The New Physical: Annual Wellness Visits
One important tool for staying healthy as a Medicare beneficiary is the Annual Wellness Visit (AWV), a preventive healthcare service that can help you stay on top of your health and identify potential health risks. During the AWV, your healthcare provider will review your medical and family history, assess your current health status, and develop a personalized prevention plan to help you stay healthy. In this blog post, we'll explore what an Annual Wellness Visit is, what services are covered, who is eligible, and why it's important to take advantage of this preventive healthcare service.
What is a Medicare Annual Wellness Visit?
Medicare Annual Wellness Visit (AWV) is a preventive healthcare service offered by Medicare to beneficiaries to help assess their overall health and create a personalized prevention plan. The AWV is a yearly appointment with a healthcare provider that includes a review of the beneficiary's medical and family history, measurement of vital signs such as blood pressure, height, weight, and body mass index (BMI), and detection of any cognitive impairment or depression.
During the AWV, the healthcare provider will also review the beneficiary's current medications and medical providers, and assess the need for additional preventive services or referrals. The AWV is not a physical exam, but rather a discussion between the beneficiary and their healthcare provider.
The AWV is covered by Medicare Part B with no out-of-pocket costs to the beneficiary, as long as the visit is performed by a healthcare provider who accepts Medicare. The purpose of the AWV is to promote wellness and prevention, and to help Medicare beneficiaries stay healthy and active as they age.
What is Covered Under Medicare Annual Wellness Visit?
Medicare Annual Wellness Visit (AWV) covers several preventive healthcare services, including:
Review of Medical and Family History: The healthcare provider will review the beneficiary's medical and family history to identify any potential risk factors.
Measurement of Vital Signs: The healthcare provider will measure the beneficiary's vital signs, such as blood pressure, height, weight, and body mass index (BMI).
Detection of Cognitive Impairment: The healthcare provider will perform a cognitive impairment assessment to detect any signs of memory loss or other cognitive impairments.
Depression Screening: The healthcare provider will screen for depression and evaluate the beneficiary's mood and overall mental health.
Personalized Prevention Plan: The healthcare provider will develop a personalized prevention plan for the beneficiary based on their current health status, medical history, and risk factors.
Review of Medications: The healthcare provider will review the beneficiary's current medications and identify any potential drug interactions or side effects.
Referrals for Additional Services: The healthcare provider may refer the beneficiary to additional preventive services, such as mammography or cancer screening, if necessary.
It's important to note that the AWV does not include a physical exam or any diagnostic tests. If the healthcare provider identifies any health concerns during the AWV, they may recommend additional tests or exams that may be covered under Medicare Part B.
What is the Cost of an Annual Wellness Visit Under Part B?
The cost for the Annual Wellness Visit under Medicare Part B is typically covered in full by Medicare, with no out-of-pocket costs to the beneficiary, as long as the visit is performed by a healthcare provider who accepts Medicare. This means that the beneficiary does not have to pay a deductible, copayment, or coinsurance for the AWV.
It's important to note that if the healthcare provider discovers and treats a new or existing health problem during the AWV, such as a diagnostic test or treatment, there may be additional costs under Medicare Part B. However, the healthcare provider must inform the beneficiary of any out-of-pocket costs before providing any additional services.
If the beneficiary chooses to receive any services or tests that are not covered under Medicare, they may be responsible for paying the full cost of those services. It's always a good idea to discuss any concerns about Medicare coverage or costs with the healthcare provider before receiving any services.
What Isn’t Covered Under AWV?
While the AWV covers many preventive services, there are some services that are not covered under the AWV, including:
Treatment for Existing Health Conditions: The AWV does not cover treating existing health conditions, such as chronic diseases or acute illnesses. If the healthcare provider identifies any health concerns during the AWV, they may recommend additional tests or exams that may be covered under Medicare Part B, but any treatment related to those health concerns may result in additional costs.
Diagnostic Tests: The AWV does not cover tests like blood tests or X-rays. Suppose the healthcare provider identifies a health concern during the AWV. In that case, they may recommend diagnostic tests, which may be covered under Medicare Part B, but any additional costs will depend on the specific test and whether Medicare covers it.
Any additional services beyond what is covered under AWV: If the healthcare provider recommends any additional services beyond what is covered under the AWV, such as immunizations or screenings for specific conditions, those services may be covered under Medicare Part B, but any additional costs will depend on the specific service and whether Medicare covers it.
Physical Exams: The AWV does not include a physical exam. If the beneficiary wishes to have a physical exam, they may need to schedule a separate appointment with their healthcare provider, which may result in additional costs.
Beneficiaries need to discuss any concerns about Medicare coverage or costs with their healthcare provider before receiving any services.
When Am I Eligible for AWV?
If you have Medicare Part B coverage, you are eligible for an Annual Wellness Visit (AWV) once every 12 months. You are eligible for your first AWV after you have been enrolled in Medicare Part B for 12 months.
After the first AWV, you will be eligible for subsequent AWVs every 12 months. It's important to note that the 12-month period starts on the date of your last AWV, not the calendar year. This means that you can schedule your next AWV 12 months from the date of your last AWV, not necessarily on January 1st of the next calendar year.
What is The Difference between Annual Wellness Visit and a Physical Exam?
The main difference between an Annual Wellness Visit (AWV) and a physical exam is that an AWV is a preventive healthcare service designed to assess and maintain the beneficiary's overall health, while a physical exam is a more comprehensive examination of the body to detect any health problems.
Here are some of the differences between the two:
Purpose: The purpose of an AWV is to develop a personalized prevention plan and identify potential health risks, while the purpose of a physical exam is to evaluate the overall health of the patient, detect any health problems, and diagnose any underlying medical conditions.
Services Provided: During an AWV, the healthcare provider will review the beneficiary's medical and family history, assess their current health status, perform a cognitive impairment assessment and depression screening, and develop a personalized prevention plan. During a physical exam, the healthcare provider will typically perform a more comprehensive examination of the body, including measurements of vital signs, a head-to-toe physical exam, and various diagnostic tests.
Coverage and Costs: The AWV is covered by Medicare Part B and does not require any out-of-pocket costs from the beneficiary. However, a physical exam may involve additional diagnostic tests or procedures that may not be covered by Medicare, and the beneficiary may be responsible for any costs not covered by Medicare.
It's important to note that an AWV is not a substitute for a physical exam, and a healthcare provider may recommend a physical exam if they identify any health concerns during the AWV. Similarly, if the beneficiary wishes to have a physical exam, they may need to schedule a separate appointment with their healthcare provider, which may result in additional costs.