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‘Welcome To Medicare’ Preventative Doctor Visit May Be Paid In Full

Question: I got information about a “Welcome to Medicare” medical exam. Do I have to do that? Will I lose my Medicare if I refuse?

Answer: Medicare provides for the “Welcome to Medicare” preventive visit with your primary physician when you first enroll in Medicare. This physical is offered to you in the first year (12 months) of your Medicare Part B enrollment. The idea behind this program is that some individuals have not gone to a physician or the same physician with any regularity. Medicare knows that if you find out about medical problems early on, they are easier to treat. This physical may find some of those medical problems or help to prevent those medical problems from happening at all. Your health stays more stable when you are regularly seeing a primary care physician, and not using the Emergency Department of the local hospital, or an urgent care clinic for your medical care.

If you have decided to stay with Original Medicare this “Welcome to Medicare” physical does not require you to meet your $185 deductible or your 20 percent cost share of the office visit. This first physical is covered and paid for in full by Medicare Part B. This Welcome to Medicare Physical applies to those individuals who are new to Medicare Part B.

Those individuals, who had coverage through an employer or insurance through their spouse’s work, may not have enrolled in Part B when they turned 65. When they begin Part B coverage later, they get this Welcome to Medicare Physical even though they have had Part A already. Your physician visits are covered through Part B coverage, so if you are just enrolling in Part B, this benefit applies to you when you join Medicare Part B.

During this “Welcome to Medicare” Physical, your physician should be having a conversation with you to review your past medical and surgical histories, current medications and supplements, family history, alcohol, tobacco and drug use, your diet, your physical activity level, risk factors for depression, advance directives you may have as well as the usual, height, weight and blood pressure.

This “Welcome to Medicare” exam is fully covered and paid for by Original Medicare. You certainly don’t have to do this, but why not begin your Medicare coverage with a good baseline of your current physical status. Many people turning 65 today are very healthy and active, and feel much younger than their years, at least that is what they tell me. Take this opportunity to see your doctor or a new doctor to begin your Medicare years. You will not lose your Medicare coverage if you don’t go, but you can only use this benefit in the first 12 months of coverage.

Another Original Medicare benefit is 100 percent coverage for an Annual Wellness Exam for all individuals with Medicare Part B. This cannot be used during the same 12 months as your “Welcome to Medicare” Physical. This Annual Wellness Exam is for every year after your first year of Medicare Part B eligibility. Many individuals with Medicare are healthy and have few diagnoses. They may not go to their primary care physician regularly. Medicare is encouraging those with Medicare to go at least yearly to see their primary care physician, and hopes this fully covered & paid for visit will help make that happen.

There are many preventive services that are paid at 100 percent which include nearly all Medicare coverage preventive services. These preventive services lists can be found in the 2019 Medicare & You Handbook or at the medicare.gov website.

So as long as your physician codes your physicals correctly, Medicare will pay for your “Welcome to Medicare” physical now and your Annual Wellness Exams in years to come.

It is important to remember that if you have a Medicare Advantage Plan, your situation may be different. Look in your coverage book, or call your insurance company for a clarification of what they cover and how they cover it.

We all know that medical conditions and illnesses are easier to treat and usually less invasive, if treated early and on an ongoing basis. Don’t wait until it is really serious to see your physician. If you already don’t have one, find a primary care physician, make an appointment and stay healthy.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.

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