Medical-insurance jargon can be confusing and sometimes deceptive. Some words get mistaken for others, different companies may have their own definitions of a procedure, and buzzwords come and go. Medicare is no exception.
Wellness is one such word. A vague term that means different things in different contexts, it’s more about marketing than anything else. I mean, who doesn’t want to be well?
Thus we come to Medicare’s Annual Wellness Visit. Medicare beneficiaries need to be aware that although some aspects of this visit are useful and may make you more aware of health concerns, it’s not an examination and it’s not an annual physical as most of us understand it. Not knowing the difference between the Annual Wellness Visit and an annual physical examination will cost you money – sometimes a lot of money. And you can’t count on your doctor or the billing office to know or tell you the difference.
What’s Medicare’s Annual Wellness Visit?
A better question would be what is it not? It’s not a physical examination. Yet many Medicare recipients assume that’s what it is.
Here’s how it works. If you’ve had Medicare Part B for at least 12 months Medicare will pay for an annual wellness visit with your doctor at no cost to you. It starts with a questionnaire called a Health Risk Assessment that you complete before speaking to your doctor. During the visit your doctor will:
Review your medical and family history
Review your current providers and prescriptions
Check your height, weight, blood pressure, and other routine measurements
Provide personalized general health advice
Give you a list of your risk factors and treatment options
Give you a screening checklist for appropriate preventive services
Discuss advance-care planning
Perform a basic cognitive assessment to look for signs of dementia, including Alzheimer’s disease
Compare that to a complete physical examination which should include all of the above plus:
Heart and respiration rate
Examination of your
Heart and lungs
Abdomen
Head and neck
Neurological responses
Skin
Joints and extremities
Prostate, testicles, penis, and check for hernias (men)
Breasts and pelvis (women)
Lab tests:
Complete blood count
Blood chemistry panel
Urinalysis
Lipid panel
Fecal occult blood to test for signs of colon cancer or polyps, which can be pre-cancerous
What happens when you and your doctor think you’re there for a complete physical, but mistakenly you’ve told the the receptionist you’re there for the annual wellness visit? You’ll be charged for each procedure or test your doctor does, but Medicare won’t cover them.
Preventive care under Medicare Part B is discussed in detail in Your Guide to Medicare Preventive Services.
While some Medicare Advantage plans may cover an annual physical, you need to check with your insurance company. As the annual wellness visit is also available to those on a Medicare Advantage plan, you need to specify that you’re asking about a physical exam and not the annual wellness visit
How to prevent costly mistakes
Not every doctor offers the Medicare annual wellness visit, so when you make your appointment make sure you specify you want the free Medicare visit; verify it again when you get to the doctor’s office, and again at the end of the visit to make sure it’s been coded correctly before the office submits it to Medicare.
Know the limits of the annual wellness visit
Know what’s included in an annual physical examination
Medicare also offers new Part B enrollees a Welcome to Medicare visit during their first year of coverage, but that’s not a physical exam either.
Medicare in the news
NPR: How seniors could lose in the Medicare wars
NY Times: Why Medicare and Social Security are Sustainable
Kaiser Health News: Why do politicians weaponize Medicare? Because it works
NPR: Medicare announces plan to recoup billions from drug companies
The Hill: Democrats and Republicans can agree: Cut the waste in Medicare Advantage