The old saying goes that an ounce of prevention is worth a pound of cure. Change those measurements from pounds to dollars, and you see why Medicare puts so much emphasis on preventive services. As any doctor will tell you, it’s far less expensive to try to prevent illness than it is to treat it.
The Affordable Care Act (sometimes called Obamacare) took this premise even further. While some preventive services still require a copayment or coinsurance, many others are now entirely free if you meet certain guidelines and age requirements.
There are basically three types of doctor visits that may include preventive care and can be covered by Medicare:
New enrollees are often confused by the differences among these visits, because they are similar but not the same. It is always a good idea to clarify the type of visit you are scheduling before you book an appointment, so you know what services you are getting and what is or isn’t covered by Medicare.
It’s important to remember that a routine annual physical exam is not the same as your annual Medicare Wellness visit and is not a Medicare-covered service, meaning you will typically owe 100% of the amount due.
As the name implies, your Welcome to Medicare visit is something you schedule within the first 12 months that you have Medicare. At this visit, your doctor will go over your health and medical history, discuss your lifestyle and home welfare, and plan your future care, including preventive care. Typically, however, you do not receive preventive care at this visit – it is primarily a get-to-know-you interaction.
Your Welcome to Medicare visit may include:
The Welcome to Medicare visit is free of charge to you, meaning it doesn’t require any Medicare Part B coinsurance or copays, and it doesn’t count toward your Part B deductible. It is only covered one time, and the appointment must be held within the first 12 months of enrolling in Medicare Part B.
A Medicare preventive visit is not the same as the Welcome to Medicare visit. You might visit your doctor for a standard preventive care visit to perform some of the tests and screenings that were suggested at your Welcome to Medicare visit, as needed.
A preventive visit is an opportunity to discuss your health with your doctor, including preventive services you may need.
Many screenings at a preventive visit are covered in full by Medicare, meaning you pay nothing out of pocket for the visit. But you may need some testing that does include costs such as Part B coinsurance or copayments, and you may potentially face some costs if your doctor decides you need additional treatment or diagnostic testing based on the results of your appointment.
The preventive exam doesn’t routinely cover some tests, such as lung exams and reflexes. However, if your doctor has discussed a symptom with you that requires that screening, Medicare may cover it.
A Medicare annual Wellness visit (AWV) is similar to a standard preventive care visit to your doctor intended to check on your health, prevent and avoid disease and create a plan to maintain wellness. But these types of visits are also different.
The yearly Wellness exam is your yearly check in, while preventive services are scheduled as needed. Once you have been enrolled in Part B for more than 12 months, you are eligible for a yearly Wellness visit.
The annual Wellness visit can include preventive services such as:
At the annual Wellness visit, you can make an appointment for any preventive care you need.
Medicare doesn’t cover routine physicals. You are accountable for 100% of costs for a routine physical, which can average from $50- $200 or more.
According to Medicare.gov, the following tests and screenings can be covered by Medicare for free without out-of-pocket copays or coinsurance, depending on your situation and depending on whether your doctor accepts Medicare assignment:
Some of the following tests and screenings may require you to pay a Medicare deductible, copay or coinsurance:
As of 2020, new Medicare beneficiaries cannot purchase a Medigap plan (also called Medicare Supplement Insurance) that covers the Part B deductible. However there are some types of Medigap plans that cover Part B coinsurance costs.
Medicare Advantage plans (also called Medicare Part C) are an alternative to Original Medicare that sometimes provide additional benefits.
Every Medicare Advantage plan must provide the same hospital and medical benefits as Medicare Part A and Part B, which means that the benefits listed in this article are covered by Medicare Advantage. Some Medicare Advantage plans may also cover additional preventive services that Original Medicare doesn't cover.
Speak with a licensed insurance agent to find Medicare Advantage plans in your area and to enroll in a plan that works for you.
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