By the time we become eligible for Medicare, most of us have learned that change is constant and inevitable.
At times, change can be challenging and confusing. Recent changes in Medicare coverage and new services, such as the free "Welcome to Medicare" preventive visit and the "Annual Wellness Visit" have proven to be confusing for some. People want to know are these two visits the same thing? What do they mean by the term "visit"? Are they physical exams? Are there co-pays?
First, it is important to know that neither of these visits is considered a physical exam.
Physical exams are not covered by Medicare. Let's start with the one-time "Welcome to Medicare" preventive visit, which is available only during the first 12 months that an individual is enrolled in Medicare. This is a free visit covered by Original Medicare and most Medicare Advantage plans. As always, contact your MA plan if you are unsure whether it covers a particular service. Remember, if you are new to Medicare you need to know whether your health care provider accepts Medicare.
During the "Welcome to Medicare" visit, your provider will record your personal and your family's medical histories, check your height, weight and blood pressure, calculate your body mass index and do a simple vision test. Your provider will also review the prescription and over-the-counter drugs that you take. This can be an excellent time to ensure that you are taking the right medications and to reduce the risk of dangerous drug interactions. It is also a time to discuss recommended preventive tests, screenings and immunizations designed to plan for a healthy future.
The "Annual Wellness" visit is also free and can be scheduled once every 12 months. You don't need to have a "Welcome to Medicare" preventive visit before getting a yearly free "Wellness" visit if you have been enrolled in Medicare for at least 12 months.
If you had a "Welcome to Medicare" visit, you will need to wait 12 months before you are eligible for the "Wellness" visit.
The "Annual Wellness" visit is very similar to the "Welcome to Medicare" visit and it focuses on developing or updating a personalized prevention plan based on your health and risk factors.
The prevention plan creates a schedule of recommended screening tests for the next five to 10 years. Since 2011, under the new health care law, many of these screening tests are free to people with Original Medicare. As of 2012, Medicare Advantage plans must also cover the same screening tests as long as you follow the guidelines of your plan. Screening tests that are now completely covered by Medicare without a deductible or co-pay include cardiovascular screenings, mammograms, pelvic exams for women, colonoscopy, flu shots, bone mass measurements, HIV screening and smoking cessation counseling. Additional screening tests may be free to those who are at risk for specific diseases or conditions. Your health care provider may order additional tests or procedures based on the results of your screening tests. These additional services will not be free.
The focus of both medical visits is the prevention of disease through early screening and detection and learning how to ensure a healthier future. Remember to be specific when scheduling a "Welcome to Medicare" or "Annual Wellness" visit to ensure that you will not be billed for the service.
For more information, go to www.medicare.gov or contact your local Office for the Aging or county NY Connects program.
Wayne L. Shepard is director of the Delaware County Office for the Aging. 'Senior Scene' columns can be found at www.thedailystar.com/seniorscene.