My buddy Frank called his doctor's office in January and said he wanted to book his "annual physical." The receptionist said, "Great, we'll put you down for your Medicare wellness visit." Frank figured those were the same thing.
So Frank showed up expecting the full works. He wanted the doctor to look at a mole on his shoulder, check his bad knee, and run the blood work he gets every year. Instead, he filled out a long questionnaire, had his blood pressure taken, talked about his vaccines, and was out the door in half an hour. Three weeks later, a bill came for the knee exam and the blood work.
Well, folks, Frank wasn't mad at the doctor. He was mad that nobody explained the difference. So let me explain it now, before you book yours.
Is the Medicare wellness visit the same as a physical?
No. Medicare's yearly wellness visit is a planning visit. It's about preventing problems and making a plan for the year ahead. It's not a head-to-toe physical exam, and Original Medicare doesn't cover a routine physical.
That doesn't make the wellness visit less valuable. It just means you should know what you're booking so you don't get surprised like Frank.
What happens at a Medicare wellness visit?
In plain words, the wellness visit usually includes a health risk questionnaire, a review of your medicines and medical history, your height, weight, and blood pressure, a check on memory and thinking, and a plan for which screenings and shots you need. It doesn't include a hands-on, head-to-toe exam, checking new problems, or extra lab tests. Those things may be billed separately.
You generally pay nothing for the wellness visit itself if your doctor accepts Medicare assignment. You can get one every 12 months. If you're in your first year of Part B, you get a similar "Welcome to Medicare" preventive visit instead.
Who can get a Medicare yearly wellness visit?
If you've had Medicare Part B for longer than 12 months, you can get a yearly wellness visit. After that, you can have one every 12 months. It doesn't matter whether you feel perfectly healthy. In fact, that's the best time to plan ahead.
If you have a Medicare Advantage plan, your plan covers the wellness visit too, but check your plan's rules about which doctors to use.
What should I ask when I book my wellness visit?
Here are those questions in words. Ask, "Is this the Medicare yearly wellness visit?" Ask, "What should I bring with me?" And ask, "If I want a new problem checked too, how will that be scheduled and billed?" Write the answers down. It's perfectly fine to ask about cost before you're seen.
What should I bring to my wellness visit?
Bring a current list of every medicine, vitamin, and supplement you take, the names of your other doctors, and your family health history if you know it. Also bring the one or two things you most want to talk about, like a fall, trouble hearing, or feeling down.
Cindy wrote a helpful guide on getting ready for your doctor visit, including a simple way to put your questions in order.
Can I get my other problems looked at the same day?
Sometimes, yes. Many doctors can handle a new problem during the same appointment, but it may be billed as a separate visit, and your usual Part B deductible and coinsurance can apply. That's what happened to Frank. The office can tell you ahead of time, so ask.
If costs like these are a stretch, check whether you qualify for a Medicare Savings Program, which can help with Part B costs.
What Frank did this year
This January, Frank booked two things when he called: his wellness visit, and a separate appointment the next week for his knee. He asked about the cost of each. No surprise bills. And at the wellness visit, he finally got his shingles shot scheduled, which he'd been putting off for three years.
Know what you're booking, folks. It's your appointment, and your wallet.
Have you been surprised by a bill after a wellness visit? Tell us in the comments what happened.
