Most people understand that an annual trip to the doctor for a “physical” is a fairly routine component of health and wellness. Many assume this annual exam is going to be a comprehensive assessment, with a battery of tests, screenings, X-rays and other diagnostic procedures.
The National Institutes of Health (NIH) characterizes a physical exam as an inspection of the body to determine whether there is or isn’t a physical problem. A typical physical exam usually includes:
- Looking at the body (inspection)
- Feeling the body with fingers or hands (palpation)
- Listening to the body’s sounds (auscultation)
- Producing sounds, usually by tapping on areas of the body (percussion)
If you pay close attention, there’s no mention of any specific diagnostic tests, screenings or procedures. Your doctor typically gathers most of the information from his or her senses – that is, what they feel, see, and hear. Based on the information they gleam from their initial assessments, they may then order tests or other procedures, but these would not be covered under the cost of the physical exam.
When it comes to a physical exam as described above, Medicare does not cover the costs. This is already getting complicated, so let’s look at what Medicare does cover.
Where to Begin: Welcome to Medicare Visit
Medicare Part B covers a “Welcome to Medicare Visit” as the first step in the process.
This initial visit is also referred to as an Initial Preventive Physical Exam (IPPE). You are eligible to receive this benefit one time within the first 12 months of enrolling in Medicare Part B.
During this we visit your provider will:
- Record and evaluate your medical and family history, ongoing health conditions, as well as any medications you may be taking.
- Check your vitals (i.e., blood pressure, vision, height and weight) to get baseline values to inform your care.
- Make sure you are current on things such as preventive screenings and services, including cancer screenings and immunizations.
- Possibly order further testing depending on your general health and your medical history.
For the Welcome to Medicare Visit, you do not have to pay a copayment, and the Medicare Part B deductible does not apply to the cost of the visit either.
Following your Welcome to Medicare Visit, your doctor will provide you with a personalized prevention plan, as well as a checklist of any recommended preventative services and screenings they recommend for you. It is important to note that the services and/or screenings recommended as part of this plan are NOT covered by the Welcome Visit. You may be responsible for any copayments associated with these services, and your Medicare Part B deductible may also apply.
After your initial Welcome Visit, you are eligible for an annual wellness visit under Medicare Part B.
Your Medicare Wellness Visit
After you’ve had Medicare Part B for at least 12 months, you are eligible for a Wellness Visit once a year, and this visit is fully covered by Medicare Part B. You may return for your Annual Wellness Visit once every 12 months (11 full months must have passed since your last visit) after that.
The aim of these Annual Wellness Visits is to further expand or revise your personalized prevention plan. The Annual Wellness Visit includes:
- A health risk assessment (your doctor will ask pertinent questions about your health)
- An analysis of your medical and family history
- Developing or updating a list of your current medical providers and medications
- Taking measurements of height, weight, blood pressure, etc.
- Looking for signs of memory loss or dementia
- Conferring personalized health advice
- A list of risk factors and treatment options (if applicable)
- A screening schedule (like a checklist) for preventive services (if applicable)
You are not required to pay a copayment for your Annual Wellness Visits, and these visits are not subject to your Part B deductible. However, you may have to pay a share of the cost for certain tests or services your doctor may recommend.
Your Welcome to Medicare Visit and Annual Wellness Visits are important Medicare benefits designed to ensure you have all the resources you need to stay healthy and prevent injury and illness.
In a Nutshell
Physicals are more involved examinations which focus more on your overall health and health goals, and many (if not most) of the services are not covered by Medicare. Beyond taking routine measurements, physicals typically involve detailed examinations, and the physician may suggest blood and/or urine tests, cancer screenings, and more.
Annual exams and wellness visits are typically short examinations that focus on elements of preventative care, and they are usually fully covered by Medicare. Various types of wellness visits include well-woman exams, well-child visits, and Medicare Annual Wellness Visits.
How The Legacy at Home Can Help With Annual Wellness Visits
At The Legacy Senior Communities, we are committed to helping seniors in every way we can. Through our at-home healthcare agency, The Legacy at Home, we are able to assist our clients with the Medicare Annual Wellness Visits in several ways. First, our staff can help you understand and complete the necessary paperwork to get enrolled in Medicare (if you haven’t already) and set up your Welcome To Medicare Visit.
Our Personal Care Assistants can help with scheduling the appointment to see your doctor and provide transportation to and from your doctor’s office. They can also work with you to ensure that you understand all of the elements of your preventative care plan and any medications you may be prescribed, and they can also help you manage your medication.
If you have any questions about how The Legacy at Home can help you or a loved one, please give us a call at (972) 244-7700 or contact us online.