Medicare Annual Wellness Visit Benefit

Little known preventive measure offered under Part B

Mary Ann HodorowiczBy Mary Ann Hodorowicz RD, LDN, MBA, CDE, CEC

By now, you have likely heard a great deal about the Affordable Care Act (ACA), and it's safe to say that you or someone you know has been touched by it.  If you have Medicare insurance, you will be very happy to know that the ACA requires Medicare Part B to cover an Annual Wellness Visit (AWV) furnished by an eligible healthcare provider for beneficiaries who have not received either the Initial Preventive Physical Examination (one time only "Welcome to Medicare" physical exam upon entry into Medicare) or the AWV within the past 12 months. This "no charge/no co-pay" (free!) AWV has been available since January 1, 2011, but many Medicare subscribers are not aware of it.  Now, at the start of this new year, is the time to schedule your visit.  The goal of the AWV is health promotion and disease detection and fostering the coordination of the health screening and preventive services that may already be covered and paid for under Medicare Part B.  Let's review the particulars.

Medicare pays for only one first AWV per beneficiary per lifetime. Then, the beneficiary is eligible to receive an AWV every year after that without cost sharing. It is a preventive wellness visit and is not a "routine physical checkup" that seniors may get periodically from their healthcare provider(s).  

In the first AWV the beneficiary's medical and family history is established and a health risk assessment (HRA) is completed; the latter takes no more than 20 minutes to complete, or it can be done by the provider.  The HRA includes:

  • measuring height, weight, body mass index, hearing and blood pressure
  • assessing nutrition, tobacco, alcohol and exercise habits
  • screening for depression, loneliness, anger, pain, fatigue, mental functioning, safety (home and car), fall risk and the ability to successfully perform daily activities
  • other health measures and habits.

Then, based on the results of the HRA, the healthcare provider creates a written screening and medical intervention schedule for the beneficiary for the next 5 to 10 years.  The provider also creates a Personalized Prevention Plan (PPP) for the beneficiary. The PPP often includes a referral, as appropriate, to health education or preventive counseling services to help the patient reduce his/her health risks and promote self-management and wellness. For example, this may take the form of a referral to a registered dietitian for an eating plan to reduce blood cholesterol, or to a counselor for smoking cessation. All subsequent yearly AWVs must also include an update of the HRA, of the written screening and medical intervention schedule, and an updated PPP, if it's appropriate.

Using preventive services and screenings can help all of us, especially seniors on Medicare, live longer, healthier lives.  So here's an invitation to all Medicare beneficiaries who opted into Medicare Part B: start 2014 with a "healthy bang" by scheduling your Annual Wellness Visit with your healthcare provider.  The life you save may be your own!  Happy New Year…a little belated!

Read Mary Ann's bio.

Read more of Mary Ann's columns.

Mary Ann is a consultant, speaker, writer and trainer for the health, food and pharmaceutical industries in nutrition, diabetes and insurance reimbursement.  Her clients include healthcare entities, membership associations, research firms, pharmacies, education/training firms, government, websites, academia, media and individual healthcare professionals.  Mary Ann specializes in helping clients establish AADE-accredited DSME programs, MNT programs, shared medical appointments, marketing and insurance reimbursement policies and procedures, and training educators on motivational interviewing and strategies for successful patient behavior change. Mary Ann is on the AADE Board of Directors and has served on numerous committees of the Academy of Nutrition and Dietetics, its practice groups and state affiliates.

For more information about Mary Ann Hodorowicz, RD, MBA, CDE, CEC and Mary Ann Hodorowicz Consulting, LLC, visit www.maryannhodorowicz.com - Nutrition, Diabetes Care & Education, Health Promotion and Insurance Reimbursement for Professionals for the Healthcare and Food Industry.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: February 12, 2014

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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