Exceptions to these include situations where you receive additional services or tests during the same appointment that fall outside the scope of a wellness visit. If you have a Medicare Advantage Plan (Part C), your annual wellness visit should still be covered, but it may be included in other services. Your Medicare Advantage contractor can answer any questions you may have.
Under Medicare Part B, the annual visit requirements allow for several services and tests. Your primary care doctor will review the medical history for yourself and your family, maintain a list of all your doctors, and review the current medications you are taking. The doctor can collect all the normal physical statistics such as your weight, your height, and your blood pressure, and review your cognitive state. The doctor will then use your Medicare wellness visit to provide you with health guidance, risk factors, and a screening schedule personalized to your specific needs.
One of the most common doctor visits is the physical exam, and while elements of a physical are similar to your Medicare wellness visit, a physical does not meet the annual visit requirements. During a physical, your doctor will examine your body from head to toe for physical indications of illness or disability. Your Medicare annual wellness visit does not include any testing of your physical condition, other than what the doctor sees while talking to you. You can think of a physical as an actual exam, and your wellness visit as more of a conversation.
While you are encouraged to make use of this free service, your Medicare annual wellness visit is not a requirement. You are free to forego the exam some years, or every year if you prefer.
Annual visit requirements generally include a concentrated focus on prevention. This means if your doctor were to treat you for existing or ongoing and chronic conditions you would likely be charged under regular Medicare rates. The appointment needs to stick to preventive care, treatment, and screenings to meet the annual visit requirements from CMS. You and your doctor only discuss treatments to prevent future illness and disability as opposed to a condition you already have.
For your visit, you will need to complete your annual wellness visit form. Known as a “Health Risk Assessment”, CMS designed the form to help capture information relevant to your current health and plan for the future. You and your doctor will update and review your annual wellness visit form at each visit. The form provides a checklist of ongoing conditions and concerns, treatment suggestions, and improvements or deterioration. The annual wellness visit form will form part of your Medical record and can be a useful guide for future issues.
