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Why You Must Know the Difference Between Medicare “Welcome” and “Wellness” Exams

wellness examsBefore you make your appointment for your yearly physical exam, you should be clear on the two kinds of check-ups that are covered by your Medicare Part B benefit.

Medicare does cover some checkups, but many people get confused, with  sometimes expensive consequences. It is not uncommon for Medicare beneficiaries to find out that many testing and preventive services may not be covered.

I’ll try to make it simple for you by explaining the difference between the single fully-covered Welcome to Medicare Preventive Visit, and annual checkups known as “Wellness Visits”.

Welcome First, Wellness Visits After The First Year

So, just what does classify as a Medicare Part B “Wellness Visit” as opposed to the free “Welcome Visit” — and when?

Allow me to outline the differences here:

The “Welcome to Medicare Preventive Visit” is covered in full when you first enroll in Medicare (within the first twelve months of coverage). The “welcome visit” includes:

•         Medical and Social History Review Related to Health
•         Counseling about Preventive Services
•         Screenings, shots and referrals if needed
•         Height, weight, body mass index , and blood pressure measurements
•         Vision test
•         Depression screening
•         Counseling for advance directives (if you choose)

The “Yearly Wellness Visit” is covered once a year beginning 12 months after your Part B coverage begins. Not really a full physical exam, the wellness visit updates personal prevention plans and assesses risk factors with a health risk assessment questionnaire.

The “wellness visit” includes:

•         Medical and family history review
•         Providers and prescriptions review
•         Height, weight, blood pressure, and other common measurements
•         Cognitive impairment evaluation
•         A list of risk factors and treatment options
•         Scheduling for screenings and other preventive services

This visit is covered once every 12 months (11 full months must have passed since the last visit). The “welcome” visit is not a prerequisite for the annual check-up.

Let Me Warn You…

You don’t pay for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your  health care provider accepts the payment amount approved by Medicare. So be careful to confirm that your doctor is accepting the approved amount for these exams in order to avoid having your Part B deductible applied to the visit.

Also, if your doctor or health care provider performs additional tests or services during the same visit that aren’t covered under these preventive benefits, you may be left paying coinsurance, and your Part B deductible could apply!

A Rude Awakening After a Physical

We’ve all heard stories recently about Medicare Part B recipients getting charged for what they thought would be a covered exam. One such story involves an unsuspecting retired engineer in Portland, Maine. Upon hearing that Medicare would cover yearly physicals, he visited his doctor for a complete work-up.

What he didn’t know was that this kind of routine physical exam was not classified as a free “Wellness Visit” under Medicare Part B. He was soon enlightened when he was hit with a bill for over $600!

I recommend that you check with a MediGap Advisors personal advisor whenever you are a bit fuzzy on just what is covered and when. Have you ever been surprised to get a bill for a check-up you thought was covered?

Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.

 

 
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