Have you had your annual Medicare wellness visit?
Whether you’re new to Medicare or haven’t easily used this benefit, here’s why it’s important.
Medicare Wellness Visits Aim to Help You Stay Healthy as You Age, Says James Sims, DNP ANP-BC, practitioner at PeaceHealth Seniors Clinic in Eugene, Oregon.
“Sometimes it’s the only visit patients make to the office during the year,” he says. “These visits give us the opportunity to know if you are up to date on your health screenings. This is also an opportunity to talk about other things that can help you maintain your health.
Annual Medicare Wellness Visits are a special type of appointment.
Medicare has specific guidelines on the type of care and topics allowed during your annual visit. This is to ensure that you and your PCP have time to focus on areas that will help you stay healthy.
What are the annual visits
Annual Medicare Wellness Visits:
- Start at age 66 (or the year after you start using Medicare). When you become eligible for Medicare at age 65, you will receive a “Welcome to Medicare” visit that can be done any time after your 65th birthday but before your 66th birthday. The following year you will have an annual visit.
- Are annual appointments with your primary care provider.
- Are recommended every year.
- Focus on prevention, health goals and advance care planning.
What annual visits are not
Annual Medicare Wellness Visits are not:
- A regular physical exam or visit to discuss an acute problem such as illness or injury.
- Designed to diagnose or treat specific health conditions.
Prepare your annual visit
Once you have scheduled your annual Medicare Wellness Visit, you will receive a questionnaire. If you use My PeaceHealth, you can log in and complete it online. Otherwise, you will receive a paper copy by mail. Fill it out in advance and bring it with you when you visit.
Before your appointment, review tips for making the most of your date. It is often helpful to write down your thoughts before your visit.
You might also want to spend a little more time on your advance care directive. If you have one, bring a copy. If you don’t, PeaceHealth offers advance care planning resources.
What to expect during your annual visit
- The visit will last 30 to 60 minutes.
- You will not need to change into your scrubs since the visit does not include a physical exam.
- You and your PCP will talk about your medical history, your answers to the questionnaire, and the risks of certain conditions. The discussion may include topics such as:
- Screenings such as mammograms or colonoscopies.
- Vaccinations to prevent things like pneumonia or shingles.
- Walking, balancing, falling or driving.
- Muscle tone and bone strength.
- Memory, hearing and vision.
After your wellness visit
Based on discussions from your visit, your PCP may recommend screenings, injections, or tests. This would likely require scheduling a follow-up appointment. It depends on the recommendation.
Your PCP can also provide guidelines or advice on how to achieve the health goals discussed during your visit.
Costs covered
For the annual wellness visit, you will not have a co-pay.
Costs are covered for:
- A wellness visit every year.
- Under traditional Medicare, this visit may occur once every 366 days.
- With a Medicare Advantage plan, this visit can occur at any time each calendar year.
- A discussion with your provider about topics related to preventative care and advance directives.
Uncovered costs
Treatments not covered by the annual wellness visit include:
- A physical exam.
- Discussion of a new health problem.
- Discussion of a current chronic illness.
- Advice on current or new medications.
- Prescription Refills
- Tests or screenings.
If you need care that is not covered by the annual wellness visit, you can:
- Make an appointment separately to discuss your concerns.
- Ask your clinic if your provider can combine a regular exam with your annual visit.
In either case, you would be responsible for any co-payment requested for the regular exam. It’s best to check with your provider and Medicare to understand how to get the most out of your benefits.
This is your advantage. Use it!
“Most routine office visits are brief. We don’t always have the opportunity to talk about preventative care and other critical topics,” says Sims. “This is why annual Medicare wellness visits are so important and why you don’t want to skip yours.”
If you have not scheduled your annual wellness visit, call your clinic to schedule that visit today.
If you have an upcoming appointment to discuss other concerns, ask if the annual wellness visit can be combined with the existing appointment.
