Medicare Preventive Visit and Annual Wellness Visit may sound the same and can often be used interchangeably by the beneficiaries but are actually pretty different. Those who understand Medicare at a fundamental level can only distinguish between the two and can leverage the benefits of both visits.
If not aware, you might be handed a bill for your visit while you were expecting it to be free. To clear the misconception and the confusion, we have detailed both visits so that you know what to expect from your visit when going for one.
So, let’s go through Annual Wellness Visit first.
What is an Annual Wellness Visit?
There is a prevalent misconception among beneficiaries that yearly wellness visits are the same as annual physical exams in Medicare. This is most likely due to most people’s familiarity with yearly physical examinations or checkups, and they believe that an annual wellness visit is the same. They are, nevertheless, quite different.
Annual Wellness Visits (AWV) for Medicare enrollees are yearly preventative visits to create or revise a customized prevention plan. These preventative visits allow patients to express their feelings about their health condition to their primary care provider by completing a health risk assessment. The provider can then utilize the data to identify risk factors, provide suitable preventive therapies, and develop a customized prevention plan.
There are three primary components to these visits:
Health Risk Assessment (HRA): Patients complete a self-administered questionnaire that covers all aspects of their health and well-being as the first component of an AWV. Patients must self-report information on the following issues for the HRA to be considered compliant:
- Health Status Self-Assessment
- Behavioral dangers
- Medical and family medical histories
- Psychosocial Consequences
- Daily Living Activities
- Instrumental Activities in Everyday Life
Questions concerning advance care planning may be included in the risk assessment form. The clinician will detect risk factors, such as cognitive impairment, based on the patient’s responses to the HRA questions and design a specific preventative plan to follow.
Vitals: Collecting and recording vitals is the second step. Height, weight, and blood pressure are typical parameters when addressing risk factors for cardiovascular disease, stroke, and hypertension. Therefore, body mass index is calculated and reported using height and weight (BMI).
Consultation: The third component of an AWV is consultation, which entails turning the HRA results into a five to ten-year care plan. Based on patient replies to the questionnaire, providers can identify risk factors and outline a preventative plan for a healthy future.
Annual Wellness Visit Includes:
- A personalized Prevention Plan of Service (PPS) is included in the Annual Wellness Visit, as well as a follow-up visit.
- A visit comprises an Initial Preventive Physical Examination (IPPE) or an Annual Wellness Visit (and) containing a typical bundle of Medicare-covered treatments that would be supplied per diem to a patient getting an IPPE or AWV.
- The physician or other trained health care professional will explain and discuss advance directives such as standard forms (along with the completion of such forms, if applicable); additional 30 minutes each will be spent on advance care planning.
What is the Welcome to Medicare Preventive Visit?
Generally, a one-time ‘Welcome to Medicare’ appointment is covered under Medicare Part B. You can avail of this appointment within 12 months of enrolling in Medicare. You won’t have to pay anything for your ‘Welcome to Medicare’ appointment unless you need treatments that aren’t covered, including lab testing or health screenings.
During the “Welcome to Medicare” visit, you can expect the doctor to:
- Keep a record of important information (height, weight, blood pressure, body mass).
- Examine your and your family’s medical history.
- Examine risk indicators that might signal the onset of a significant illness in the future.
- Present a checklist of preventative treatments (many of which Medicare covers for free — such as mammograms and immunizations) to help you remain healthy and propose tests and screenings that might spot medical concerns early.
- Provide you the opportunity to talk about end-of-life matters, such as how to write advance directives, which you may use to identify someone who will make medical choices on your behalf if you become too unwell to do so by yourself.
- As needed, give counseling and referrals.
When you have a “Welcome to Medicare” visit from a qualified physician that accepts the Medicare, Original Medicare pays 100 percent of the Medicare-approved cost. It implies you don’t have to pay anything (no deductible or coinsurance). Likewise, when you see an in-network provider fulfilling Medicare’s eligibility standards for the service, Medicare Advantage Plans are obligated to fund this visit without imposing deductibles, copayments, or coinsurance.
Your provider may uncover and need to explore or treat a new or existing condition during your preventative appointment. This additional treatment is classified as diagnostic, which means your doctor is treating you because of specific symptoms or risk factors. Therefore, analyzed diagnostic services you get during a preventative visit may be billed to Medicare.
If all of the information overwhelms you and you still cannot get into the complicated world of Medicare, Simpler Horizons Insurance Solutions are there to assist. Our licensed agents specializing in Medicare helps you find the right plan by considering your medical needs and clarify your doubt regarding choosing the appropriate plan.