Life After 50 Expo

Dear Marci,

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Dear Marci,

Do I have to pay anything for my Annual Wellness Visit?

– Micah (Richmond, VA)

Dear Micah,

The Annual Wellness Visit is one of the many preventive services that Medicare covers for free. If you have Original Medicare, you will pay no coinsurance or deductible for the Annual Wellness Visit and other preventive care services, as long as you see a health care provider who accepts Medicare assignment. This means that the doctor cannot charge you more than the Medicare-approved amount for services you receive. If you have a Medicare Advantage Plan, you will pay no coinsurance/copayment or deductible for any preventive service that is free for people with Original Medicare, as long as you see an in-network provider.

Charges may apply if you also receive a diagnostic service at the time of your preventive screening. A service is preventive if you have no prior symptoms of the disease, whereas diagnostic services tend to address symptoms or conditions you already have. Doctors may conduct diagnostic tests and procedures if you have a distinct symptom—including a symptom found during the screening—or history of a condition. For example, if a doctor finds and removes a polyp during a preventive care colonoscopy screening, the removal of the polyp is considered diagnostic and costs will likely apply.

As I mentioned, the Annual Wellness Visit is a Medicare-covered preventive screening, and no cost-sharing applies. However, if your provider investigates or treats a symptom during your Annual Wellness Visit, this care is not part of the visit, and you may be responsible for certain costs.

During your Annual Wellness Visit, you will discuss your plan of preventive care for the coming year. This visit is similar to your Welcome to Medicare visit in that it continues to examine your health and update your preventive care plan.

As part of your Annual Wellness Visit, your provider may:

  • Update your health-risk assessment
  • Update your medical and family history
  • Check your weight and blood pressure
  • Update your list of current medical providers and suppliers
  • Screen for cognitive issues
  • Update your screening schedule from previous wellness visits
  • Update your list of risk factors and conditions and the care that you are receiving or that is recommended
  • Provide health advice and referrals to health education or preventive counseling programs

It is important to understand that while the services listed above are free preventive services, costs may apply if you receive additional services during the Annual Wellness Visit.

The Annual Wellness Visit can be a good time to speak with your doctor and review your health care needs for the coming year. Understanding what is covered with no cost-sharing and when costs may apply can help you make the most of your Medicare-covered preventive services.

There are many other preventive services covered by Medicare at zero cost. You can find a list and description of these services by clicking here.

– Marci

Dear Marci,

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Dear Marci,

When I last visited my doctor, she said that we should schedule my Annual Wellness Visit soon to discuss my health. I have never had an Annual Wellness Visit before, and I am not sure what this visit is about. Is it just a regular physical exam? What happens during an Annual Wellness Visit?

–  Jackie (Lexington, KY)

Dear Jackie,

The Annual Wellness Visit is an annual appointment with your primary care doctor to develop your plan of preventive care for the upcoming year. This visit is not a head-to-toe physical; rather, it is an opportunity to discuss your current health with your doctor and create a plan for promoting your health and wellness. The Annual Wellness Visit is similar to your Welcome to Medicare visit, the one-time appointment with your doctor that takes place within the first twelve months after you enroll into Medicare. Know that you cannot have your Annual Wellness Visit within the same year that you have your Welcome to Medicare exam.

Since this will be your first Annual Wellness Visit, you and your doctor will create a prevention plan based on your needs. You will likely discuss your medical and family history, complete a health-risk assessment that considers your health status, injury risks, and any health needs, and compile a list of all of your current medical providers and medications. You can start to consider these things in advance of your appointment to prepare for the visit.

Depending on your health care needs and history, you and your doctor might do any of the following tasks during your Annual Wellness Visit:

  • Create a checklist or screening schedule for various preventive health care screenings. Medicare covers many preventive care services, and this checklist will depend on your health status and what services you are eligible to receive;
  • Identify risk factors and current medical and mental health conditions along with related current or recommended treatments;
  • Check your height, weight, blood pressure, and body mass index;
  • Screen for cognitive impairment, including diseases such as Alzheimer’s or other forms of dementia;
  • Review risk factors for depression;
  • Review your functional ability and level of safety, including screening for hearing impairments and for your risk of falling; or
  • Give health advice and referrals to education or preventive counseling services or programs aimed at reducing identified risk factors and promoting wellness, such as weight loss, physical activity, smoking cessation, fall prevention, and nutrition.

You will not have a full physical as part of your Annual Wellness visit. Rather, the visit is used to assess your overall state of health and put a plan in place to maintain and promote your well-being.

Original Medicare covers the Annual Wellness Visit with no coinsurance or deductible as long as you see doctors or other health care providers who accept Medicare assignment. Medicare Advantage plans cover all preventive services the same as Original Medicare, so your plan is not allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.

It’s very important to keep in mind that, while the Annual Wellness visit itself is free, out of pocket costs can apply for additional care you receive during or following the visit. If your primary care provider explores or treats a new or existing health issue or runs test separate from those listed above during the Annual Wellness Visit, you may be charged. Services not included in the Annual Wellness Visit are billed separately and are subject to the usual copays and deductibles.

-Marci