Wellness Visit versus Physical Exam

Let’s take a look at what Medicare covers in regards to whether your doctor’s appointment is a Physical Exam or a Wellness visit.  The NIH, The National Institute of Health defines the physical exam as when a doctor / health care provider studies your body to determine if you do or do not have a physical problem. This exam would include inspection, feeling the body with hands or fingers, listening to you take a deep breath, while touching your back, sticking out your tongue, and checking your reflexes. Any tests resulting from this physical exam will not be covered under the cost of the exam.

Medicare Part B covers a Welcome to Medicare Visit and Annual Wellness Visits. Your Welcome to Medicare Visit is called an Initial Preventive Physical Exam (IPPE) This benefit is available for a single visit once you are eligible for Part B within the first year of your enrollment.

Services completed by your provider during your IPPE include recording and evaluating your medical history, current health condition and prescriptions. Checking your blood pressure, vision and weight. Making sure your health screenings and any shots are up-to-date, and ordering any further tests. There is no copay for this visit, and Part B does not apply to the cost of the visit. After the visit you may have to pay a co-payment for recommended services, and your Part B may apply.

Your Annual Wellness Visit is developed to provide you with a personalized prevention plan. This visit would include an assessment for future health risks and any preventive measures that may be needed. Your provider will compose a list of risk factors and treatment options just for you. There is no co-payment for your Annual Wellness visit, and they are not a part of your Part B deductible. However, you may have to pay a share of the cost for recommended tests or services.