Since you were a little kid, you’ve most likely heard that you should go to the doctor every year for your annual physical exam. These exams allowed the doctor to get new measurements on your height and weight, take your blood pressure, measure your body mass index, and more. However, Medicare benefits do not include an annual physical examination. Instead, Medicare covers an annual wellness visit, which serves as preventive care.
What is the Difference Between and Annual Wellness Visit and a Physical Exam?
Annual physical exams are head-to-toe examinations that allow your primary care physician to get a full picture of your overall health. During these exams, your vital signs will be recorded and you will get an assessment done on your lungs, abdomen, brain function, reflexes, and vision. In addition, you might also get your blood or urine tested to check for certain health markers, such as high cholesterol, poor liver and kidney function, or the presence of an infection.
The Medicare annual Wellness Visit differs slightly from a standard annual physical assessment. You will still have your height, weight, and body mass index calculated, but your doctor will not perform the same hands-on tests that annual physicals include. Instead, your physician will review your past medical history and family medical history, and they will discuss any potential treatment options if you show signs of a certain disease. In addition, your physician will get an updated list of your current healthcare providers and any medications that you are currently taking.
Because this information will be collected during your visit, it will be important for you bring the necessary documentation with you. This may include your past medical records, immunization records, and family health history. You should also bring a list of your current prescription medications and any over-the-counter medications, vitamins, or supplements you take.
You will also be asked to fill out a Health Risk Assessment. This form will assess certain environmental or genetic risk factors that you may be exposed to. It will also address your behavioral risks and any injury risks you present with. You will also be asked to note any current health concerns you have.
Another test that your physician may also perform is a cognitive health screening to look for any signs of impairment or degeneration. This is done primarily in an attempt to detect early signs of Alzheimer’s disease or dementia. Your physician may also perform a depression assessment to get a better idea of your mental status and health.
If, during the wellness visit, the physician notes anything out of the ordinary, they may ask you to schedule an additional appointment to conduct further health screening.
How Much Does a Wellness Visit Cost?
Since the Medicare Wellness Visit is a form of preventive care, it is covered under Medicare Part B. Under Original Medicare, you are entitled to one of these visits every 12 months. In addition, Medicare will not charge you a dime for it as long as you visit a healthcare provider that accepts assignment.
Under your preventive Medicare benefits, the annual Wellness Visit is covered at 100 percent of the Medicare approved amount, which means it doesn’t even impact your Medicare Part B deductible. It is very important that when you call to schedule your visit, you must ask for a “Medicare annual Wellness Visit” and not an annual physical exam. As we mentioned above, these two visits are quite different from one another and they are billed differently as well.
While the initial visit and risk assessment are free, any additional testing or services that your provider requests or recommends will not be covered in the same way. Instead, these tests will be billed just like all other Part B expenses, with your deductible needing to be met first and then a 20 percent coinsurance payment for all expenses afterwards. This pricing schedule applies to all follow-up screening appointments as well.
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