I have a little way to go until I’m a senior citizen, so I asked a couple of people over 65 (my parents) about their experience with Medicare‘s wellness program.
Now in their 70s, my parents are experts at navigating a system that, as my mother put it, is actually much easier than private insurance. Still, beginning anything new at an older age including joining Medicare, can make one apprehensive.
Starting with the initial “Welcome to Medicare” visit and continuing with Medicare’s annual wellness visit, my parents see their general practitioners once a year for a checkup, which mainly consists of the doctor asking them questions about their health.
Despite going to different doctors, their experiences have been similar.
“I get the feeling the doctor is reading off a script, but that might not be a bad thing because then he’ll cover everything, which people might not mention unless the doctor asks,” my dad says. “If you say ‘yes,’ they might do additional testing or more questions.”
For example, the doctor will ask if you’ve had a fall since your last visit. If you have, they may assess your body for injury. This will be outside of the covered “wellness” services, so you may be billed for it.
Even so, it’s worth finding problems early before they become more damaging to your health — and your wallet.
“The Welcome to Medicare preventive visit is a great opportunity to take advantage of one of Medicare’s many preventive services,” says Melanie Lambert, senior Medicare advocate at the Center for Medicare Advocacy.
Here’s a closer look at what the Welcome to Medicare visit entails.
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What It Is
The Welcome to Medicare visit is designed to prevent medical issues before they become major complications.
“The Welcome to Medicare visit is an opportunity for clinicians to assess an individual’s health and establish a baseline, provide a plan for health promotion and future care, and discuss disease prevention and detection to help people stay well,” says Alan Weil, senior vice president of AARP Public Policy Institute. “The Welcome to Medicare visit helps patients catch issues early, improve quality of life and potentially reduce long-term health care costs.”
To accomplish this, the appointment involves more talking and less examining than what would happen at a traditional annual physical.
“It’s more of a check-in with your provider,” Lambert says.
And it can be more effective to hear advice from a doctor, instead of a friend or family member.
[READ: What to Do When Medicare Advantage Plans Deny Coverage]
How to Schedule a Welcome to Medicare Visit
To schedule a Welcome to Medicare appointment, simply call your primary care doctor‘s office after you turn 65 and tell them you’d like to schedule your initial Medicare visit. You don’t have to switch doctors unless you want to, but you should confirm that your doctor takes Medicare.
It’s important to note that the visit must occur during the first 12 months of having Medicare, so don’t delay, especially if you often have to wait a while for an appointment.
If it’s tricky for you to set up an appointment – because you need to upload personal and medical information to a portal, for example, ask for help from a relative, neighbor or friend.
“To me, the most important thing an older person needs is an advocate who can help them set up the appointment and coordinate information with other physicians,” says Amy O’Rourke, past president of the Aging Life Care Association and author of the book “The Fragile Years,” noting that many states have no free advocacy services to help older adults with this.
If you don’t already have someone to rely on as an advocate, ask your church or local senior center if they provide volunteer help with setting up an appointment.
If you’re going to a new doctor, there are several things you should prepare, which you can ask your advocate for help with if you need. (If you’re continuing with the same general practitioner as before you were on Medicare, they likely have most of your information already.)
Items to bring to your Welcome to Medicare visit:
— Your Medicare card
— Your medical records, including vaccination records
— A list of the prescription drugs and supplements you take, including the dose and how often you take them
— Your personal and family health history
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What to Expect at the Welcome to Medicare Visit
If you’re seeing a new doctor, it’s a great chance to get to know each other.
“The Welcome to Medicare visit is a kickoff to discussing their health care more broadly, to catch up on screening opportunities and vaccines and to be sure that the patient is eating well, getting some exercise and is not socially isolated,” says Dr. Julie Bortolotti, a family medicine physician with UTHealth Houston.
Bortolotti also uses the opportunity to get a baseline for some tests to use in the future, such as an electrocardiogram (EKG), which checks heart health, and to be sure that simple things — like hearing or vision impairment — are not limiting her patient’s functionality. These tests should be covered in your visit, but ask your doctor to confirm.
There are nine components of the Welcome to Medicare visit:
— Review medical and social history. Your doctor will collect your medical history, family history, diet, physical activities, social activities and engagement.
— Screen for depression. You will be asked a series of questions to screen for depression risk factors.
— Check functional ability and safety level. Your doctor will screen you to determine your ability to perform activities of daily living, risk of falls, hearing impairment, home and community safety, as well as cognitive assessments and care planning.
— Conduct a physical exam. You will have your height, weight, body mass index (BMI) or waist circumference, blood pressure, balance, gait and vision measured. However, unlike a traditional physical, this does not include blood work or a full-body exam.
— End-of-life planning. Your doctor will talk to you about creating an advance directive, which includes your preferences for end-of-life care.
— Review opioid prescriptions. Your doctor will review your current opioid prescriptions, if applicable, to check for any risk of opioid use disorder, pain severity and current treatment plan, and may offer nonopioid alternatives.
— Screen for substance use disorder. Your alcohol, tobacco and drug use history will be assessed to check for potential substance use disorder.
— Provide education, counseling and referral. Based on the evaluation from the previous components, your doctor will talk to you about what steps to take next and give you referrals to specialists if needed.
— Provide preventive services. This includes an electrocardiogram (ECG or EKG), and, depending on your doctor’s assessment, other preventive services, such as cancer screenings, vaccinations and medical nutrition therapy.
Your doctor will also go over a personalized plan for conditions for which you are at high risk.
“I would use the wellness visit to discuss specific tests that are recommended to prevent diagnoses you are high risk for, such as weight issues for diabetes or osteoporosis,” O’Rourke says. “Think of it as a starting point to review recommended further testing.”
How Much Does the Welcome to Medicare Visit Cost?
For Medicare beneficiaries, the Welcome to Medicare visit is free. Medicare Part B covers the Welcome to Medicare visit, as long as it takes place within the first 12 months of the patient joining Medicare.
Fortunately, most doctors accept Medicare. The Centers for Medicare and Medicaid Services reported in November 2024 that 98% of providers take Medicare.
“Almost every place we go to takes Medicare — more places than when we had private insurance,” my dad says.
O’Rourke recommends maximizing your Welcome visit by making sure you’re taking advantage of all the free services offered. You can confirm with the medicare.gov website, or ask your doctor’s office.
“Check the list and review with the physician to ensure all (free) tests are being done,” she says.
What Other Costs Are Involved?
The free Welcome to Medicare visit can turn into a paid appointment very quickly if you’re not clear on its purpose, which is prevention and planning.
For instance, if you ask about a chronic illness, you may be charged a copay for a visit you thought was free, Bortolotti says.
Discussions of chronic problems fall under the category of “evaluation and management” instead of “prevention.” Therefore, they are subject to your deductible, copay and/or coinsurance.
Also, if your doctor brings up further testing, don’t blindly agree. If you’re unsure whether there will be a charge, ask your doctor to identify which services will incur an extra cost.
“Getting medical care is often signing a blank check. Always ask the cost up front,” O’Rourke says.
Another consideration before agreeing to further testing with an additional cost is how likely you would be to follow the treatment or recommendations if the test comes back positive.
Services that are not free in the Welcome to Medicare visit and can trigger extra costs include:
— Treatment for or a discussion about a chronic or acute condition
— Testing that your doctor orders outside of what’s covered, such as blood tests or imaging
— The services of a routine physical, such as a full-body exam
Why Doesn’t Medicare Cover Annual Physicals?
Patients are often surprised to learn that a full physical is not included in the Welcome to Medicare visit or subsequent Annual Wellness visits. If you have a physical, you should expect to pay the full price completely out of pocket.
“An annual physical should be covered,” O’Rourke says. “However, the (Medicare) program is designed to treat specific diagnoses, not help prevent them.”
Medicare Part C, also called Medicare Advantage, which is an extra charge, sometimes covers annual physical exams, with some restrictions.
“For those in Medicare Advantage plans, staying in-network is key to avoiding unexpected charges,” Weil says.
Additionally, if you have secondary or supplemental insurance, check to see if that plan covers an annual physical.
The bills for my parents’ last annual visits went through Medicare first, and anything not covered went to their secondary insurance. After that, their patient responsibility was $15 for my mom and $18 for my dad.
For her part, Bortolotti prefers wellness visits, such as the Welcome appointment.
“They are more useful than a routine physical and more suited to patients’ needs as they get older,” she says.
Bottom Line
As the old saying goes, an ounce of prevention is worth a pound of cure.
“Preventing a chronic condition can help the older adult maintain an active lifestyle, which is critical to successful aging,” O’Rourke says.
As my parents have found, Medicare’s wellness services, including the Welcome to Medicare visit and the Annual Wellness visit, are helpful and easy to schedule and attend.
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What Is the “Welcome to Medicare” Preventive Visit? originally appeared on usnews.com
