Welcome to Medicare Insurance Coverage

In trying to assist you in understanding the complexity of Medicare insurance, we are providing you with some helpful information. 

As a newly enrolled Medicare subscriber, you have certain benefits available to you during the first 12 months you have Medicare.  This benefit is referred to as a Welcome to Medicare Visit.   

This visit is a preventive evaluation and management service.  The goals are health promotion and disease detection.  The components required in providing a “Welcome to Medicare Preventive Visit” are as follows;

• Review of individual’s medical and social history.

• Review of individual’s potential (risk factors) for depression and other mood disorders. 

• Review of individual’s functional ability and level of safety.

• A physical exam which includes only height, weight, blood pressure, BMI and visual acuity.  (This is not a hands-on exam.)

• End of Life planning.

• Evaluations/Referrals based on above. 

Please make sure that you inform the office when scheduling your appointment “this is my Welcome to Medicare Preventive Visit”, to ensure proper billing and reimbursement. 

 

Annual Wellness Visit

Medicare also offers another covered service for their patients (after 12 months of enrollment in Medicare), known as an “Annual Wellness Visit”.  This yearly visit is an evaluation for risk and determination of covered tests for Medicare, and is NOT a “hands-on” physical exam. 

The components required in providing an Annual Wellness Visit (AWV) are as follows:

• Establishment of an individual’s medical/family history.

• Establishment of a list of current providers and suppliers that are regularly involved in providing medical care to the individual.

• Measurement of an individual’s height, weight, BMI (or waist circumference), and blood pressure. 

• Detection of any cognitive impairment that the individual may have.

• Review of the individual’s potential (risk factors) for depression based on the use of an appropriate screening instrument (PHQ-9).

• Review of the individual’s functional ability and level of safety based on direct observation or the use of appropriate screening questions. 

• Establishment of a screening schedule. 

• Establishment of a list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or are underway for the individual and a list of treatment options.

The Annual Wellness Visit DOES NOT require a hands-on physical examination to charge for the service.  Please make sure that you inform the office when scheduling your appointment “this is an Annual Wellness Visit NOT an Annual Exam, or Physical to ensure proper billing reimbursement. 

Lastly, Preventive exams (well physicals, hands-on exam) are NOT covered by Medicare.  These exams include a complete physical exam, immunization advice, screening tests (lab and x-ray) and guidance on topics such as diet and exercise.  Please make sure that you inform the office when scheduling this non-covered appointment “this is for my Annual Physical exam”. 

If you have additional questions, please contact a Medicare representative, your benefits packet from Medicare, or one of our business office staff. 

​