Once you’re on Medicare, you’re entitled to an annual wellness visit. Not to be confused with a regular physical, this appointment lets you work with your doctor or another health care professional to come up with a plan to get and stay healthy.

In this week’s column, Phil Moeller, the author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs and co-author of the updated edition of How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security, helps a reader sort out some bad information he got about these visits and explains why not everyone loves them.

Got a question of your own about Medicare or Social Security? Send it to askphil@considerable.com.

Is an annual wellness visit mandatory?

Patrick: May of this year will mark my second year of Medicare (with supplemental coverage). The first year was very busy, as my wife suffered a stroke, and seeking a Welcome to Medicare exam never crossed our minds.

Recently, when speaking to the scheduling department for our primary care physicians group, we were informed that we could be denied our Medicare coverage if we did not expedite our annual wellness visit.

I have read your Medicare book from cover to cover and scoured the internet looking for any mention of the annual wellness visit being mandatory and can find nothing. Can a medical group make the annual wellness visit mandatory in order to continue treating a patient with Medicare coverage?

What I did find in my reading was a lot of negative feedback from Medicare enrollees concerning their experience with the practitioners administering the exams, the information gathered, and the questions asked. Thanks for all you do and all of the knowledge that you have shared.

Phil Moeller: First off, Medicare will not deny you coverage if you do not have this visit. I am hoping you just misunderstood your doctor’s office and that what the scheduling department meant is that Medicare might not cover this specific Welcome to Medicare visit if you didn’t see the doctor within the one-year window. 

A Welcome to Medicare preventive visit , which includes certain screenings at no cost, must happen in the first 12 months after you sign up for Part B. After a year, with Medicare Part B you’re entitled to an annual wellness visit, typically with no deductible and co-insurance.

Good doctors find ways to provide good services, and this annual wellness visit should not be an exception.

To reassure you, there is nothing in Medicare’s official explanation of annual wellness visits that says or even hints that your overall Medicare coverage might be in jeopardy if you failed to have the appointment.

You say you have original Medicare (Parts A & B) with a Medicare supplement plan. A third of Medicare users have private Medicare Advantage insurance plans. Those plans can provide additional benefits beyond what’s offered by original Medicare, but they cannot take away any of those benefits. 

Like you, I have heard that some doctors’ offices do a poor job during these annual wellness visits. The purpose of the visits is to permit your physician to develop and review a personalized health plan.

This can entail gathering substantial personal information, as illustrated in this Medicare brochure designed for doctors. That can include your medical and family history, demographic data, an overview of your current health and cognitive abilities, an assessment of whether you can safely function on your own, and more.

Given that Medicare doesn’t pay doctors much beyond $100 for most of these annual visits, this doesn’t leave a doctor a lot of time. 

However, good doctors find ways to provide good services, and this annual wellness visit should not be an exception. When scheduling this visit, you should make sure it will also include advance care planning to discuss end-of-life issues. Medicare has packaged this session with the annual wellness visit and will pay additional fees to doctors to provide this service.

Many people naturally shy away from planning for the end of their life, let alone even talking about it. But I am a strong believer that such issues are too important to be ignored, and that people owe it to their family members not to neglect them.

Because of Medicare’s modest reimbursement rates, some doctor’s offices seek to provide additional health services during the annual wellness visit. Such services permit the office to charge more money for your visit. 

It’s perfectly okay for you to ask ahead of time exactly what will happen during one of these visits and to make sure you (and Medicare) are not being billed for health services you don’t wish to receive.


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