“What the heck is it?” It’s not uncommon for something we used to know by one name now described by another word. When I was a kid, it was a swamp; today it’s wetlands. We used to re-use things; now they’re re-purposed. Improving something now means it’s re-imagined. The terms may change but the definition stays the same.
That’s not the case with Medicare. We’re used to going to the doctor for an annual physical. When you go on Medicare you get an annual wellness visit. It sounds the same, but the definition is different.
Federal law clearly prohibits Medicare from paying for annual physicals. However, Obama-Care introduced the re-imagined exam for everyone over the age of 65. Your first annual visit after going on Medicare is called the Initial Preventive Physical Examination; the doctor just calls it your Welcome to Medicare visit. Unlike a true physical, your Welcome to Medicare visit contains no poking, prodding, or fingers going places that make your eyes bug out. The physician asks a lot of questions about your medical and social history and then becomes a counselor to talk about preventative services.
Specific components of your first annual wellness visit include:
- Gathering height, weight, and blood pressure numbers
- Calculating your body mass index (BMI)
- A simple vision test
- Reviewing risk factors for depression, functional ability and safety level
- Reviewing current opioid prescriptions
- Checking the quality of your vision
- Checking for potential substance use disorders
- Providing education, counseling, and any referrals based on all these components
- A written plan for screenings, vaccinations, and other preventative services
- End-of-life planning, if you agree
12 months later you go back to the doctor for your second preventative visit. The purpose of this not-a-physical exam is to update everything from your Welcome to Medicare visit. In this visit there will be:
- A review of your medical and family history
- Gathering your height, weight, blood pressure and other routine measurements
- Checking for any cognitive impairment
- Personalized health advice
- Updating your list of current medical providers, suppliers, prescriptions, health risk factors and the schedule for any preventative services you need or are suggested.
Medicare pays 100% of your Welcome to Medicare visit as long as it’s given by a participating provider, which is a doctor who accepts what Medicare pays for the visit. There’s no deductible, copay or coinsurance—nothing out of your pocket.
If you still have your heart set on an annual physical, you can get one. But you’ll have to pay for some or all of it depending on how the doctor codes the various parts of the exam.
So, let’s see. In today’s language, the Welcome to Medicare visit is not for old people; it’s for mature adults who are not retiring, but transitioning to a new phase of life and have access, not to doctors, but medical providers who don’t examine, but visit when you come to their office. Why make it easy when difficult will do?