Frequently Asked Questions

Medicare pays for two types of wellness visits: a one-time Welcome to Medicare Visit and an Annual Wellness Visit. Within the first 12 months of becoming a Medicare Part B participant, Medicare covers the one-time Welcome to Medicare Visit. It includes a review of your medical and social history related to your health, and education and counseling about preventive services, such as certain screenings, shots and referrals for other care that is needed. The visit is a great way to get up-to-date with your primary care provider about how to stay healthy. You are eligible for your first Annual Wellness Visit if you have been enrolled in Medicare for more than 12 months and have not had a Welcome to Medicare Visit in the past 12 months. An official government booklet called Your Guide to Medicare's Preventive Services explains all of the preventive services that Medicare covers in detail and outlines how often those services are covered. It is available online at: http://www.medicare.gov/Pubs/pdf/10110.pdf

No. Medicare does not pay for routine preventive physical examinations.

During the visit, your primary care provider will • Record your medical history • Check you height, weight and blood pressure • Give you a simple vision test Depending on your general health and medical history, further tests may be ordered. You will get advice to help you prevent disease, improve your health and stay well. You will also get a written plan letting you know which screenings and other preventive services you need.

Plan to bring the following: • Your medical and immunization records (only if you are seeing a new provider--call your former provider to get the necessary copies) • Your family health history, which will help your provider know if you are at risk for certain diseases • A list of prescription and over-the-counter medications that you currently take, how often you take them and why

If you have had Medicare Part B for longer than 12 months, you can get this yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. The visit includes the following: • Review of medical and family history • A list of current providers and prescriptions • Height, weight, blood pressure and other routine measurements • A screening schedule for appropriate preventive services • A list of risk factors and treatment options for you in a personalized patient plan

Your first Annual Wellness Visit has a lot in common with the Welcome to Medicare Visit. The main difference is the timing. If you are newly enrolled in Medicare, you are eligible for the one-time Welcome to Medicare Visit only within the first year. The Annual Wellness Visit can take place every 12 months. The first visit can be scheduled either 12 months after the Welcome to Medicare Visit or after more than 12 months of your enrollment in Medicare. Another difference you may see in your providers practice is that a skilled clinical professional completes the Annual Wellness Visits. Your primary care provider must complete your Welcome to Medicare Visit, but from there your visits can be conducted by a Medicare approved clinical professional (this may vary by physician office).

An annual physical is a much more extensive examination than the Welcome to Medicare Visit or Annual Wellness Visit. In addition to collecting medical history, an annual physical may also include a vital sign check, lung exam, head and neck exam, abdominal exam, neurological exam and dermatological exam. Clinical laboratory tests are not included in either the Welcome to Medicare Visit or the Annual Wellness Visit. If you provider needs to evaluate and treat a medical problem during a wellness visit he or she would need to charge for this separately, and the cost of the tests would be applied to your deductible or copay

No.

No. There is no deductible or copay for either one. But keep in mind that either of these visits could cost you some money out of pocket. For example, you may need to have a medical condition evaluated or treated in a way that goes beyond the purpose of a wellness visit. Under Medicare rules, the additional time or treatment would be billed as an office visit, with Medicare paying 80% of the allowed charges and the rest being applied to your deductible or copay.

An Annual Wellness Visit will include a screening blood pressure check and a cognitive assessment which will assess your memory. Once these results are put into your health record, if your provider is not the one performing the visit he or she will review the notes and results provided by the clinical professional. Your provider may then schedule a follow-up, if necessary. The follow-up would be billed as an office visit, with Medicare paying 80% of the allowed charges and the rest being applied to your deductible or copay.

Medicare determines which preventive - or screening - tests are covered and when they should take place, and no copay or deductible is required for these. A screening test is given to those who have no symptoms of a condition, such as measuring cholesterol levels in people who have no symptoms of heart disease. A diagnostic test is used to confirm a suspected condition if your first test shows one might be possible. Sometimes a screening test becomes diagnostic if potential concerns are found and more testing must be done.