What New Medicare Patients Need to Know about the Welcome to Medicare Exam

Medicare is confusing! If you’re newly 65 and starting with Medicare, you might hear about a “Welcome to Medicare Exam,” that you can do with your doctor here at Generations. While this sounds like a useful opportunity to come to chat with your doctor about your general health, it is not always what you expect. There are many rules and regulations established by Medicare that healthcare providers must follow, and many of our patients find confusing. So here is a breakdown of some different doctor’s appointments you might have with us:

Welcome to Medicare Exam

This exam takes place within the first 12 months you are enrolled in Medicare Part B or you forfeit this benefit. This is a one-time exam, paid for by Medicare, during which you and your doctor can talk about your health history and any medications you are taking. You might also hear it called the Initial Preventive Physical Examination (IPPE). During this visit:

• You may be asked to fill out a questionnaire about your health history and family health.
• We will check your height, weight, vision, blood pressure, and body mass index (BMI), review diet and activity levels, as well as, review or examine only the body systems in which your health history deems necessary. This is the extent of the physical exam.
• We’ll ask you about your advance directives if you have any and if not, recommend you create these documents.
• We will provide education about screening tests Medicare recommends and may outline a plan for preventative care.
• We may also perform a health risk assessment to determine functional ability and level of safety. This assessment will be performed annually at your Medicare Annual Wellness Visit.

Here is the confusing part: This exam does not cover any sick care or the typical hands-on, head-to-toe care you associate with the annual physicals you may have had in the past, other than what is indicated above. This visit is to learn about you and assess your general health and well-being, but does not include any physical tests. If you need further testing, prescriptions, or a more thorough exam, we’ll schedule a separate appointment with you.

Medicare Annual Wellness Visit

After your Welcome to Medicare Exam, it is recommended that you visit us annually for your Medicare Annual Wellness Visit to review and update your personalized prevention plan. Your provider will also perform a health risk assessment through a series of questions, just like they did in your initial “welcome” exam. Like the “welcome” exam, the Annual Wellness Visit is paid for by Medicare. However, it does not include any physical examination. Additionally, there are no screenings or preventative testing specifically associated with this appointment.

Annual Physical Exam

This is what you have come to know as your yearly physical. During this full physical examination, we draw blood to check cholesterol levels and check your vital signs. Your provider will do a full review of body systems, which includes checking your heart, lungs, head, and neck. They will also assess your neurological state and reflexes and check your abdomen for anything amiss. This exam is never covered by traditional Medicare. If you choose to have this Annual Physical Exam it will be only at your request and fully at your expense. However, if you have opted out of traditional Medicare and purchased a commercial Medicare Advantage plan, the Annual Physical Exam is included as a covered benefit but does not cover any preventative tests.
If you have questions about your new Medicare plan, ask our team for help!