Physical Exams

Medicare - Annual Wellness Visit

MedicareMedicare is a federal government health insurance program that gives you health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months due to a severe disability, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD), no matter your income. You can receive health coverage directly through the federal government (see: Original Medicare) or administered through a private company (see: Medicare Advantage Plan).  covers a yearly appointment to discuss your plan of preventive carePreventive care is care to keep you healthy or prevent illness, such as routine checkups, flu shots, and tests like prostate cancer screenings and yearly mammograms. in the coming year. This appointment is called the Annual Wellness VisitThe Annual Wellness Visit is  a once a year visit covered by Medicare in which you can meet with your doctor to develop a prevention plan based on your needs. It will give you an opportunity to create and update a medical history a list of your medications and a list of your current providers and suppliers. During this visit your provider will record your weight, height, blood pressure, and BMI, as well as screen for cognitive issues and depression and your ability to function safely at home. The provider should give you a 5 to 10 year screening schedule or checklist and health advice and referrals to health education or preventive counseling services or programs aimed at reducing identified risk factors and at promoting wellness.. The Annual Wellness Visit is similar to the one-time Welcome to Medicare preventive visit but has important differences. For example, like the Welcome to Medicare visit, the Annual Wellness Visit is not a head-to-toe physical. However, you cannot receive your Annual Wellness Visit within the first year you are enrolled in Medicare or within the same year you have your Welcome to Medicare exam. During the first Annual Wellness Visit, you and your doctor or health care providerA health care provider is an individual or facility, such as a doctor or hospital, which provides health care services. See also: Provider. will create a prevention plan based on your needs. As part of the visit, your doctor will:
  • Give you a health-risk assessment: This may include a questionnaire that you complete (with or without the help of your doctor) before or during the visit that looks at your health status, injury risks, risky behaviors and urgent health needs.
  • Take your medical and family history
  • Make a list of your current providers, durable medical equipment (DME)Durable medical equipment (DME), also known as DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) is equipment that primarily serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home; for example, wheelchairs, oxygen equipment, and hospital beds. To be covered by Medicare, durable medical equipment must be prescribed by a doctor. Many types of adaptive equipment are not covered. suppliers and medications: Medications include prescriptionA prescription is an order for a health care service or drug written by a qualified health care professional. medications, as well as vitamins and supplements that you may take.
  • Create a written 5-10 year screening schedule or check-list: This checklist depends on your individual health status, screening history and what age appropriate, Medicare covered, preventive services you are eligible for.
  • Identify risk factors and current medical and mental health conditions  along with related current or recommended treatments
  • Check your height, weight, blood pressure, and body mass index
  • Screen for cognitive impairment: Cognitive impairment includes diseases such as Alzheimer’s or other forms of dementia. Medicare does not require that physicians use a test to screen patients. Doctors are asked to rely on their observation of the patient or on reports by the patient and others.
  • Review risk factors for depression
  • Review your functional ability and level of safety: This includes screening for hearing impairments and your risk of falling. Your doctor must also assess your ability to perform activities of daily living such as bathing and dressing and also your level of safety in your home.
  • Give health advice and referrals to health education or preventive counseling services or programs aimed at reducing identified risk factors and promoting wellness: These include weight loss, physical activity, smoking cessation, fall prevention, and nutrition.
Annual Wellness Visits after your first visit may be slightly different. As part of subsequent wellness visits, your doctor will:
  • Update the health-risk assessment you completed
  • Update your medical and family history
  • Check your weight and blood pressure
  • Update your list of current medical providers and suppliers
  • Screen for cognitive issues
  • Update your written screening schedule from previous wellness visits
  • Update your list of risk factors and conditions and the care you are receiving or that is recommended
  • Provide health advice and referrals, to health education or preventive counseling services or programs.
Original MedicareOriginal Medicare, also known as Traditional Medicare, is the federal health insurance program, created in 1965, under which the government pays providers directly for each service a person receives (on a fee-for-service basis). Almost all doctors and hospitals in the United States accept Original Medicare. The majority of people with Medicare are enrolled in Original Medicare, as opposed to a Medicare Advantage Plan. covers the Annual Wellness Visit with no coinsuranceThe coinsurance is the portion of the cost of care you are required to pay after your health insurance pays. Usually, it is a percentage of an approved amount. In Original Medicare, the coinsurance is usually 20 percent of Medicare’s assignment. or deductibleThe deductible, also known as the elimination period in long-term care, is the amount you must pay for health care expenses before your health insurance begins to pay. Deductible amounts can change every year. if you see doctors or other health care providers who accept the Medicare approved amountThe approved amount, also known as the Medicare-approved amount, is the fee that a health insurance plan sets as as the amount a provider or supplier should be paid for a particular service or item. Original Medicare calls this assignment. See also: Take Assignment, Participating Provider, and Non-Participating Provider. in full. Medicare AdvantageMedicare Advantage, also known as Part C, Medicare Private Health Plan, or Managed Care Plan, and formerly known as Medicare + Choice, is the part of Medicare concerning private health plans. It lets you get your Medicare benefits from a private health plan contracted by the government to provide this coverage. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs and coverage restrictions. Some plans (MAPDs—Medicare Advantage Prescription Drug Plans) offer Part D drug coverage as part of their benefits packages. You must have Medicare Part A and Part B to join a Medicare Advantage Plan. Medicare Advantage Plans include HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), PFFS (Private Fee-for-Service) plans, SNPs (Special Needs Plans) and MSAs (Medical Savings Accounts), and may have a POS (Point-of-Service) option. See also: Private Plan Card  Plans cover all preventive services the same as Original Medicare. This means Medicare Advantage Plans will not be allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-networkIn-network means part of a managed care plan’s network of providers. If you use doctors, hospitals, pharmacies, home health agencies, skilled nursing facilities, and equipment suppliers that are in your private health plan’s or Medicare private drug plan’s network, you will generally pay less than if you go to out-of-network providers. providers. If you see providers that are not in your plan’s networkA network is a group of doctors, hospitals, and pharmacies that contract with a managed care plan to provide health care services to plan members. Generally, managed care plan members may only receive covered services from providers in the plan’s network. Networks may be made up of both preferred and non-preferred providers., charges will typically apply.