Medicare wants you to be as healthy as possible. Because of this, Medicare offers you the opportunity to receive many of your preventive screenings and tests at no out-of-pocket cost to you. If you are in the first 12 months of starting your Part B, these benefits are called “Welcome to Medicare” visits. If you have had Part B for more than 12 months, they’re called “Wellness” visits. There are, however, a couple of rules that must be followed for you to receive these benefits at no cost.
The first thing to know is, you only receive one “Wellness” visit per year. If you go to a specialist, and they code your visit as a “Wellness” visit, you cannot go to your primary care physician and receive another “Wellness” visit. It is your responsibility to know how your visit is coded. If you do not want a visit to a specialist or primary care physician coded as a “Wellness” visit you must speak up.
The second, and maybe the most important, thing to know is; for a visit to be coded as a “Wellness” visit it must be for preventive services only. Your “Medicare and You Handbook” states; “If you doctor or other health care provider performs additional tests or services during the same visit that aren’t covered under this preventive benefit, you may have to pay coinsurance, and the Part B deductible may apply.” In other words, if you are having a medical issue and go to your doctor and discuss this issue, you probably will not be able to use your “Wellness” visit and must pay your copay or coinsurance. “Wellness” visits are for preventive screenings and tests only!!
If you go to your primary care physician or specialist, and they “break the news” to you that a visit is not eligible to be coded as “Wellness”, please be patient with your provider. It’s not that they do not want to help you; it’s that Medicare will not approve it.
If you have questions regarding any aspect of Medicare or Medicare health plans feel free call us at Alabama Health Guidance (256-648-5710), stop by our office at 885 Florence Blvd (Four Lane Shopping Center) or email me at firstname.lastname@example.org.
Alabama Health Guidance is an independent insurance agency and is not affiliated with Medicare or any other government agency.