Medicare now covers an annual “Wellness” visit to a primary care physician at no cost to the patient. But, as with the “Welcome to Medicare” visit, the list of what is covered “for free” is very limited. Anything beyond the list (provided below) will result in a bill.
Medicare.gov provides the following information:
- Yearly “Wellness” visits: If you’ve had Part B for longer than 12 months, you can get this visit to develop or update a personalized prevention help plan to prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It also includes:
- A review of your medical and family history
- Developing or updating a list of current providers and prescriptions
- Height, weight, blood pressure, and other routine measurements
- Detection of any cognitive impairment
- Personalized health advice
- A list of risk factors and treatment options for you
- A screening schedule (like a checklist) for appropriate preventive services. Get details about coverage for screenings, shots, and other preventive services.
This visit is covered once every 12 months (11 full months must have passed since the last visit).
Your costs in Original Medicare
You pay nothing for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply.
However, if your doctor or other health care provider performs additional tests or services during the same visit that aren’t covered under these preventive benefits, you may have to pay coinsurance, and the Part B deductible may apply.
Wellness visit vs Sickness visit
If a person has a health issue, whether major or minor, Medicare will cover the doctor visit – but deductibles, 20% co-insurance, and Medicare Advantage co-pays will be charged to the patient.
In this situation, the patient must have a new health issue, or be seeing the doctor to assess an ongoing health problem.
Medicare will pay for the three parts of a standard office visit: taking a HISTORY; performing a PHYSICAL EXAM, and developing an ASSESSMENT/PLAN.
As I wrote yesterday regarding the Welcome to Medicare Visit, the patient might expect to get a “free exam”, but he could end up with a bill. The bill will depend on the patient’s Medicare coverage. Does he have only Medicare? Does he have a Medicare supplement, and which one? Is he enrolled in a Medicare Advantage plan?
For a quick overview of your Medicare choices, take a look at this short video: Intro to your Medicare Choices