What Medicare Enrollees Should Know About Yearly Exams

Feb. 16, 2023

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Everyone should visit with a trusted doctor or health care provider every year for a wellness exam. These visits give patients the chance to ask about health concerns that may not be related to a specific condition. For people enrolled in Medicare programs, this can be even more important. 

There are two types of wellness visits with doctors. One is a Medicare Annual Wellness visit. The other is an annual physical. 

What is the difference between the two exams? 

The Medicare Annual Wellness visit is a chance to develop or update your care plan based on current health and risk factors. It helps Medicare understand members’ health concerns and needs each year. The wellness exam is a hands-off visit, meaning the doctor will mostly ask questions and complete various assessments. 

The physical exam is a hands-on visit. In this visit, the doctor will listen to your heart and lungs and may run laboratory tests or an electrocardiogram (EKG). 

What does Medicare cover? 

Medicare covers the Medicare Annual Wellness visit every 365 days. It is no cost to any Medicare member.
Medicare does not cover annual physical exams. Because they are not covered by traditional Medicare, annual physical exams can be expensive. Often these exams require testing. Tests increase costs. 

BlueCross BlueShield of South Carolina Medicare Advantage plans do cover an annual physical exam. But under BlueCross Medicare Advantage plans, members do not have any cost from the physical, including tests. This is different from other Medicare plans. 

What can I expect from each exam? 

An annual wellness exam includes:

  • A health risk assessment.
  • A screening and vaccination schedule.
  • Personalized health advice.
  • Advanced care planning. 
  • Other screenings, such as those for cognitive health or depression. 

The wellness exam typically takes 45 minutes to an hour with the doctor or provider. 

“The Medicare Annual Wellness Exam is a whole-person focused exam. The doctor assesses how social factors and aging affect you physically and how they might affect your medical conditions,” says Lindsey Giglio, a registered nurse and director of quality and provider partnerships at BlueCross. “The wellness exam is important so providers can discuss how to improve or maintain mental and physical health as members age and discuss age appropriate preventive screenings.”

An annual physical exam includes a health assessment that includes family history and biometric measurements such as blood pressure, height and weight. The doctor will listen to your heart and lungs. The exam may include a pelvic or rectal exam. The doctor may take blood and urine samples for lab studies. 

These exams take 30 – 45 minutes with the doctor or provider. 

“Physical exams are important because during a hands-on exams the provider will see, listen to and feel the body. They may find something that is not necessarily always reviewed, which may be an ignored symptom of a new or worsening condition,” Giglio says. 

How often can I get the exams? 

You can get both an annual physical and an annual wellness exam once every year. This means you cannot schedule the next exam until 365 days have passed. If you see your doctor on March 1 one year, you will have to go after March 1 of the following year for the same visit.  

How do I schedule an exam? 

It is important that members ask for an annual physical exam specifically. Many doctors do not schedule these because traditional Medicare does not cover them. If you have a BlueCross Medicare Advantage plan that does cover the annual physical exam, talk with your doctor about scheduling one in addition to your annual wellness exam. 

If you call a doctor to schedule a visit other than a normal follow-up, you need to specify whether you’d like to schedule an annual wellness visit or an annual physical. 

Is there an incentive for the exams? 

This year, BlueCross is offering a $40 incentive for Medicare Advantage members who get an annual wellness exam. The $40 incentive is added to members’ Over-the-Counter (OTC) benefit and can be used to purchase medical supplies, medications or vitamins, or other items with their FlexCard.

To learn more about BlueCross’ Medicare Advantage plans, contact our experienced counselors at 800-760-3690

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