What is Medicare’s Annual Wellness Visit?

As with any major change, it can take a while to become accustomed to Medicare’s unique health care system. Whether it’s enjoying the freedom of no longer being subject to provider networks or figuring out how to read your Medicare Summary Notice, adjusting to this new insurance can take time. One of the most confusing parts of this transition is moving from a yearly physical to an Annual Wellness Visit (AWV). New Medicare beneficiaries are often unprepared for what an AWV entails, and, perhaps more importantly, what exactly they cover.

What is an Annual Wellness Visit?

Medicare’s Annual Wellness Visit is a time with your provider to review your current health and risk factors and develop or update a personalized plan to help prevent disease or disability. During this visit, your provider will typically ask you to fill out a questionnaire called a Health Risk Assessment. Your doctor may take routine measurements, review your medical history, and go over your current medications. Based on all this information, your provider can provide personalized health advice and potentially develop a screening schedule for appropriate preventive services. Down the road, these visits will also become a time when your doctor will perform cognitive assessments and help you with advance care planning. These visits are covered 100% by Medicare as a preventive service.

How does an Annual Wellness Visit differ from a yearly physical?

It is important to understand that an Annual Wellness Visit is not the same as a yearly physical exam. The simplest way to understand the difference is that an AWV is proactive and preventive, whereas a routine physical is reactive and diagnostic in nature. During a physical exam, your doctor is looking for things of concern – they may be discussing new symptoms, evaluating current diagnoses, and likely ordering blood work to assess health. While you may be used to these annual visits, this is no longer what a yearly checkup with your doctor will look like. As stated above, AWVs are in place to review any changes to your medical history, update your care plan, and stay on top of your health care as you age. They are in place to help you stay healthy, not to diagnose new problems.

When do I see a provider with a concern?

With annual physical exams becoming a thing of the past, you may be wondering when you are supposed to see a provider with a health concern. The answer is simple – whenever you need to! Medicare (and Medicare Supplement plans) were developed with seniors in mind. They provide excellent coverage and have very few barriers to care. If you have chosen to get your care through Original Medicare and a Medicare Supplement plan, you do not have to go through the hassle of checking networks and securing referrals, and you have very few out of pocket costs. You have comprehensive coverage, and it is there to use when a new health concern arises, or you need to evaluate your current treatments. Many individuals are used to saving up their concerns knowing that their doctor will give them a head-to-toe assessment at their annual checkup. However, the move to Medicare requires a mindset shift to that of seeking out care when symptoms arise and viewing your annual doctor visit as one that offers a holistic and preventive view of your overall health.

Annual Wellness Visits and blood work

Perhaps the most misunderstood claim for providers and beneficiaries alike is that of blood work. The blood work you may be used to receiving alongside an annual physical is ordered with the intent to look for all issues (regardless of if your provider has reason to believe there may be something wrong). Medicare does cover medically necessary clinical diagnostic laboratory tests when a health care provider orders them, but these tests do not fall in line with Medicare’s vision for AWVs. Even if your doctor believes a certain lab test is necessary, ordering it alongside an AWV could result in a claims denial from Medicare. As stated above, if you develop a new or ongoing health concern, you should schedule a separate visit with your doctor during which they can assess, order lab work, and potentially diagnose or treat the problem.

The big takeaways

• Be clear when scheduling your appointments.
  • When scheduling your annual checkup, be sure to state that you want an Annual Wellness Visit.
  • Schedule your AWV once every 12 months.
• Confirm that the doctor is performing services that fall under the AWV.
  • If your doctor does something or orders something that you are concerned does not fall under the purposes of an AWV, ask your doctor if the service will be covered.
• Schedule visits with your doctor when the need arises.
  • Do not save all your concerns for your annual checkup, schedule a sick visit with your doctor if you think there is something going on that needs to be addressed.