Q: Is it true that Medicare provides for one wellness visit a year?
A: Medicare covers one “Welcome to Medicare” preventive visit in your first year of having Medicare Part B, then one wellness visit per year after that, with zero cost-sharing as long as you see the appropriate providers. These visits are not head-to-toe physicals.
During the welcome visit, your provider will review your medical and social history, your health status and risk factors. Your provider will then give you resources related to your risk factors and health needs, and will give you a checklist or written plan with information about other preventive services you may need.
Annual wellness visits, which Medicare will cover once you’ve had Part B for 12 months, are yearly appointments with your primary care provider to create or update a personalized prevention plan. This plan can help prevent illness based on your current health and risk factors.
For both preventive visits, be prepared with information about your medical history, family history, the providers you see, durable medical equipment you use, and medications you take.
Q: Will my Medicare Advantage plan cover cancer screenings?
A: The best answer is that it should, but it depends on a few factors.
Medicare Part B covers many preventive services with no cost-sharing, as long as you meet the eligibility requirements. Preventive services recommended by the U.S. Preventive Services task force are covered with zero cost-sharing, so you will not owe any deductible or coinsurance when you receive them. A service is considered preventive if you have no prior symptoms of the disease.
If you are in a Medicare Advantage Plan, your plan cannot charge you for preventive care services that are free for people with Original Medicare, as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.
Similarly, for people with Original Medicare, it is important to make sure the provider you’re seeing accepts assignment, aka they’re a Medicare-participating provider. If you see a non-participating or opt-out provider, you might be responsible for part or all of the cost of your service. Always check in advance of appointments and tests to be sure the provider accepts assignment.
Some of the common screenings that are covered as preventive care include colorectal screenings such as stool testing and colonoscopies, mammograms, and screenings for prostate cancer, lung cancer, and cervical and vaginal cancer.
For a complete list of what’s covered and eligibility requirements, visit www.medicare.gov/coverage.
Navigating Medicare
Are you turning 65 this year and are new to Medicare? Sign up to take a free virtual class to help navigate the health benefits maze.
The class will be from 9-11 a.m. Friday via Zoom.
Experts will provide unbiased information to help attendees learn: the difference between Original Medicare and Advantage Plans; if they qualify for valuable premium savings programs; the best time to enroll in Medicare health care plans; when they can make changes to their coverage; and how to protect against fraud.
This class will be hosted by MMAP (Michigan Medicare/Medicaid Assistance Program) and Region IV Area Agency on Aging. No selling will occur at the class. Note: This class is tailored to Michigan residents.
To register follow this link or contact Amy Nichols at 982-7748 or amynichols@areaagencyonaging.org.