Annual Physical vs Annual Wellness Visit
Annual checkups with your primary care provider (aka PCP) are vital to identifying and preventing potential health problems. It is also a perfect time to establish a relationship with your doctor and establish baselines that aid future healthcare decisions.
Even though these visits have many benefits, only 1 in 5 adults opt for an annual checkup. Younger adults may be able to get away without having an annual checkup as they are less likely to have a health condition. However, for individuals 65+ it is vital to have annual checkups as age is a major factor in many conditions including cognitive disabilities, cardiovascular issues, cancer, arthritis, osteoporosis, diabetes, and more.
There are many misconceptions surrounding this type of visit, specifically for people new to Medicare. Below is a more thorough explanation of these terms and what each visit offers:
Routine Physical Examination
This is the annual exam you maybe be more familiar with as it was likely covered on your prior insurance plan. However, Medicare does not cover this exam. The items covered during this visit are similar to the Annual Wellness Visit, but with a few additional items including:
- Review of your physical appearance for abnormalities that may suggest a potential condition, such as discoloration of the eyes and difficulty walking or speaking.
- Physical examinations. These include palpating parts of the body to feel for abnormalities, testing motor functions, checking reflexes, and possibly examining the genitalia and rectum regions.
- Laboratory tests. This includes a lipid panel, diabetes screen, thyroid screen, complete blood count, metabolic panel, and more.
Welcome to Medicare Visit
Within your first 12 months on Medicare’s Part B, you are eligible for the Welcome to Medicare preventative visit. This visit does not require your Part B deductible be met to receive 100% coverage. The items covered during this visit are similar to the Annual Wellness Visit, but with a few additional items including:
- A simple vision test.
Annual Wellness Visit
After your first 12 months on Medicare’s Part B, you are eligible for an Annual Wellness visit. This visit does not require your Part B deductible be met to receive 100% coverage. During your visit, your doctor will develop or update a personalized prevention plan based on your current health and risk factors. The covered portions of this visit include:
- Health Risk Assessment. This may include a questionnaire you complete prior to the visit.
- Review of your medical history.
- Review of family history.
- Review your functional ability and level of safety. This includes a screening for hearing impairments, your risk of falling, and your ability to perform activities of daily living as well as similar assessments.
- Developing or updating a current list of prescription medications and durable medical equipment (DME).
- Developing or updating a current list of providers.
- Height, weight, blood pressure, and other routine measurements.
- Cognitive impairment assessment that screens for forms of dementia such as Alzheimer’s.
- Screen for depression and other mood disorders.
- An offer to discuss creating advanced directives, which determine how you want medical decisions to be handled if you are too ill to speak for yourself. Usually, a power of attorney is designated or a living will is created. While your health care provider can aid in this process, you can also acquire the services of an attorney, or local state health department.
- Personalized health advice.
- Developing or updating a list of risk factors and treatment options.
- Advanced care planning.
- A screening schedule for preventative services (other screenings, shots, etc.) that spans the next 5 to 10 years.
As a part of your Annual Wellness Visit, your doctor may want to run additional tests or provide additional services that are covered separately from the Annual Wellness visit. Some of these items are eligible for full coverage, but many will only be covered 80% by Medicare. So, make sure you get a Medicare Supplement Plan to help cover the extra 20%! These additional items may include:
- Vaccinations such as flu, pneumococcal, or Tdap.
- Screenings for cardiovascular conditions. Check out our article here that discusses blood pressure screenings, cholesterol screenings, cardiac stress tests, and more!
- Women’s care such as Pap smears, pelvic exams and mammograms.
- Men’s care such as prostate specific antigen (PSA) tests for prostate cancer.
- Many “medically necessary” laboratory tests are covered by Medicare including blood tests, urinalysis, tests for tissue samples, and more.
Another common misconception individual have is that Annual Wellness Visits are mandatory and it may affect your coverage if you do not get one. This is simply not true! If you visit your doctor more regularly, you may already be receiving many of the items covered during an Annual Wellness Visit. Or, you may simply forget to schedule a visit during a very busy year. Regardless, do not worry if you happen to miss an Annual Wellness Visit one year, but make sure you get to your next one!