Medicare-Approved Annual Visits

doctor-with-patient-exam

So what is a Medicare Approved Annual Visit?

Medicare Part B (Medical Insurance) offers many services, but will it cover an annual physical? The short answer is no. The long answer is that Medicare Part B doesn’t cover an annual physical, but it does cover other annual visits to evaluate your health and discuss any concerns.

So what does it cover?

During your first year of enrollment in Medicare Part B, you’re going to schedule a ‘Welcome to Medicare’ appointment with your doctor. It is a one-time appointment offered to all those enrolled in Part B during your first 12 months of enrollment. The visit will be free of charge (no deductible or copay) if:

  1. You are enrolled in original Medicare. (Prior to the appointment, confirm that your doctor accepts the Medicare-approved payment as full payment, or you will be stuck paying it out-of-pocket.)
  2. Or, you are enrolled in a Medicare Advantage plan. (Prior to the appointment, confirm that you have chosen a doctor in the plan’s provider network.)

This ‘Welcome to Medicare’ visit is strictly to identify your current health status and establish a baseline to create a personalized health plan of action moving forward. You will need to provide your doctor with your medical records (including immunizations), your family health history, and a list of all current medications—over the counter and prescriptions.

During this visit, your doctor will:

  • Assess your vitals
  • Discuss your family medical history
  • Perform a simple vision test
  • Discuss relevant and serious health concerns
  • Possibly suggest future test and screening appointments to be scheduled

Although it seems very similar to a physical, it lacks the preventative services and tests that physicals include. This visit is strictly to document a snapshot of your current health for comparison with future visits and to potentially catch serious health concerns early. To understand exactly what is included in this visit, click here.

What about my yearly exam?

Although the ‘Welcome to Medicare’ appointment is a basic discussion and look into your health, you can have access to annual wellness visits in the years following. To be qualified for these yearly wellness visits, you must remain enrolled in Medicare Part B for more than 12 months. These annual visits serve as checkpoints to evaluate your health plan, discuss any concerns, and to confirm any changes in your plan. You doctor helps coordinate a schedule for appropriate preventative services and creates a list of risk factors and treatment options. To understand all preventative services offered by Medicare, refer to Your Guide to Medicare’s Preventive Services. It will break down each service by what’s covered, how often, and who is covered.

Some highlights from the guide linked above include full coverage for the following tests:

  • Lipid blood panel to check cholesterol every five years
  • Colorectal cancer screenings every 12 to 120 months (depending on the test)
  • Mammogram screenings once a year

If you need more frequent testing than outlined above, you could be charged the Part B deductible, copays, excess charges, and coinsurance. This is where Medigap comes into play. Medigap may cover all or part of these costs, including many deductibles and copays. To learn more about your options, click here.

Your takeaways?

Medicare will not provide you with an annual physical, but through Medicare Part B you can schedule your one time ‘Welcome to Medicare’ appointment and future annual wellness visits (after your first year of enrollment). Through these appointments, you and your doctor will discuss and create a personalized health plan based on your health and wellness needs and situation.

Need more guidance on this topic? We help hundreds of seniors every year navigate through the Medicare maze. With options from 15 different insurers, we can customize the right plan for your health and finances and help you today while preparing for tomorrow. We understand that each client is a unique individual, and we want to help you find the best plan and the right insurer. We ensure that your options remain flexible so you can use the providers and doctors of your choice. We’ll happily address your questions and concerns and help you find the best plan for you. Contact us today for in-person appointment by email or phone at 919-704-6147 or 800-774-1434.


Sources:
https://www.medicare.gov/Pubs/pdf/10110.pdf

Annual Wellness Visit


https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf