What’s a “Medicare Wellness Visit” and do I need one?
What is a Medicare Wellness Visit?
A Medicare Wellness Visit, also known as the "Annual Wellness Visit," is a yearly preventive service offered to Medicare beneficiaries who have had Medicare Part B for longer than 12 months.
Unlike a traditional physical examination, the Medicare Wellness Visit focuses on developing or updating a personalized prevention plan and performing a health risk assessment. This service is part of Medicare's preventive care services aimed at early detection of diseases and prevention strategies. In a nutshell, the purpose of a Medicare Wellness Visit is to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors.
🗒️ NOTE: As a new Medicare beneficiary, you are also entitled to a “Welcome to Medicare” preventive visit (AKA Initial Preventive Physical Exam or IPPE), which is a one-time appointment you can choose to receive within the first 12 months of receiving Medicare Part B. The aim of the visit is to promote general health and help prevent diseases.
How Does a Wellness Visit Differ from a Physical Exam?
Your yearly wellness visit is NOT a physical exam. The difference between a physical exam and a wellness visit is basically the difference between your doctor focusing on what’s wrong versus focusing on what’s right. Both are important - it just depends on the situation.
Physical Exam 👉: an assessment of your body’s health. The primary purpose is to look for health problems.
Wellness Visit 👉: helps your doctor understand what’s working for you and how to best support your continued health and well-being.
Photo: www.cms.gov
Benefits of a Medicare Wellness Visit
While a Medicare Wellness visit is not mandatory, there are very good reasons to have one every year:
During the visit, your doctor can observe and learn a good deal about your health and wellness, such as issues with balance, hearing, eyesight or memory. These observations help determine what to keep an eye on going forward and whether to recommend additional tests or exams.
Your wellness exam will also include a health risk assessment (HRA), which is a form you fill out and review with your doctor. Your answers help to identify any risks and your doctor can work with you to reduce them, potentially preventing a future health diagnosis or complication.
Your doctor will make sure your medical record is accurate and up to date. Together, you’ll review your current health conditions and medications as well as note other providers or specialists you see. All the information from your wellness exam is recorded and available to your healthcare team to ensure that your care is coordinated across all visits and services.
What to Expect at a Medicare Wellness Visit
📝 Personalized Prevention Plan: One of the primary benefits of the Medicare Wellness Visit is the creation or update of a personalized prevention plan. This plan is tailored to the patient's current health status and risk factors, focusing on preventing future health problems and improving overall health.
🩺 Health Risk Assessment: The visit includes a health risk assessment questionnaire that the patient fills out. This assessment helps identify health risks and the patient's necessary interventions to mitigate these risks.
📋 Medical History Review: It provides an opportunity to review the patient's medical and family history, helping in the early detection of potentially hereditary conditions.
💉 Updated Vaccinations: The visit can be used to update necessary vaccinations, which are crucial in preventing diseases.
🧠 Screening for Cognitive Impairment: Screening for cognitive impairments, including dementia and Alzheimer's disease, can be part of the visit, especially important for the elderly population.
👨⚕️ Establishing a Health Care Provider Relationship: This visit establishes a relationship with a healthcare provider, which can be beneficial for long-term health management.
Costs of a Medicare Wellness Visit
Medicare Part B covers an Annual Wellness Visit if the provider accepts assignment (Meaning your physician will be paid directly by Medicare and has agreed to accept the payment amount Medicare approves for the service). The Part B deductible does not apply. However, you may have to pay a share of the cost for certain recommended tests or services.
Preparing for your Medicare Wellness Exam
Below are some important items to bring along to your Medicare Wellness Exam:
A list of your medications, including prescription, over the counter (OTC) vitamins, supplements and herbal items
A list of all the health care providers you see, including names and contact information
Your completed health history form and health risk assessment, if sent to you by your doctor’s office ahead of time
Summary
In short, you don’t “need” a Medicare Wellness Visit but you are entitled to one if you have had Medicare Part B for 12+ months. It is our recommendation that you take advantage of this Medicare benefit!
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