Did you know that you’re eligible for what’s known as a “Welcome to Medicare” preventive visit during the first 12 months of enrolling in Part B? This is a one-time preventive visit with $0 out-of-pocket costs when receiving the service from a provider in our network. Your primary care provider (PCP) will review your medical history, establish the state of your health, and provide a plan for your future care.

Did you also know once you’ve had Medicare Part B for longer than 12 months, you may be eligible for an annual wellness visit? This visit provides a snapshot of your current health and is intended to serve as a preventive service. Both the “Welcome to Medicare” and annual wellness visit have a $0 out of pocket cost for you as long as you see an in-network provider and do not receive diagnostic care during your visit.

Does Medicare require an annual wellness visit?

You’re not required to have a “Welcome to Medicare” or annual wellness visit. This means there’s no penalty if you choose not to go. Also, you don’t need to complete a “Welcome to Medicare” visit to qualify for future wellness visits. However, we definitely recommend you take advantage of these preventive care visits when you’re eligible. It’s a great way to seek routine preventive care and stay on top of your overall health and wellness so you can live life boldly.

What can you expect during your annual wellness visit?

The goal of your annual wellness visit is to develop a prevention plan specific to you and your healthcare needs. Think of it as an assessment of your overall health and well-being. Your PCP may ask you to fill out a questionnaire called a “Health Risk Assessment”, which helps develop your personalized prevention plan. They will also review your medical and family history, measure your height, weight, and blood pressure, and review any other preventive screenings you may need to complete throughout the year.

How can you prepare for your annual wellness visit?

It’s a good idea to come prepared! This gives you and your PCP more time during the visit to discuss your health. Here are a few things to bring with you:

• A list of all the medications you take (including prescription, non-prescription, vitamins and supplements). If it’s easier, bring the bottles with you in a bag.
• A full list of health care providers you see including their names and contact information.
• Your completed health risk assessment and health history form, which may be sent by your PCP ahead of your visit.
• Any additional questions or topics you’d like to discuss with your PCP.     

Is the annual wellness visit the same as an annual physical exam?

Just remember that your annual wellness visit is not a physical exam. If you’re confused, don’t worry! An annual physical exam may be more extensive than an annual wellness visit. When thinking about the differences, think of the word “physical.” Your annual wellness visit includes assessments, but the provider doesn’t physically touch you, unless you have a specific diagnosis or symptom. The idea is to paint a picture of your health and create a plan for your future care. Your annual physical includes a physical exam, and your provider will check your weight, height, and body mass index (BMI).

Does Original Medicare cover your annual physical exam?

Medicare does not cover an annual physical exam. This means that if you have Original Medicare (Parts A and B) only, you may be on the hook for the entire amount for a routine physical exam, unless you have a Medigap plan.

Do Medicare Advantage plans cover your annual physical exam?

Remember that Medicare Advantage plans cover the same services as Medicare Part B. This means your plan will cover your “Welcome to Medicare” preventive visit and your annual wellness visit. Also, most of the time, a Medicare Advantage plan will cover your annual physical exam. ApexHealth Medicare Advantage Plans do cover an annual routine physical at $0 cost-share to you. Remember to check your Evidence of Coverage for more information about covered benefits that you can take advantage of.

An important tip from our ApexAssistants

If you have Original Medicare, remember when scheduling a “Welcome to Medicare” or annual wellness visit, ask for it specifically by name. If you ask for a “physical,” Medicare will not cover it and you could be responsible for the entire amount of the exam. A Medicare Advantage plan will cover both of these visits, plus an annual physical exam, in some cases.

ApexAssistants are here to help you find a doctor, schedule these appointments for you and answer any questions you may have. Give us a call at (844) 279-0508 (TTY: 711). Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.

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