Medicare Beneficiaries Need to Know the Difference Between a Wellness Visit and a Physical

Medicare covers preventative care services- including an annual wellness visit. But confusing a wellness visit with a physical could be very costly.

As part of the Affordable Care Act- Medicare beneficiaries receive a free annual wellness visit. At this visit- your doctor- nurse practitioner or physician assistant will generally do the following:

  • Ask you to fill out a health risk assessment questionnaire
  • Update your medical history and current prescriptions
  • Measure your height- weight- blood pressure and body mass index
  • Provide personalized health advice
  • Create a screening schedule for the next 5 to 10 years
  • Screen for cognitive issues

You do not have to pay a deductible for this visit. You may also receive other free preventative services- such as a flu shot.

The confusion arises when a Medicare beneficiary requests an “annual physical” instead of an “annual wellness visit.” During a physical- a doctor may do other tests that are outside of an annual wellness visit- such as check vital signs- perform lung or abdominal exams- test your reflexes- or order urine and blood samples. These services are not offered for free and Medicare beneficiaries will have to pay co-pays and deductibles when they receive a physical. Kaiser Health News recently related the story of a Medicare recipient who had what she assumed was a free physical only to get a $400 bill from her doctor’s office.

Adding to the confusion is that when you first enroll- Medicare covers a “welcome to Medicare” visit with your doctor. To avoid co-pays and deductibles- you need to schedule it within the first 12 months of enrolling in Medicare Part B. The visit covers the same things as the annual wellness visit- but it also covers screenings and flu shots- a vision test- review of risk for depression- the option of creating advance directives- and a written plan- letting you know which screenings- shots- and other preventative services you should get.

To avoid receiving a bill for an annual visit- when you contact your doctor’s office to schedule the appointment- be sure to request an “annual wellness visit” instead of asking for a “physical.” The difference in wording can save you hundreds of dollars. In addition- some Medicare Advantage plans offer a free annual physical- so check with your plan if you are enrolled in one before scheduling.