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About a month ago from ISAHU's Twitter via CoSchedule

Confusion on Medicare Wellness Visits

by Pam Evans, ISAHU Member

In 2011 CMS added two types of preventive exams under Part B; the “Welcome to Medicare” visit and the “Annual Wellness”visit. There has been much confusion among agents, providers, and individuals about what these visits actually cover.

Both visits are not the standard “Annual Physical” most people are familiar with. In a traditional annual physical the physician will review an individual’s medical history, perform an exam, and order routine lab tests. This type of physical exam is coded as a “routine physical”. Medicare does not pay for this service at all.

Below is an explanation from www.Medicare.gov that details exactly what is covered by Medicare for the Welcome to Medicare and AnnualWellness visits:

Preventive visit & yearly wellness exams

How often is it covered?

Medicare Part B (Medical Insurance) covers:

  • The “Welcome to Medicare” preventive visit: You can get this introductory visit only within the first 12 months you have Part B. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including certain screenings, shots, and referrals for other care, if needed. It also includes:
    • Height, weight, and blood pressure measurements
    • A calculation of your body mass index
    • A simple vision test
    • A review of your potential risk for depression and your level of safety
    • An offer to talk with you about creating advance directives.
    • A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.

This visit is covered one time. You don’t need to have this visit to be covered for yearly “Wellness” visits.

  • 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).

This article originally appeared in the ISAHU June 2015 Newsletter.

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Indiana State Association of Health Underwriters

Indiana State Association of Health Underwriters