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Ashford Insurance

What is a Medicare Annual Wellness Visit?

Sonia Ashford

Sonia Ashford

Sonia Ashford is the owner of Ashford Insurance, an independent health insurance agency specializing in Texas Medicare insurance.

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease and disability, based on your current health and risk factors.

What is a Medicare Annual Wellness Visit?

The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease and disability, based on your current health and risk factors. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical. Also, this service is similar to but separate from the one-time Welcome to Medicare preventive visit.

Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy.

During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:

  • Check your height, weight, blood pressure, and other routine measurements
  • Gove you a list of risk factors and treatment options for you.
  • Review your functional ability and level of safety
  • Learn about your medical and family history
  • Make a list of your current providers, durable medical equipment (DME) suppliers, and medications
  • Create a written 5–10-year screening schedule or checklist
  • Screen for cognitive impairment, including diseases such as Alzheimer’s and other forms of dementia
  • Screen for Depression
  • Provide personalized health advice and referrals to health education and/or preventive counseling services aimed at reducing identified risk factors and promoting wellness

Annual Wellness Visits after your first visit may be different. At subsequent AWVs, your doctor should:

  • Check your weight and blood pressure
  • Update the health risk assessment you completed
  • Update your medical and family history
  • Update your list of current medical providers and suppliers
  • Update your written screening schedule
  • Screen for cognitive issues
  • Provide health advice and referrals to health education and/or preventive counseling services

Your provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your provider thinks you may have a cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium.

Your costs in Original Medicare

Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider. The Part B deductible doesn’t apply. This means you pay nothing (no deductible or coinsurance).

However, you may have to pay co-insurance, and the Part B deductible may apply if:

Your doctor or other health care provider performs additional tests or services during the same visit. Medicare doesn’t cover these additional tests or services under this preventive benefit.

If Medicare doesn’t cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s requirements for the service.

Note:

If you have a current prescription for opioids, your provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your provider will also review your potential risk factors for substance use disorder and refer you for treatment if needed.

Contact your healthcare provider if you want to schedule your Annual Wellness Visit!

 

Photo by Karolina Grabowska

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Sonia Ashford

Sonia Ashford

Sonia Ashford, “The Medicare Insurance Lady”, has been helping Medicare eligibles in Texas with their Medicare Insurance since 2005.