As of January this year, Medicare began covering an Annual Wellness Visit (AWV), a new benefit resulting from the Affordable Care Act. The AWV takes place with one’s primary care provider, is covered once every 12 months after the first year of Medicare coverage, and has no deductibles, coinsurance or copayments.
Among other things, the Annual Wellness Visit includes the provider taking your medical history, a health risk assessment, an evaluation of your physical condition, and a screening for cognitive impairment, including depression. It also includes a personalized prevention plan, where the doctor develops a strategy with you to manage your health, including planning the preventive services and screenings you may need over the next 5 to 10 years. The plan helps you take advantage of Medicare’s preventive services, many with no cost-sharing. Also resulting from ACA, eliminating the cost-sharing for many preventive services covered by Medicare marks a major milestone in Medicare’s efforts to keep beneficiaries healthy rather than just pay for treatment when people are sick. Over 800,000 beneficiaries have used the AWV benefit as of June 2011.
The Annual Wellness Visit is different than the Welcome to Medicare visit. The Welcome to Medicare visit is for beneficiaries new to Medicare (see the FAQ below). Neither the AWV nor the Welcome to Medicare visit is a routine physical exam. Both provide you with an opportunity to talk with your doctor about your health concerns. In addition, while the AWV has no cost-sharing, if your doctor performs other services or orders extra testing not included in the AWV during the same appointment, the doctor may claim for those additional services and you may have a copay.
Key publications from Medicare.gov:
You pay nothing out of pocket for this visit. However, you may incur a copayment or deductible expense if additional services are performed or ordered by your doctor.
After you have had Medicare Part B for more than 12 months. If you have had a “Welcome to Medicare” visit within the last 12 months, you must wait 12 months after your Welcome visit to schedule your Annual Wellness Visit.
You may have an Annual Wellness Visit once every 12 months.
Your first Annual Wellness Visit will include:
Subsequent Annual Wellness Visits will include:
No. An annual physical is a much more extensive physical examination. In addition to collecting a medical history, it may also include: vital signs check, lung exam, head and neck exam, abdominal exam, neurological exam, dermatological exam, and extremities exam. The Annual Wellness Visit is not meant to replace your annual physical.
You will see your primary care provider which could be a physician, nurse practitioner or physician assistant. However, most of your time may be spent with an allied health profession, such as a nurse or medical assistant who will gather most of your medical history so that your physician can determine an appropriate preventive health screening plan.
Medicare covers a one-time “Welcome to Medicare” visit within the first 12 months you have Medicare Part B. If you did not receive your Welcome to Medicare visit and have been with Medicare for more than 12 months, you are eligible for your Annual Wellness Visit.
As of January 2011, you pay nothing out of pocket for this visit.
A “Welcome to Medicare” visit includes the following:
No. You do nott have to have a “Welcome to Medicare” visit before getting an Annual Wellness Visit, but if you have the “Welcome to Medicare” visit, you willl have to wait 12 months before you can have your first Annual Wellness Visit.
Medicare covers many screenings for people who are at high risk for certain diseases. During your Annual Wellness Visit, you and your doctor will decide what tests and screenings you need.
To help schedule your Welcome to Medicare visit or determine when you become eligible for your first Medicare Annual Wellness Visit, call your primary care physician.
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