Wellness Visit or Physical for Medicare Recipients

Choice-4111580_640For those of us on Medicare, which generally includes those over the age of 65 or disabled persons, Medicare offers a little-known free benefit, an annual wellness visit, as part of the preventative care services it provides. However, confusing a wellness visit with a physical examination could be very costly. 

As part of the Affordable Care Act, Medicare beneficiaries receive a free annual wellness visit. At this visit, your doctor, nurse practitioner, or physician assistant will generally do the following: 

  • Ask you to fill out a health risk assessment questionnaire 
  • Update your medical history and current prescriptions
  • Measure your height, weight, blood pressure and body mass index
  • Provide personalized health advice 
  • Create a screening schedule for the next 5 to 10 years
  • Screen for cognitive issues

You do not have to pay anything, not even a deductible, for this visit. You may also receive other free preventative services, such as a flu shot. 

The confusion arises when a Medicare patient requests an "annual physical" instead of an "annual wellness visit." During a physical, a doctor may do other tests that are outside of an annual wellness visit, such as check vital signs, perform lung or abdominal exams, test your reflexes, or order urine and blood samples. These services are not offered for free, and Medicare patients may have to pay co-pays and deductibles when they receive a physical. Kaiser Health News recently related the story of a Medicare recipient who had what she assumed was a free physical only to get a $400 bill from her doctor’s office. 

Adding to the confusion is that when you first enroll, Medicare covers a "welcome to Medicare" visit with your doctor. To avoid co-pays and deductibles, you need to schedule it within the first 12 months of enrolling in Medicare Part B. The visit covers the same things as the annual wellness visit, but it also covers screenings and flu shots, a vision test, review of risk for depression, the option of creating advance directives, and a written plan, letting you know which screenings, shots, and other preventative services you should get. 

To avoid receiving a bill for an annual visit, when you contact your doctor's office to schedule the appointment, be sure to request an "annual wellness visit" instead of asking for a "physical." The difference in wording can save you hundreds of dollars. 

Of course, those who have supplemental insurance in addition to Medicare (Medigap or Medicare Advantage) may have a different experience, including having to pay nothing for a physical examination; if you want a physical instead of just a wellness visit, you should check with your supplemental insurance carrier or your doctor’s billing office to determine whether there will be a charge based on the additional insurance coverage that you have.

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