Sonia Ashford is the owner of Ashford Insurance, an independent health insurance agency specializing in Texas Medicare insurance.
The Welcome to Medicare preventive visit is a one-time appointment you can choose to receive when you are new to Medicare. The aim of the visit is to promote general health and help prevent diseases.
The “Welcome to Medicare” physical exam is a one-time, preventive physical exam Medicare covers within the first 12 months that you have Medicare Part B. The visit will include a thorough review of your health, along with education and counseling about the preventive services you need, like certain screenings, shots, and referrals for other care.
Your doctor will check that you are up to date with preventive screenings and services, such as cancer screenings and immunizations. Further tests may be ordered, if necessary, depending on your general health and medical history. Your doctor will also give you advice to help you prevent disease, improve your health, and stay well. You will get a written plan (such as a checklist) when you leave, letting you know which screenings and other preventive services you should get in the future.
Your doctor will also talk with you about creating advance directives. Advance directives are legal documents that explain in writing what kind of health care you would want if you were too ill to speak and/or make decisions for yourself. Talking to your family, friends, and health care providers about your wishes is important, but these legal documents help ensure your wishes are followed.
Once you enroll in Medicare Part B, schedule your “Welcome to Medicare” preventative visit right away. Medicare will only cover this physical exam if it occurs within the first 12 months from when you enroll in Medicare Part B.
If you’ve had Medicare Part B for over 12 months, you can get a yearly “Wellness” visit instead. This visit is also covered and can help you and your doctor develop a personalized health plan.
Medicare Part B covers your one-time Welcome to Medicare preventive visit. Note that you must receive this visit within the first 12 months of your Part B enrollment.
This visit includes a review of your medical and social history related to your health. It also includes education and counseling about preventive services.
During your Welcome to Medicare preventive visit, your provider should:
The Welcome to Medicare preventive visit is not a head-to-toe physical. This visit is also separate from the Annual Wellness Visit (AWV), which you can choose to receive once each year.
You pay nothing for the visit Original Medicare covers the Welcome to Medicare preventive visit at 100% of the Medicare-approved amount when you receive the service from a participating provider, meaning your doctor or other qualified health care provider accepts assignment. This means you pay nothing (no deductible or coinsurance). The Part B deductible doesn’t apply.
However, you may have to pay co-insurance, and the Part B deductible may apply if:
Medicare Advantage Plans are required to cover this visit without applying deductibles, co-payments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During your preventive visit, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.
When you make your appointment, let your doctor’s office know you would like to schedule your “Welcome to Medicare” preventive visit. Bring the following to your appointment:
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.
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Sonia Ashford, “The Medicare Insurance Lady”, has been helping Medicare eligibles in Texas with their Medicare Insurance since 2005.