As part of the Affordable Care Act, Medicare now covers annual wellness visits and will provide payment for the creation of a personalized prevention plan. The wellness visit will include a health risk assessment to:
- Establish or update the individual’s medical and family history;
- Create a list of current providers and suppliers involved in providing medical care, including a list of prescriptions;
- Take measurements of height, weight, body mass index, blood pressure and other routine measurements; and
- Detect cognitive impairments.
During the wellness visit, the health professional will establish or update a screening schedule for the next 5-10 years, based on recommendations of the United States Preventive Services Task Force (USPSTF). The recommendations of USPSTF are based on an individual’s age and health status. The visit may include health education or preventive counseling services designed to reduce risk factors that have been identified during the visit. Examples of such education and counseling services include those designed to promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention and nutrition.
The wellness visit may be conducted by a physician or another practitioner whose services are recognized by Medicare. Such practitioners include physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, clinical social workers, and clinical psychologists. Practitioners may also include health educators, registered dietitians, or nutrition professionals working under the supervision of a physician.
The services for which no cost-sharing (deductible and/or co-payment) will be charged are:
- Mammograms every 12 months for eligible beneficiaries age 40 and older;
- Colorectal cancer screening, including flexible sigmoidoscopy or colonoscopy (see below);
- Cervical cancer screening, including a Pap smear test and pelvic exam;
- Cholesterol and other cardiovascular screenings;
- Diabetes screening;
- Medical nutrition therapy to help people manage diabetes or kidney disease;
- Prostate cancer screening (for most codes);
- Annual flu shot, pneumonia vaccine, and the hepatitis B vaccine;
- Bone mass measurement;
- Abdominal aortic aneurysm screening to check for a bulging blood vessel;
- HIV screening for people who are at increased risk or who ask for the test.
Cost-sharing is also eliminated for the wellness visit and personal prevention plan.
CMS (Centers for Medicare and Medicaid) indicates that the following preventive services covered by Medicare will continue to be subject to cost-sharing:
- Digital rectal examination furnished as a prostate cancer screening service;
- Glaucoma screening;
- Diabetes self-management training services;
- Barium enema furnished as a colorectal cancer screening.
Note that, for all services, current coverage policies continue to apply. For example, Medicare only covers bone mass measurements once every two years for qualified high-risk individuals. Testing within that time frame for people who meet the eligibility criteria will not be subject to a deductible or co-payment. Bone mass measurement will not be covered for someone who is not a high risk individual, however, regardless of the change in cost-sharing requirements.