How does a Medicare Wellness Visit compare to an Annual Physical

Kaila

SF VIP

Rather than post this article below, within the already 3-page ongoing (and worth wile reading) SF thread regarding Have you had a Medicare Wellness Visit;

I decided to post this article in a separate specific thread, here,

after I looked up the topic, to see what direct info is available, on what they each are, exactly.

I found it very informative !

so I am posting it here for all of you.


Routine care is not covered by Medicare, but these Wellness Visits are fully covered and paid for, even without the deductible being met, as they are considered Preventative Care. And thus, they are a little different than a "Routine" Annual physical would be.

From Medicare.org​

What Does the Medicare Wellness Visit Cover?​

Since you were a little kid, you’ve most likely heard that you should go to the doctor every year for your annual physical exam. These exams allowed the doctor to get new measurements on your height and weight, take your blood pressure, measure your body mass index, and more. However, Medicare benefits do not include an annual physical examination. Instead, Medicare covers an annual wellness visit, which serves as preventive care.

What is the Difference Between and Annual Wellness Visit and a Physical Exam?

Annual physical exams are head-to-toe examinations that allow your primary care physician to get a full picture of your overall health. During these exams, your vital signs will be recorded and you will get an assessment done on your lungs, abdomen, brain function, reflexes, and vision. In addition, you might also get your blood or urine tested to check for certain health markers, such as high cholesterol, poor liver and kidney function, or the presence of an infection.

The Medicare annual Wellness Visit differs slightly from a standard annual physical assessment.
You will still have your height, weight, and body mass index calculated, but your doctor will not perform the same hands-on tests that annual physicals include. Instead, your physician will review your past medical history and family medical history, and they will discuss any potential treatment options if you show signs of a certain disease. In addition, your physician will get an updated list of your current healthcare providers and any medications that you are currently taking.

Because this information will be collected during your visit, it will be important for you bring the necessary documentation with you. This may include your past medical records, immunization records, and family health history. You should also bring a list of your current prescription medications and any over-the-counter medications, vitamins, or supplements you take.

You will also be asked to fill out a Health Risk Assessment. This form will assess certain environmental or genetic risk factors that you may be exposed to. It will also address your behavioral risks and any injury risks you present with. You will also be asked to note any current health concerns you have.

Another test that your physician may also perform is a cognitive health screening to look for any signs of impairment or degeneration. This is done primarily in an attempt to detect early signs of Alzheimer’s disease or dementia. Your physician may also perform a depression assessment to get a better idea of your mental status and health.

If, during the wellness visit, the physician notes anything out of the ordinary, they may ask you to schedule an additional appointment to conduct further health screening.

How Much Does a Wellness Visit Cost?
Since the Medicare Wellness Visit is a form of preventive care, it is covered under Medicare Part B. Under Original Medicare, you are entitled to one of these visits every 12 months. In addition, Medicare will not charge you a dime for it as long as you visit a healthcare provider that accepts assignment.

Under your preventive Medicare benefits, the annual Wellness Visit is covered at 100 percent of the Medicare approved amount, which means it doesn’t even impact your Medicare Part B deductible.
It is very important that when you call to schedule your visit, you must ask for a “Medicare annual Wellness Visit” and not an annual physical exam.
As we mentioned above, these two visits are quite different from one another and they are billed differently as well.

While the initial visit and risk assessment are free, any additional testing or services that your provider requests or recommends will not be covered in the same way. Instead, these tests will be billed just like all other Part B expenses, with your deductible needing to be met first and then a 20 percent coinsurance payment for all expenses afterwards. This pricing schedule applies to all follow-up screening appointments as well.
 

Are we confusing a wellness visit to a physician's office and an in home wellness visit?

No, I don't think so, Harry.:geek:

The article above is about the Annual Wellness Visits to a Primary Care doctor office, that are offered at no cost, to anyone with Medicare. In the USA, that is many people over 65 yr old, Or Soc. Sec. Disability Recipients (SSDI) of any age.

There is a lot of general confusion about what exactly the so-called Wellness Office Visit is, and what the purpose would be, and whether or not, to bother to go for one.

Each person can decide whether they want one or not, and for some people, they might be very useful, while for others, they might be useless.

The article above will help me, myself, to decide whether to schedule one or not, or how much priority I will give it or not give it,
and if I do go, I will be much better aware of what it actually is, and what types of help I might be able to get from going.

I thought that some others at SF, might find it useful as well,
to have the more clear info about what that type of doctor visit is, in order to make a decision about whether it is of benefit for each one of us.

Some wonder whether they are the same as a yearly physical, and no, they are not the same, but some of the same issues could be addressed, or discussed. Or some other issue you didn't have time for, possibly. Or didn't because you didn't need a physical at that time.

For some people who cannot pay for a physical, or for any doctor visits at all, even when they want one,
or for those who prefer not to pay for one;

it might be much better than no visit, or than not having any Primary Care doctor.

In the USA, it is usually helpful in our medical system, to have a connection with a specific Primary Care doctor, in case you need any care at some point, or a medication ongoing or in the future, or if you want some advice about a medical concern, ideas for how to reach a health goal, suggestions, answers to health/medical questions, etc.

I just copy/printed it here, in case someone else finds the article informative for themselves.

The discussion about Wellness visits in the other SF thread is excellent, but seems to include lots of questions people have about what those type of visits are and are not.
 
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My experience has been that if you dare mention any symptom or problem during the “Wellness Visit”, it immediately becomes a primary care visit, and charged at whatever their copay is for such.
Thank you for that input! It's important to be aware of that possibility.
Perhaps each doctor has some differences in where and how, they draw that line. I don't know
 
Not very well, the wellness visit alone doesn't offer much.

This year my doctor combined them, maybe a good idea, lets them bill more too I guess...

That is informative. Thanks for both.
That the Wellness visit by itself doesn't offer much.

And interesting too, that they could combine them.
I wonder if other doctors would do that.
For you, you get whatever benefits you can get from each of them, with only needing to go that once.
For your doctor, they bill Medicare for the parts of the visit they will cover, including the Wellness visit parts. Medicare wouldn't cover the parts considered routine, such as repeated yearly tests for ailments that you don't have any symptoms.
Then again, if the visit does include an ailment, then Medicare would cover part of that, so you wouldn't have the entire expense. That might be a good option for some of us.
 
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My experience has been that if you dare mention any symptom or problem during the “Wellness Visit”, it immediately becomes a primary care visit, and charged at whatever their copay is for such.
Thank you for sharing this info. My husband has a wellness visit coming up and I'll remind him about this.

Every time he has one he says they're totally worthless. But the doctor insists on him having the wellness visit or he will no longer be his primary doctor. I guess he gets paid well for these "wellness" visits.
 
Last year when I was seeing my doctor for BP issues the assistant asked if I wanted a wellness visit and I said absolutely not. If my doctor insisted I would find a new one.
 
My experience has been that if you dare mention any symptom or problem during the “Wellness Visit”, it immediately becomes a primary care visit, and charged at whatever their copay is for such.

That is correct. I am going to mention that I want to try out a certain prescription during my next wellness visit. I am hoping it will only cost me the $5 copay for an office visit. But God only knows what they will end up billing me for, lol.
 
Thank you for sharing this info. My husband has a wellness visit coming up and I'll remind him about this.

Every time he has one he says they're totally worthless. But the doctor insists on him having the wellness visit or he will no longer be his primary doctor. I guess he gets paid well for these "wellness" visits.

Bingo.

I looked at the Explanation of Benefits for one of my wellness visits. The dr office billed $450 (for a 15 minute event) and the ins co paid them about $400 !! Gravy train.

Hmmm. In my previous post, I was talking about them changing a wellness visit to an office visit if you mention any symptom at all. But I can't imagine they would charge more than $450 for an office visit. Can they charge for an office visit AND a wellness visit on the same day, I wonder?
 
This is what took place at my "wellness visit" this week. Whoever she was, nurse/assistant, weighed me, took my blood pressure, and asked some questions.

"What year is it?"

"What month is it?"

"Spell "table" backwards."

"I'm going to give you three words to remember, and I'm going to ask you what they are later."

She handed me a piece of paper with a drawing of tilted intersecting s exagons and asked me to copy the drawing.

Then she asked me what the three words were.

Then I asked her at what age they start asking these questions. She looked at me and really didn't know. I said, "Sixty five?" She said, "Yes."

When we were finished, I told her to tell my doctor that I wasn't taking this "test" again.

She then gave me a yes/no and multiple choice questionnaire to fill out that asked about exercise, if I'd fallen or had concerns about falling, if I was depressed, etc.

When my doctor came in, she said that she was told that I didn't want to take the "test" again and to just remind them of that at the next "wellness visit".

I said I was glad that she didn't ask me to count backwards by sevens because I couldn't do it when I was forty, twenty, or ten years old. My doctor has a sense of humor. That's one of the reasons I like her. The other reasons are that she plays ball, listens, and doesn't dismiss my concerns. If I want a certain test, she doesn't argue with me, she orders it.

The doctor asked me about any meds I was taking and asked about supplements I was taking. We discussed some test results. She asked me about getting a flu shot, getting a mammogram, and taking a fecal occult blood test. She asked about my vision and if there were any changes. She asked if I got headaches. She asked me if I coughed. She asked if there were any medications she needed to order for me. Furthermore, she asked me if I had any concerns or if there was anything else I needed to talk about. Then she checked my ears, listened to my lungs, and checked my breasts. (Previous visits, she also checked my mouth and nose, she didn't do that this time.) I think she was having a slow afternoon because she was relaxed, unhurried, and took her time. I was with her for a good thirty minutes.

And that was my "wellness visit". Evidently, I'm going to live.

Bella ✌️
 
Thank you for the sharing of your experience and for that very specific input, and for the real-time example of your "Wellness" visit, @Bella
I found it valuable information.

I wonder how little or much, different doctors might tweak what they do, at that type of office visit, for themselves/ their own priorities, and for the specific patients needs.

Then I asked her at what age they start asking these questions. She looked at me and really didn't know. I said, "Sixty five?" She said, "Yes."
Exactly the same question in my mind, as I was reading your post!
Gosh, 65? o_O:rolleyes:

I would think that a trained person or any doctor, could just have some general interaction and conversation with the patient, and make their own observations, and be able to conclude which, if any, of further "tests" might be useful or totally useless.
 
Furthermore, she asked me if I had any concerns or if there was anything else I needed to talk about.
As someone else posted, if you talk about anything else, isn't that when it turns from a "wellness" visit into a primary care visit and you get charged the co-pay? Is that how they get you?
 
As someone else posted, if you talk about anything else, isn't that when it turns from a "wellness" visit into a primary care visit and you get charged the co-pay? Is that how they get you?
My doctor brought up copays as we were talking about other topics and said that, "unlike today," there would be a copay for that specific service. I'm not sure how other medical professionals bill for whatever is discussed during a "wellness visit." I was responding to questions she was asking me. Then she asked me if I had any concerns. I don't think my doctor was out to get me to pay for a primary care visit.

I believe the best course of action is to bring up the issue and directly ask the doctor, "If I ask you a question or want to discuss anything else, will I be charged for a primary care visit?" If you're worried that a "wellness visit" will turn into a primary care visit because you asked a question. :)
 
This is what took place at my "wellness visit" this week. Whoever she was, nurse/assistant, weighed me, took my blood pressure, and asked some questions.

"What year is it?"

"What month is it?"

"Spell "table" backwards."

"I'm going to give you three words to remember, and I'm going to ask you what they are later."

She handed me a piece of paper with a drawing of tilted intersecting s exagons and asked me to copy the drawing.

Then she asked me what the three words were.

Then I asked her at what age they start asking these questions. She looked at me and really didn't know. I said, "Sixty five?" She said, "Yes."

When we were finished, I told her to tell my doctor that I wasn't taking this "test" again.

She then gave me a yes/no and multiple choice questionnaire to fill out that asked about exercise, if I'd fallen or had concerns about falling, if I was depressed, etc.

When my doctor came in, she said that she was told that I didn't want to take the "test" again and to just remind them of that at the next "wellness visit".

I said I was glad that she didn't ask me to count backwards by sevens because I couldn't do it when I was forty, twenty, or ten years old. My doctor has a sense of humor. That's one of the reasons I like her. The other reasons are that she plays ball, listens, and doesn't dismiss my concerns. If I want a certain test, she doesn't argue with me, she orders it.

The doctor asked me about any meds I was taking and asked about supplements I was taking. We discussed some test results. She asked me about getting a flu shot, getting a mammogram, and taking a fecal occult blood test. She asked about my vision and if there were any changes. She asked if I got headaches. She asked me if I coughed. She asked if there were any medications she needed to order for me. Furthermore, she asked me if I had any concerns or if there was anything else I needed to talk about. Then she checked my ears, listened to my lungs, and checked my breasts. (Previous visits, she also checked my mouth and nose, she didn't do that this time.) I think she was having a slow afternoon because she was relaxed, unhurried, and took her time. I was with her for a good thirty minutes.

And that was my "wellness visit". Evidently, I'm going to live.

Bella ✌️
Hi Bella,

What were the 3 words to remember. I'm having this visit tomorrow and want to cheat in case I forget them. lol
 
I do continue to wonder how much (or little) variation there may be,
in how each doctor's medical practice might adapt the Wellness Visit.

I understand now, after this thread, that it is definitely not a physical.
Might be a useful appointment, or might be useless, to the patient, depending on how it is handled and what that individual's needs are.
 

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