Health Benefits: Annual Wellness Visit
Medicare began offering a variety of preventive health services at no cost for eligible seniors, due to the 2010 Affordable Care Act’s mandate for preventive care coverage. For services to be done at no cost, seniors need the service orders to happen during their Annual Wellness Visit (AWV). The physicians at Comprehensive Cancer Centers urge all seniors to get their AWV exams.
The Annual Wellness Visit is a yearly appointment with a patient’s primary care provider (PCP) to create or update personalized prevention plans and account for any risk factors due to age, health or family history. This plan may help prevent illness based on current health and risk factors, or uncover new risks that were previously undetected. The AWV is not a head-to-toe physical (which Comprehensive recommends for everyone) and the service is similar to but separate from the one-time Welcome to Medicare preventive visit.
Who is Eligible for an Annual Wellness Visit (AWV)?
Medicare Part B covers the Annual Wellness Visit if:
- A patient has had Part B for more than 12 months
- A patient has not received an AWV in the past 12 months
Additionally, patients may not receive their AWV within the same year as they get their Welcome to Medicare preventive visit. As with any medical coverage question or eligibility determination, Comprehensive recommends patients consult their insurance coverage documentation or speak with their insurance representatives.
What Happens During an Annual Wellness Visit (AWV)?
During a patient’s first Annual Wellness Visit, their primary care provider will develop a personalized prevention plan for them. A provider may also complete the following during the evaluation:
- Check height, weight, blood pressure, and other routine measurements.
- Present a health risk assessment that can include a questionnaire completed before or during the visit that asks about health status, injury risks, behavioral risks, and urgent health needs.
- Review functional ability and level of safety, which includes screening for hearing impairments and risk of falling. Doctor must also assess the ability to perform activities of daily living (such as bathing and dressing), and levels of safety at home.
- Learn about a patient’s medical and family history.
- Make a list of current providers, durable medical equipment (DME) suppliers, and medications that include prescription medications, as well as vitamins and supplements a patient is taking.
- Create a written 5-10 year screening schedule or checklist. A PCP will keep in mind a patient’s health status, screening history, and eligibility for age-appropriate, Medicare-covered preventive services.
- Screen for cognitive impairment, including diseases such as Alzheimer’s and other forms of dementia. Medicare does not require that doctors use a test to screen for these. Instead, doctors are asked to rely on their observations and/or on reports by patients and others.
- Screen for depression.
- Provide health advice and referrals to health education and/or preventive counseling services aimed at reducing identified risk factors and promoting wellness Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.
AWVs after a first visit may be different. At subsequent AWVs, a patient’s primary care provider should:
- Check weight and blood pressure
- Update the health risk assessment you completed
- Update medical and family history
- Update list of current medical providers and suppliers
- Update written screening schedule
- Screen for cognitive issues
- Provide health advice and referrals to health education and/or preventive counseling services
What Will An Annual Wellness Visit (AWV) Cost?
For those who qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During the course of your AWV, your provider may discover and need to investigate or treat new or existing health issues. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit. Again, for insurance coverage eligibility, check your plan documentation and speak with plan representatives.
Comprehensive Cancer Centers Can Help
Physicians at Comprehensive Cancer Centers provide a variety of treatment options for seniors who’ve been referred to the practice by a patient’s primary physician either through AWV tests or other screenings. For certain patients, clinical research studies currently being conducted at Comprehensive Cancer Centers may offer additional treatment options. Please click here to learn more. To schedule an appointment with the team at Comprehensive Cancer, please call 702-952-3350.
The content is this post is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions and/or insurance coverage eligibility for Medicare, Medicaid or any other plan.
