Medicare Annual Wellness Visit vs Annual Physical in Palm Beach County, FL

What it involves

Medicare.gov describes the yearly Wellness visit as a conversation-based visit with your provider to create or update a personalized prevention plan. It states plainly that it isn't a routine physical exam. A physical is a hands-on exam of your body and health concerns. The two can be scheduled separately, which is the key to avoiding a surprise bill. The practice accepts Medicare, and the [[Medicare and Medicaid coverage article|/medicare-medicaid-primary-care-coverage/]] explains the plans it takes.

Who this is for

• Patients on Medicare who want to know what their yearly wellness visit covers
• Patients new to Medicare who are planning their first year of preventive care
• Patients who want a physical exam as well as a prevention plan
• Caregivers booking visits for a parent on Medicare

What to expect

• A health risk questionnaire, which Medicare says you fill out as part of the wellness visit
• Routine measurements such as height, weight, and blood pressure, and a review of your history and medicines
• A written checklist of the screenings and vaccines Medicare says you should get
• A clear plan for any separate visit about specific health concerns or a physical exam

What Medicare says the wellness visit includes

According to Medicare.gov, your provider will do the following at the yearly Wellness visit:

• Take routine measurements such as height, weight, and blood pressure
• Review your medical and family history and your current prescriptions
• Give you health advice and a written plan listing the screenings, vaccines, and other preventive services you need
• Offer to talk about advance directives
• Perform a cognitive assessment, looking for signs of dementia
• Evaluate potential risk factors for substance use disorder and refer you if needed

What it is not

Medicare.gov says the visit is not a routine physical exam and advises that if you have specific concerns about your health, you should schedule a separate appointment so the wellness visit stays focused on prevention. A physical examines you and responds to symptoms, while the wellness visit builds a plan. Many patients need both, in separate appointments. Bone health is a good example of a question to bring to the visit, and the osteoporosis and bone density guide explains who is advised to have a bone density scan.

Who qualifies and how often

Medicare.gov says Part B covers a yearly Wellness visit once every 12 months. Your first one cannot take place within 12 months of your Part B enrollment or your Welcome to Medicare preventive visit, though you do not need to have had that earlier visit to qualify. The Welcome to Medicare visit is a separate one-time check-up covered once during your first 12 months of Part B.

What you may pay

Medicare.gov says you pay nothing for the wellness visit if your provider accepts assignment, and the Part B deductible does not apply. But it warns that you may owe coinsurance, and the deductible may apply, if the provider performs additional tests or services during the same visit that Medicare does not cover under the preventive benefit. If a service Medicare does not cover, such as a routine physical exam, is added, you may have to pay the full amount for it.

How to plan the visit with the office

Tell the office when you book that you want the wellness visit, and ask whether you also want a separate physical. Bring your medical records, your family health history, and a list of every prescription, over-the-counter drug, vitamin, and supplement with how often you take each and why. Medicare.gov asks you to bring these. The practice's preventive care and annual physical visits page explains what a physical includes. Screenings are part of that conversation, and the colorectal cancer screening guide explains the tests the National Cancer Institute describes and the ages it gives.

Self-pay and other coverage

Patients without Medicare, or without coverage for a particular visit, can also be seen. The practice lists self-pay visit fees of $160 for a new patient and $100 for a follow-up visit, which is posted on the site as the current self-pay rate. Call the office to confirm what applies to you before your visit.

Sources

• Medicare.gov — Yearly "Wellness" visits
• Medicare.gov — "Welcome to Medicare" preventive visit