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Ep. 18: What is covered by a Medicare Wellness Visit?

October 15, 2019

It is daunting enough just to sign up for Medicare, let alone know all of the requirements or coverage options for it.  There is one thing to know for sure:  healthcare is about prevention now.  Even Medicare acknowledges that.  In the past few years, coverage and policies have changed to accommodate prevention by adding "Wellness Visits."  In fact, many insurance providers beyond Medicare even coverage free wellness visits.

The idea is to check in with your provider.  Chat all about your life and your health so your provider can give guidance and make a plan for how to keep you healthy and active.  These Wellness Visits are very different from physicals or treatment-based visits, and it is important to know the difference.

Trudy Argubright, APRN has been a nurse practitioner for more than 20 years, and joins the Pulse to discuss what Medicare does and does not cover, and how to take advantage of those opportunities.

Episode Summary

After signing up for Medicare coverage, the first step is the "Welcome to Medicare Wellness" visit.  This appointment goes above and beyond what normal visits cover, and acts as a baseline assessment, especially for people who have not been to see a primary provider in a long time.  The visit includes risk assessments and can include, as needed, a variety of tests, which are all covered by the visit.  Normal wellness visits do not cover the expense of such tests, which is why the Welcome visit is so important.  It is also important to know that the Welcome visit is "Use it or lose it" for the first year; if you don't take advantage of the Welcome visit, the opportunity is gone forever.

After that, Medicare covers annual "Wellness Visits," which have to be at least 365 days apart to be covered.  This visit is a check-in with Medicare Wellness nurses, who go through an assessment and question about all aspects of your lifestyle and any new challenges or concerns.  It is a way to try to leave no stone unturned in detecting any signs of coming problems or diseases.  Even simple things like not sleeping as well give a direction for what to keep an eye on.

The Wellness Visit itself does not include any prescriptions, lab testing, x-rays, etc.  The visit is strictly a visit.  However, the visit is when your provider might decide to order a lab test or recommend a certain screening to find out more based on what you talk about.  These add-ons are not necessarily covered by Medicare and are not part of the visit.  They, and any follow-up visits, are subject to deductibles. 

That one Wellness Visit a year is incredibly valuable for providers, since it gives them a chance to think about other issues that might be going on.  If you are always scheduling appointments with your provider about your high blood pressure, then all the provider is thinking and asking about is the high blood pressure.  The Medicare Wellness Visit gives an opportunity to find out about changes in vision, eating, sleeping, walking, pain, and more.  

Schedule your annual Medicare Wellness Visit, and don't miss out on the benefits of the "Welcome to Medicare" Visit within the first year of enrolling.


Trudy Argubright, APRN, FNP

Perry Memorial Family Health Clinic


Resources - review what is covered and learn about the "Welcome to Medicare Wellness" Visit

Welcome to Medicare & Wellness