The term “wellness visit” refers to an annual appointment with your primary care physician to discuss your current state of health and address any medical concerns you may have. Wellness visits may also be used to set up testing for ongoing or worsening symptoms as well as to make changes to medications or lifestyle.
What’s important to keep in mind is that wellness visits only pertain to the actual visit and time spent with your primary care physician. They do not pertain to lab tests and procedures or treatments given at clinics. While these things may be ordered by your doctor at the time of your wellness visit, they would be looked at as separate appointments when it comes down to billing and payment.
How Often Should You Schedule a Wellness Visit?
While the standard for a wellness visit is once a year, everyone is different, so only you and your physician can determine how often you should schedule a wellness visit. Some people with ongoing healthcare concerns will need to be seen more frequently, while others may only need to be seen on the traditional once-per-year schedule. It’s important to keep all appointments and notify your doctor’s office as soon as possible if you need to reschedule.
Does Original Medicare Cover Wellness Visits?
Original Medicare covers wellness visits under Part B preventive services. Medicare Part B provides an outpatient benefit and includes many preventive services, including a “Welcome to Medicare” visit when you are first eligible, and after 12 months, an annual “Wellness Visit.” If medications are prescribed during a wellness visit and can be self-administered and purchased from a retail pharmacy, these drugs would fall under Medicare Part D. If hospitalization is required pursuant to a wellness visit, then Medicare Part A would apply to the cost of treatment while in a hospital or skilled nursing facility.
Do Medicare Advantage Plans Cover Wellness Visits?
Although you may be familiar with Medicare Part A and Medicare B, the inpatient and outpatient benefits respectively, a third option may be available in the form of a Medicare Advantage plan, sometimes referred to as Medicare Part C. These plans are provided by private insurers, and the Medicare Part C provider must be approved by Medicare. The insurer must also adhere to the guidelines set out by the program on a federal level; however, coverage can vary by state, provider and plan. Because of this, Medicare Advantage plans do provide the same Part A and Part B coverage as Original Medicare, including wellness visits.
Although Medicare Part C providers must follow Original Medicare guidelines at a minimum, many Medicare Advantage plans provide additional benefits. Medicare Advantage plans may provide additional coverage in the form of discounts, memberships, healthcare classes or full or partial reimbursement for healthcare-related expenses that are not covered by Medicare. To learn more about your coverage options and any potential additional benefits, consult with your Medicare Advantage plan directly.