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What is the Welcome to Medicare Preventive Visit?

Sonia Ashford

Sonia Ashford

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.

What is the Welcome to Medicare Preventive Visit?

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.

When do I get my “Welcome to Medicare” physical exam?

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.

Eligibility

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.

Covered services

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:

  • Check your height, weight, and blood pressure.
  • A calculation of your body mass index (BMI).
  • A simple vision test.
  • Review your medical and social history.
  • Certain screenings, flu, and pneumococcal shots, and referrals for other care, if needed.
  • Review your potential for depression and other mental health conditions.
  • Review your ability to function safely in the home and community.
  • Provide you with education, counseling, and referrals related to your risk factors and other health needs.
  • An offer to talk with you about creating advance directives.
  • Give you a checklist and/or written plan with information about other preventive services you may need.

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.

Cost in Original Medicare

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:

  • 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.

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.

Things to know

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:

  • Medical records, including immunization records.
  • Family health history. Try to learn as much as you can about your family’s health history before your appointment.
  • Any information you can give your doctor to help determine if you are at risk for certain diseases.
  • A list of any prescription drugs, over-the-counter drugs, vitamins, and supplements that you currently take, how often you take them, and why.

Note:

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.

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.