Understanding Medicare coverage of preventive medicine, which focuses on promoting health and wellness and preventing illness and disease, is essential. As the population ages, preventive care and services like health screenings are especially important for older adults who face an increased risk for health issues.
Often concerned with cost, more than half of the nation’s seniors aren’t up to date with preventive care recommended by their doctor. But skipping these visits could come at the price of an individual’s health; effective treatment for illness and disease often depend on timely diagnosis.
The good news is some preventive screenings and services for adults 65 and older are covered by Medicare. The difference is, how Medicare defines those preventive services isn’t the same as private insurance. For example, Medicare doesn’t cover annual “head to toe” physical examinations. Instead, benefits include an initial “welcome” preventive visit, followed by yearly wellness visits.
“When a patient with private insurance comes for their annual physical, it usually covers a wellness portion and an acute illness portion — with the exception of addressing and evaluating a significant acute illness,” said Dr. Deepak Honaganahalli, an internal medicine physician at UCHealth Primary Care – Greenwood Village. “Medicare doesn’t consider the discussion of aliments, beyond the scope of managing pre-existing conditions, part of the annual wellness visit, so patients may incur a co-pay or other charges for that.”
Before making appointments for preventive services, seniors should have a firm grasp on what is covered by Medicare so they know what services they are entitled to and what to expect, said Dr. Roger Bermingham, a geriatric physician at UCHealth Family Medicine Center – Fort Collins. More details about what to expect and what is covered in the “Welcome to Medicare” preventive visit are available on Medicare’s website.
Does Medicare cover a preventive visit?
Medicare Part B enrollees are eligible for one “Welcome to Medicare” preventive visit within the first 12 months of their coverage. This is a once-a-lifetime visit, which may also be referred to as an Initial Preventive Physical Examination (IPPE). This visit is performed by your doctor and typically includes:
- Reviewing medical history (conditions, surgeries, medications).
- Checking blood pressure, height, weight, Body Mass Index (BMI), and vision (and possibly hearing).
- Screenings for any necessary disease prevention, as well as depression and personal safety.
- Administering any needed vaccinations.
- Discussing advance directives (a legal document for your health providers and loved ones documenting your health care wishes in case you are unable to make decisions).
Yearly wellness visit
After 12 months of Medicare coverage, individuals are eligible for a yearly wellness visit. The visit serves as a deeper dive into how an individual is functioning day-to-day physically and emotionally, and may also address planning for the future.
How to make the most of your “Welcome to Medicare” preventive care visit: “It’s really helpful if new patients bring their medical records, as well as any advance directives, power of attorney documents or living wills so we can review and scan them into our records,” Bermingham said. “It’s also important to bring a detailed list of all current medications, including vitamins and supplements.” When making your appointment, be sure to specifically request a Welcome to Medicare Preventive Visit. During the appointment, your doctor may recommend a screening or service that is not covered by Medicare, so talk to your provider if you are concerned about out-of-pocket costs.
How to make the most of your “Welcome to Medicare” preventive care visit:
“It’s really helpful if new patients bring their medical records, as well as any advance directives, power of attorney documents or living wills so we can review and scan them into our records,” Bermingham said. “It’s also important to bring a detailed list of all current medications, including vitamins and supplements.”
When making your appointment, be sure to specifically request a Welcome to Medicare Preventive Visit. During the appointment, your doctor may recommend a screening or service that is not covered by Medicare, so talk to your provider if you are concerned about out-of-pocket costs.
“Wellness visits are important because we don’t get the opportunity to address a patient’s social determinants of health or other health promotion aspects during an acute care visit,” Honaganahalli said.
Patients should expect to spend time answering questions or completing assessments about their well-being and risk factors. Bermingham said some individuals are hesitant to admit loss of memory or other issues during the cognitive assessment.
“I’ve had patients ask me if I am going to take away their keys,” he said. “I try to dig deeper into their concerns. I understand there’s a fear of losing autonomy and freedom, but we’ll work with our patients to make plans that will be of greatest benefit to them.”
This visit can be performed by a doctor or a member of the clinic staff and typically entails:
- Creating or updating a personalized prevention plan.
- Screening for disease management (some recommended screenings may not be covered, so patients should first ask their provider about any out-of-pocket expenses).
- Assessing for memory, depression, mobility and fall risk.
More details about yearly wellness visits are available on Medicare’s website.
Remember, if you want to discuss any acute concerns during the wellness visit, make sure to mention that when you make the appointment so additional time is scheduled. And you may be responsible for a co-pay or other charges.
“Even though it may look different than what folks are used to, regular preventive care is very important for overall health,” Bermingham said.