Making Medicare's Wellness Visit Work for You

What Wellness Visits Do and Don't Do

Medicare Wellness Visit
Medicare offers a Wellness Visit once a year. Jose Luis Pelaez Inc/Blend Images/Getty Images

How would you like to have one-on-one time set aside with your doctor to talk about how to prevent disease and stay healthy? If you are on Medicare, you already do. Once every 12 months, you are offered a Wellness Visit. Learn what this visit does and does not include to take advantage of the opportunity.

Understanding Your Health Risk

Your healthcare provider will take the time to review your situation and decide if steps need to be taken to decrease your risk or screen for disease.

Health Risk Assessment (HRA): The Centers for Medicare and Medicaid (CMS) has not developed a formal HRA form but the American College of Physicians (ACP) provides a basic template that many medical practices adapt to their needs. The HRA form is used to jumpstart a conversation between you and the doctor. It tackles issues ranging your mobility to signs of depression to lifestyle choices like whether or not you wear a seatbelt.

Family History: Certain medical conditions may run in the family. Understanding if you are genetically predisposed to certain illnesses will allow your doctor to tailor a screening plan to your needs.

Medical History Review: Your healthcare provider will review your personal medical history, including your medical conditions, surgeries, and medications, including over the counter vitamins and herbal supplements. It is important to know what routine tests are indicated based on your own history.

Screening at the Wellness Visit

Your doctor may complete or recommend screening in any of the following areas during your Wellness Visit.

Cancer: Breast cancer, cervical cancer, colon cancer, lung cancer or prostate cancer screening may be indicated based on your age, gender, risk factors and life expectancy.

Most of these tests will not be completed at this visit but may be ordered at that time.

Depression: Depression increases your risk for health complications and impairs quality of life. Screening will allow your doctor to offer you the help you need.

Blood Pressure: Your blood pressure will be measured at every visit. High blood pressure increases your risk for heart disease and stroke. Treatment with lifestyle changes or medication will be based on your measurements.

Cognitive Impairment: Memory issues are more common as we get older. CMS does not tell your doctor which screening test to use. Whichever test he chooses, it will allow your doctor to keep track of changes over time and to offer additional services and medications as they are needed.

Obesity: Your height and weight will be measured at your Wellness Visit and used to calculate a BMI. A BMI greater than 30 will prompt obesity counseling. Your waist circumference may also be measured as this can be seen as a risk factor for metabolic syndrome.

Other Preventive Tests and Services: Additional screening tests, if indicated, may look for abdominal aortic aneurysm, high cholesterol, diabetes, glaucoma, hepatitis C, HIV, osteoporosis or sexually transmitted infections. Certain vaccinations (i.e. influenza, pneumococcal) may also be offered at your Wellness Visit.

Personal Health Advice

The Wellness Visit is an opportunity for extra face time with your doctor to make sure all the tests you need are arranged in a timely manner. You will be given a written document at the end of your Wellness Visit that outlines your risk factors, recommended tests and when those tests should be completed.

Wellness Visit Caveats

  1. Your Wellness Visit does not include a physical exam. Medicare does not pay for routine physical exams.
  2. For most people, the Wellness visit is free. However, you may pay for your Wellness Visit if your doctor does not accept assignment.
  3. If other health issues are addressed at the time of your Wellness Visit, i.e. an acute illness or follow-up of a long-standing medical problem, you may be charged for that part of your visit.
  4. If you are on a Medicare Advantage plan, you do not qualify for a Wellness Visit. Your plan may provide another option.

Sources:

American College of Physicians. A Checklist for Your Medicare Wellness Annual Visit. https://www.acponline.org/system/files/documents/running_practice/payment_coding/medicare/hra.pdf . Accessed January 28, 2016.

Centers for Medicare & Medicaid Services. The ABCs of the Annual Wellness Visit (AWV). https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf. Published January 2015. Accessed January 28, 2016.

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