medicare wellness exam | Medicare Plan Finder

Take Advantage of Medicare Wellness Exams and Preventative Benefits

Anastasia Iliou General, Medicare

Medicare offers many benefits at zero cost to recipients, but many of the 59 million Americans enrolled are either not aware of all the Medicare wellness benefits or are simply not taking full advantage of all of these offered services.

For example, in 2014 only around 14% of Medicare recipients received the free Medicare wellness exam covered under Medicare Part B.  This exam, known as the Annual Wellness Visit, or sometimes known as the acronym AWV, is covered at zero cost to recipients.

What is Included in Medicare Wellness Exams?

Once you’ve had Medicare Part B for at least 12 months, you are eligible for a zero cost yearly* Medicare wellness exam. The purpose of this wellness visit is to work with your doctor to identify any risk factors to watch, as well as to develop a plan for staying healthy.

*Keep in mind that the AWV is available every twelve months. For example, if your first AWV is June 2, you cannot recieve your next one until June 2 of the following year. If you make your appointment for June 1, you may not be covered.

During the wellness visit, your doctor, nurse practitioner, or another health care professional will review things like your health history, take measurements such as weight and body mass index (BMI), and will help develop a preventative care plan tailored for you.

Some items that may be reviewed during your Medicare Wellness Visit include:

  • A Health Risk Assessment (HRA) questionnaire
  • Review of personal medical history and family medical history
  • Measurements including height, weight, BMI, and blood pressure
  • Assessment for any cognitive impairment and mood disorders
  • Review of any difficulty you may be having in performing day-to-day tasks

Your health care provider may also help you establish a plan for potential risk areas including fall prevention, nutrition, weight loss, and tobacco cessation.

What is not Included in your Medicare Annual Wellness Visit (AWV)?

It is important to know that the Medicare Annual Wellness Visit covers a specific set of wellness services and is different than an annual physical, which is not covered by Medicare. It is also important to note that any additional services performed during your Medicare exam may result in an additional copay or deductible cost.

For example, Mary is 68 years old and visits her doctor a few days after her birthday, as she does every year for her free Medicare wellness exam. During the visit, Mary mentions that her right foot has been bothering her, and after further examination, her doctor orders a blood test to check for gout.

In this scenario, Mary’s wellness visit is still free, but she may pay a copay for the additional foot examination as well as the blood test.

Medicare Wellness Exam vs. Annual Physical

The annual wellness visit is not the same as the yearly physical you may be familiar with. For a typical physical, your healthcare provider will perform a hands-on, head to toes exam including lung, abdominal, and neurological exams. Medicare exams are different.

The Medicare annual wellness visit includes similar assessments but does not include any exams that require the healthcare provider to physically examine you. During your wellness visit, your provider may schedule additional preventative screenings, or may further examine any issues you are having.  

What to Bring to Your Medicare Annual Wellness Visit

One of the main purposes of the annual wellness exam is to identify any potential health risks and develop a plan to manage them. So, you will want to share your family and personal health history with your provider in as much detail as possible.

Some things to bring include:

  • Medical and immunization/vaccination records
  • Detailed personal and family health history
  • Detailed list of medications and supplements including dosage and frequency
  • Full list of health care providers you are currently seeing

Other Medicare Wellness Benefits

In addition to the annual wellness exam, there are a number of additional services, screenings, and vaccinations covered at no cost including:

  • Alcohol screening
  • Bone mass measurements
  • Cardio screening
  • Colorectal screening
  • Diabetes screening
  • Hepatitis screening
  • HIV screening
  • Lung, prostate, and cervical cancer screenings

Medicare Vaccine Coverage and the Medicare Flu Shot

Medicare Part B also covers some other Medicare wellness benefits like preventative vaccines, including yearly flu shots. Ask your doctor about getting your flu shot during your Medicare exam.

However, Medicare does not provide maintenance coverage for other vaccines including Shingles, Tetanus (Tdap), and Meningococcal. These vaccines and additional immunizations are typically covered under Part D prescription drug plans.

To ensure you are covered for these vaccines and other prescription medication, you can add a Part D plan to Medicare Parts A and B, or choose a Medicare Advantage plan that includes Part D coverage.

Other Ways to Make the Most of Your Medicare Plan

Find Doctors in Your Plan Network

Some carriers have doctor and hospital search engines so you can see which doctors are covered under your plan. ZocDoc is a great non-affiliated doctor search website as well. If you continue to use a doctor that is outside of your plan, you’re wasting potential savings that you’ll receive if you visit a doctor who is within your plan’s network.

Use Generic Drugs

The same goes for pharmacies and drugs. Your coverage is likely much higher for generic brand prescription drugs, so ask your doctor for a generic version when he gives you a prescription. Your coverage includes mail-order prescriptions as well. Mail-order is often cheaper because there are fewer labor costs! Plus, you can buy bigger supplies.

Know Your Additional Benefits

Some Medicare plans include discounts and freebies like gym memberships, massages, nutrition classes, support groups, and even LASIK surgery. Some even provide “rewards” in the form of discounts if you stay healthy.

Get More Benefits with Medicare Advantage

There are many Medicare preventative services that Original Medicare covers, but do you need more?

A Medicare Advantage plan is a private Medicare plan that includes your Part A and Part B benefits and can extend your coverage to include more things like:

A Medicare Advantage Plan and Part D prescription drug coverage can help cover you for these additional costs and help you live the healthiest life possible. Our agents can help you understand all of your plan options and enroll you in a plan that fits your specific needs and budget. If you interested in arranging a no-cost, no-obligation appointment, fill out this form or call at us 833-438-3676.