Does Medicare Cover Annual Physicals? – Overview
Medicare mainly covers the cost of healthcare services that are used to diagnose and treat medical conditions.
Medicare covers preventive services, including annual wellness visits. However, annual wellness visits are different from annual physical exams.
In this article, we shall learn the details of wellness visits covered by Medicare.
What is an Annual Physical Examination?
Annual physical examinations are yearly visits to your doctor. These visits are meant to ensure that you are overall healthy and have not developed any medical conditions/disorders since your last examination.
Annual physical exams are commonly used to monitor health and identify potential issues early. Still, people who have a complex medical history and those who want to feel assured of their good health can benefit greatly from this type of exam.
Physical examinations are a great way to detect, prevent and treat numerous medical ailments and illnesses in the human body.
Medicare Coverage for Initial Physical Examination
Does Medicare cover Annual Physicals – Medicare Coverage for Initial Physical Examination
A person enrolled in Medicare Part B qualifies for the initial preventive physical examination (IPPE) within the first 12 months of enrollment.
This is also known as a Welcome to Medicare physical exam. This physical exam is conducted within the first 12 months of enrolling in Medicare Part B.
Medicare eligibility typically begins at age 65. People with disabilities may qualify earlier, depending on their health condition.
Some of the tests in an IPPE include:
#1. Preventive service education
#2. Medical history review
#3. The social health history review
The Welcome to Medicare preventive visit (IPPE) is covered without cost to the patient for Medicare Part B beneficiaries, if the healthcare provider accepts assignment.
Medicare Coverage for Annual Visits
Medicare Part B covers one annual wellness visit each year at no cost to the beneficiary if the healthcare provider accepts Medicare assignment.
As per the Centers for Medicare & Medicaid Services (CMS), the types of healthcare professionals who can perform Medicare-sponsored annual wellness visits include:
#1. Doctor or physician
#2. Licensed nurse practitioner
#3. Certified clinical nurse specialist
#4. Physician Assistant
#5. Health educator
#6. Registered dietician
#7. Clinically-attached healthcare professional working as a consultant
Medicare Part B covers one annual wellness visit (AWV) every 12 months, which includes the following services:
#1. Completing a health risk assessment
#2. Setting up a personal prevention plan
#3. Updating personalized protection plan
Medicare Part B covers various preventive services, including:
#1. Colorectal cancer screening
#2. Bone mass measurements
#3. Diabetes screening
#4. Depression screening
#5. Medical nutrition therapy
#6. Glaucoma screening
#7. Breast cancer screening
#8. Prostate cancer screening
An AWV does not include ECGs or lab tests, but these may be ordered separately if medically necessary, potentially incurring additional costs. However, the healthcare professional may advise these tests during the same visit.
In such a case, you may have to bear the cost of additional services in copayments, deductibles, and application payments.
To learn more details about whether Medicare covers annual physicals, you can visit the official Medicare website at www.medicare.gov or call directly at 800-633-4227.
Why Does Medicare Not Cover Annual Physicals?
The main reason why Medicare does not cover annual physicals is the difference between the two.
Medicare does not cover annual physical exams as defined by a comprehensive physical examination and various tests; instead, it covers an annual wellness visit which focuses on prevention and planning for healthcare needs.
The annual wellness visit includes reviewing your medical and family history and developing or updating a personalized prevention plan and may consist of screenings, preventive services, and educational information, not just routine measurements.
Wellness visits are meant to improve your overall health by examining your medical history and status. Physical exams are more hands-on, whereas annual visits are more hands-off when evaluating.
Conclusion
Medicare has strict rules regarding coverage for preventive care, including the list of tests that are included and excluded.
Generally, Medicare covers one IPPE during your first year with Medicare Part B. Original Medicare covers one AWV every 12 months.
When you schedule an AWV, you should specify the type of appointment you require. This will avoid several unnecessary personal costs.
If you are unsure of your plan’s coverage, it is advisable to contact Medicare beforehand.
See Also
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