What is a Medicare wellness exam?
Unlike a traditional annual physical, which is diagnostic and can involve hands-on exams and lab work, the Medicare wellness exam is a preventative health planning visit. Its purpose is to help you and your provider develop or update a personalized prevention plan to help you stay healthy and avoid disease. It's a key benefit of Medicare Part B and is covered once every 12 months for eligible recipients. The visit is generally free, with no copayment or deductible, provided your healthcare provider accepts Medicare assignment. If any additional tests or services are performed to address specific health issues, you may incur additional costs.
Components of your wellness visit
Your Medicare wellness exam includes several key components, often starting with a questionnaire called a Health Risk Assessment (HRA). You may complete this form before or during your appointment. The HRA helps your provider understand your current health status and potential risks. The visit will also cover:
Health history review
- Your provider will review and update your medical and family history, including past illnesses, surgeries, and hereditary conditions.
- You will also provide a list of all your current healthcare providers and any specialists you see.
Medication and supplement review
- You will go over a complete list of all prescriptions, over-the-counter medications, vitamins, and supplements you currently take.
- Your provider may discuss potential risks, such as with opioid use, and evaluate your pain management plan.
Routine measurements and screenings
- Vital signs: Your height, weight, body mass index (BMI), and blood pressure will be measured.
- Cognitive assessment: Your provider will perform a cognitive assessment to look for any signs of memory loss or other cognitive impairments that could indicate conditions like dementia.
- Depression screening: A screening for depression and other mood disorders is also typically included to address mental health concerns.
- Functional ability and safety assessment: Your provider will assess your ability to perform daily activities and evaluate your risk of falling and other safety issues in your home and community.
Personalized health advice and plan creation
Based on your HRA and other screenings, your provider will offer personalized health advice. This may include referrals to educational or counseling services for weight loss, smoking cessation, fall prevention, or nutrition. You will receive a written, personalized prevention plan and screening schedule for the next 5 to 10 years, including recommendations for preventive services and immunizations.
Social determinants of health (SDOH)
Starting in 2024, an optional SDOH risk assessment can also be included. This helps your provider understand how factors like your living environment, access to food, and social engagement might impact your overall health.
Comparison: Medicare wellness exam vs. annual physical exam
To clarify the differences, here is a comparison table outlining the key aspects of a Medicare wellness exam versus a traditional annual physical.
| Feature | Medicare Wellness Exam | Annual Physical Exam |
|---|---|---|
| Purpose | Preventative health planning, risk assessment, and screening schedule. | Diagnostic. Address current health concerns, symptoms, and existing conditions. |
| Cost | 100% covered by Medicare Part B (if provider accepts assignment), no deductible or copay for the visit itself. | Not covered by Medicare as a standard benefit. Patients pay 100% out-of-pocket unless they have a supplemental plan. |
| Includes Hands-on Exam? | No. A physical examination is not included. | Yes. Includes a hands-on physical assessment. |
| Includes Lab Tests? | No. Lab work is not part of the covered service. | Yes. Often includes blood work and other tests. |
| Focus | Proactively manage long-term health, identify risk factors, and create a future-focused plan. | Reactively address immediate health issues, diagnose problems, and provide treatment. |
Preparing for your appointment
To make the most of your wellness visit, it's wise to come prepared. Gathering this information in advance will ensure a productive conversation with your provider.
- Complete your HRA: Fill out the Health Risk Assessment questionnaire beforehand if it was provided to you.
- Bring your lists: Create an up-to-date list of all your medications, vitamins, and supplements, including dosages. Also, list all your current healthcare providers.
- Document your history: Have your family's medical history as detailed as possible, including hereditary conditions.
- Update records: Bring immunization records and dates of your most recent preventive screenings (e.g., mammogram, colonoscopy).
- Prepare your questions: Write down any health concerns or questions you want to discuss with your provider, such as changes in your memory, mood, or physical abilities.
After the exam: Putting your plan into action
Following your wellness exam, you'll have a written prevention plan. It is your responsibility to follow through on the recommendations. This might involve scheduling screenings, pursuing referrals to specialists, or enrolling in educational programs. The ultimate goal is to empower you with the knowledge and resources to take control of your long-term health. For more detailed information on Medicare's coverage of wellness visits and other preventive services, visit Medicare.gov.
Conclusion
Understanding what to expect in a Medicare wellness exam is the first step toward better preventative healthcare. This yearly visit is a valuable tool for proactively managing your health, identifying risks early, and working with your provider to create a personalized plan for a healthier future. By preparing thoroughly for your appointment, you can ensure a productive and comprehensive review of your health and well-being.
