Encouraging health and well-being is key to disease prevention, particularly as individuals age. For new Medicare enrollees, a “Welcome to Medicare” preventive healthcare visit is available. In this session, a doctor assesses the individual’s health and medical history, providing valuable healthcare information. Explore the coverage of the “Welcome to Medicare” visit, distinctions from annual wellness visits (AWVs), and additional preventive care options offered by Medicare in this article.
What is the Welcome to Medicare preventive visit?
Medicare Part B covers a single Welcome to Medicare visit, which must be completed within the initial 12 months of Medicare enrollment.
You won’t incur charges for the visit unless additional services like laboratory tests or health screenings are provided.
The Welcome to Medicare visit includes:
- Medical and Social History:
- Review of past illnesses, surgeries, family medical history.
- Assessment of current medications, dietary supplements, lifestyle factors.
- Exam:
- Basic examination covering height, weight, BMI calculation, blood pressure check, and a simple vision test.
- Safety and Risk Factor Review:
- Utilization of questionnaires or screening tools to assess hearing loss, fall risk, home safety, and depression risk.
- Education:
- Doctor guidance based on collected information, covering recommended health screenings, vaccinations, specialist referrals, and advance directives such as resuscitation preferences.
Is the physical the same as AWVs?
Both the “Welcome to Medicare” physical and AWVs aim to monitor an individual’s health, constituting similar assessments but distinct services. The Welcome to Medicare physical occurs within the initial 12 months of enrollment, serving as a one-time health assessment.
After more than 12 months with Medicare Part B, individuals can undergo an AWV annually, encompassing a “Health Risk Assessment” test. A cognitive impairment test may be conducted to identify early signs of Alzheimer’s or dementia.
Utilizing this information, the doctor develops a personalized illness prevention plan, aiming to forestall future health issues based on the individual’s health and potential risk factors. Subsequent AWVs involve updates to the prevention plan, ensuring it aligns with the evolving health needs of the individual.
AWVs incur no cost and have no Part B deductible. However, if the doctor orders additional tests or services, coinsurance may apply, along with the potential for the Part B deductible, similar to the Welcome to Medicare visit.
Who is eligible to conduct a Welcome to Medicare visit?
Your doctor can perform this visit if they accept assignment, agreeing to receive payment directly from Medicare at an approved amount for the provided services.
Before delivering any services beyond the Welcome to Medicare visit, your doctor should inform you. This allows you to decide whether you wish to receive those additional services at that time.
Which preventive services does Medicare provide coverage for?
Medicare encompasses various preventive services and screening tests, addressing conditions such as
- abdominal aortic aneurysm
- bone mass issues
- Cancer
- cardiovascular disease
- Depression
- Diabetes
- Glaucoma
- hepatitis B and C
- HIV
- obesity,
- sexually transmitted infections (STIs).
Additionally, Medicare extends coverage to vaccinations for hepatitis B (for those at medium or high risk), influenza, and pneumococcal disease.
Enrollees in Medicare can also avail themselves of
- counseling services
- Therapies and lifestyle training
- encompassing alcohol misuse counseling
- cardiovascular disease behavioral therapy
- diabetes self-management training
- nutrition therapy services
- obesity counseling
- STI counseling
- tobacco use counseling
Immunizations
Certain vaccinations receive coverage, including:
- Hepatitis B: Applicable for individuals at medium or high risk of contracting hepatitis B.
- Influenza: Administered once per flu season.
- Pneumococcal disease: Coverage includes two vaccines – the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and the 13-valent pneumococcal conjugate vaccine (PCV13).
The bottom line
In summary, prioritizing preventive care is crucial for detecting and preventing various conditions. The Welcome to Medicare visit assists your doctor in evaluating your health and providing care recommendations.
This visit can be scheduled within the first 12 months of Medicare enrollment, involving a review of your medical history, a basic examination, risk and safety assessment, and healthcare recommendations.
It’s essential to note that the Welcome to Medicare visit differs from an annual physical, as certain services like laboratory tests and screening exams are not part of it.
Nevertheless, Medicare may cover some of these services periodically as part of preventive care.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
