October 3-9, 2022, has been designated as “Active Aging Week.” The purpose of the week is to encourage older adults to stay physically active so they can continue to thrive with healthy bodies, minds, and spirits. Part of maintaining your health as you age is regularly checking in with your primary care provider.

Medicare coverage varies for different types of medical visits, but one important appointment to take advantage of is your yearly “Wellness” visit. While they may sound similar, this visit is different from a routine physical exam (not covered by Medicare) or your “Welcome to Medicare” preventive visit (done within the first 12 months you have Medicare Part B).

It’s important to book your “Medicare annual wellness visit” by name and not schedule an annual physical, or you may wind up with medical bill for the wrong type of appointment!

Those who have had Medicare Part B for at least 12 months are eligible for their annual wellness visit. You’ll then have to wait at least 12 months to get your next wellness visit.

The purpose of this appointment is for your provider to evaluate your health and current risk factors and create a personalized plan to help you prevent disease and/or disability. The appointment isn’t mandatory, but it can be very beneficial for maintaining your health.

This visit can include the following steps:

• Completing a Health Risk Assessment, which is a questionnaire about your current health status and risk factors.
• Reviewing your personal and family medical history.
• Assessing your ability to perform Activities of Daily Living (ADLs), your safety at home, and your fall risk.
• Checking routine measurements like height, weight, and blood pressure.
• Reviewing your current medications. If you are prescribed any opioids, your provider may evaluate your risk of developing an opioid use disorder, provide treatment options beyond opioid use, evaluate your pain levels, and/or refer you to a specialist. They may also refer you for substance use disorder treatment if they deem it necessary.
• Creating a list of any risk factors you have and what treatment options are available to you.
• Creating a personalized schedule for preventive services you’ll need, like screenings and immunizations.
• Assessing your cognitive functioning to look for signs of dementia and Alzheimer’s disease. If you have signs of a cognitive impairment, Medicare will cover a separate visit to discuss these possible conditions in more detail and develop a care plan.
• Advance care planning.
• Offering personalized actionable advice on your health.

Your first wellness visit will likely be the most comprehensive, while future wellness visits are usually more of an update to your personalized health plan to help prevent disease or disability, based on your current health status and conversation with your health care provider.

If your qualified health care provider accepts assignment (meaning, they agree to be paid directly by Medicare for the amount Medicare approves and not bill you for anything more than the Medicare deductible and coinsurance), you won’t have to pay anything for this visit. Always confirm this information when you schedule your appointment.

You may have to pay coinsurance and/or the Part B deductible if the provider provides any additional services or runs any tests during the same visit. If Medicare doesn’t cover these services or tests, you may have to pay the full amount for them, so always be sure to discuss with your provider prior to proceeding with these tests or services.

As always, it’s a great idea to keep detailed notes in your Health Care Tracker about the visit. Then, it will be easier to spot if there are any discrepancies on your Medicare Summary Notice (MSN). If you do believe you are a victim of Medicare fraud, abuse, or errors, you can always contact the Wisconsin Senior Medicare Patrol (SMP) on our toll-free helpline at 888-818-2611. You can also email smp-wi@gwaar.org. Just make sure you do not include any sensitive personal information in your messages, like your Medicare or Social Security numbers.