Did you know that there is a difference between preventative visits and how Medicare covers them? There is the “Welcome to Medicare Visit” and then also the “Annual Wellness Visit”. Each of these exams offers different services. It is important to be careful about when you schedule these because Medicare will not cover them if they are not done within a specific time frame.
Welcome to Medicare Visit
The welcome to Medicare visit is a one-time exam for people who are new to Medicare Part B. Medicare will cover this preventative service if it is completed within the first 12 months of your Part B effective date.
This visit will include a review of your medical history as well as education related to your health and preventative services. Below is a list of what is done during the exam
- Height, weight, and blood pressure measurements.
- A calculation of your body mass index.
- A simple vision test.
- A review of your potential risk for depression and your level of safety.
- An offer to talk with you about creating advanced directives.
- A written plan letting you know which screenings, shots, and other preventive services you need.
A big part of the welcome to Medicare exam involves identifying any potential risk factors, including family history, that may increase your chances of developing certain conditions and diseases.
It is important to bring copies of your medical records if you are seeing a new doctor, a list of any medications you take (including any over the counter medication), and you may also want to bring a family member or caregiver with you; sometimes, they may be able to provide additional information to help your doctor better understand your health issues and risk factors.1
Medicare Annual Wellness Visit
If you’ve had Medicare Part B for over 12 months, you are entitled to a yearly Wellness visit. Medicare will cover this visit once every 12 months. It is important to keep in mind that Medicare does NOT cover routine physical exams and the yearly wellness visit is not a physical. If you do get a physical exam, you will be expected to cover the entire cost of the service (unless supplementary insurance provides coverage).
The Medicare Annual Wellness Visit focuses on prevention planning and reviewing the medical history.2
The focus of the annual wellness visit is to develop or update a personalized prevention plan to help prevent disease and disability, based on your current health and risk factors. Your provider may also perform a cognitive impairment assessment.
The cognitive impairment assessment is performed to look for signs of Alzheimer’s disease or dementia and check for depression and other mood disorders. Your provider may order other tests, if necessary, depending on your general health and medical history.
The personalized prevention plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include:
- A review of your medical and family history.
- Developing or updating a list of current providers and prescriptions.
- Height, weight, blood pressure, and other routine measurements.
- Detection of any cognitive impairment.
- Personalized health advice.
- A list of risk factors and treatment options for you.
- A screening schedule (like a checklist) for appropriate preventive services. Get details about coverage for screenings, shots, and other preventive services.
- Advance care planning3
Keep in mind that you cannot receive your annual wellness visit within the same year as your Welcome to Medicare preventive visit.4
You pay nothing for the Welcome to Medicare preventive visit and the Annual Wellness visit if your doctor or other qualified health care provider accepts Medicare Assignment. The Part B Deductible doesn’t apply to these two services.
However, you may have to pay coinsurance amounts, and the Part B deductible may apply if:
- Your doctor or other health care provider performs additional tests or services during the same visit.
- The preventative benefits don’t cover these additional tests or services.
Be sure and schedule your Welcome to Medicare or your Annual Wellness visit this year!
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- The Welcome to Medicare Visit with Your Doctor – Plan Prescriber, https://www.planprescriber.com/new-to-medicare/the-welcome-to-medicare-visit/
- Medicare Annual Wellness Visit: Everything Medical Practices Must Know, https://www.prevounce.com/medicare-annual-wellness-visit-everything-medical-practices-must-know#ch1, Prevounce Health
- Annual Wellness Visit Coverage, https://www.medicare.gov/coverage/yearly-wellness-visits
- Annual Wellness Visit – Medicare Interactive, https://www.medicareinteractive.org/get-answers/medicare-covered-services/preventive-services/annual-wellness-visit