Yearly “Wellness” visit
Medicare covers wellness visit each year for all beneficiaries who have not had the Welcome to Medicare visit within the last 12 months and who have not had an annual wellness visit within the past 12 months.
Be aware that it is not a routine physical. It does not include any clinical laboratory tests, but your doctor may give you referrals for tests.
Why the visit is important
You and your doctor need to periodically talk about how you are doing and what preventive care you might need outside of normal sick visits.
What the visit is
- HRA - Give self-reported information. You can complete the HRA before or during the AWV encounter; it should take no more than 20 minutes.
- Medical and family history –
- Medical events of your parents, siblings, and children
- Past medical and surgical history, including experiences with illnesses, hospital stays, operations, allergies, injuries, and treatments
- Use of, or exposure to, medications and supplements, including calcium and vitamins
- We encourage providers to pay close attention to opioid use during this part of the AWV, which includes opioid use disorders (OUD). If a patient is using opioids, assess the benefit for other, non-opioid pain therapies instead, even if the patient does not have OUD but is possibly at risk.
- List of current providers and suppliers - Include current beneficiary providers and suppliers that regularly provide medical care
- Measure - Height, weight, body mass index (BMI; or waist circumference, if appropriate), and blood pressure, and other routine measurements deemed appropriate based on medical and family history
- Cognitive abilities - Assess the beneficiary’s cognitive function by direct observation, while considering information from beneficiary reports and concerns raised by family members, friends, caregivers, and others
- Review the beneficiary’s potential risk factors for depression, including current or past experiences with depression or other mood disorders - Use any appropriate screening instrument. You may select from various available standardized screening tests designed for this purpose.
- Review the beneficiary’s functional ability and level of safety - Use direct observation of the beneficiary or select appropriate questions from various available screening questionnaires, or use standardized questionnaires recognized by national professional medical organizations to assess, at a minimum, the following topics:
- Ability to successfully perform ADLs
- Fall risk
- Hearing impairment
- Home safety
- Establish an appropriate written screening schedule for the beneficiary, such as a checklist for the next 5 to 10 years - Base written screening schedule on:
- Recommendations from the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP)
- The beneficiary’s HRA, health status and screening history, and age-appropriate preventive services Medicare covers
- Establish a list of beneficiary risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or underway - Include the following:
- Mental health conditions including depression, substance use disorder, and cognitive impairment
- Risk factors or conditions identified through an IPPE
- Treatment options and their associated risks and benefits
- Furnish the beneficiary personalized health advice and appropriate referrals to health education or preventive counseling services or programs - Include referrals to educational and counseling services or programs aimed at:
- Community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including:
- Fall prevention
- Physical activity
- Tobacco-use cessation
- Weight loss
- Furnish, at the beneficiary’s discretion, advance care planning services - Include discussion about:
- Future care decisions that may need to be made
- How the beneficiary can let others know about care preferences
- Caregiver identification
- Explanation of advance directives, which may involve the completion of standard forms
Your doctor will schedule additional appointments or submit referrals for other care for you.
Bringing the following information will help ensure your time with the doctor is spent well:
- Medical records, including immunization records
- A detailed family health history
- A full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
- A full list of current providers and suppliers involved in providing care, including community-based providers (for example, personal care, adult day care, and home-delivered meals)