As the new year approaches many patients start thinking about their annual physical appointment. But did you know that there is a difference between a Health Assessment (aka. Physical Exam) and an Annual Wellness Visit? Both are geared towards keeping you healthy, and making sure you are getting the preventative services you are entitled to through your insurance company, but there are some pretty significant differences also. Keep reading to find out more.
Health Assessment aka. Annual Physical Exam – This benefit is for patients without the standard Red, White and Blue Medicare and is considered part of a patient’s Preventative Care benefits. This also includes commercial insurances, Medicare replacement plans and Medicaid plans. Health Assessments are generally covered 100% by most insurance plans which means no out of pocket cost to you. (Be sure to check your plan booklet to see what your costs may be.)
These visits include:
A comprehensive history and head to toe physical exam performed by the Physician or Mid-Level provider.
Documentation of the status of chronic and stable conditions.
Documentation of additional issues that will require a follow up visit.
Age appropriate counseling, screenings and tests, including fasting lab work, Paps, EKG, mammogram, colonoscopy and Bone Density Screening.
Age and risk appropriate vaccines.
Annual Medication refills.
Documentation of all providers involved in patient’s care.
Generally does not require a copay.
What is NOT covered:
A preventative visit that takes place LESS THAN 366 days since your last one.
The addressing of new or worsening conditions.
Diagnostic testing for a condition.
If you chose to address new issues, or focus your visit on one issue instead of letting our office follow your insurance companies guidance and requirements for what a Health Assessment visit does and does not entail your visit will have to be coded as a “Problem” or “Sick” visit and will be subject to the copay/deductible/co-insurance requirements of your insurance plan.
Annual Wellness Visit – This is a covered benefit of the Red, White and Blue Medicare that does not involve an office visit with the Physician. Designated members of the Clinical Staff may perform these visits. Medicare DOES NOT cover a routine physical checkup aka. Health Assessment.
These benefits include:
A comprehensive history and Health Risk Assessment.
Documentation of all medications and providers involved in your care.
Review of your potential risk factors.
Review of your functional ability and safety, and cognitive functioning.
Assessment of vitals.
Review and establish a schedule for future screenings.
Provide personalized health advice regarding counseling services and programs
Assist in Advance Care Planning services.
Refill of annual medications.
What is NOT covered:
Comprehensive head to toe physical exam.
An AWV that takes place LESS THAN 366 days since the last one.
Addressing of new or worsening conditions
Vaccinations performed that day.
Whether you are seeing your doctor for a Health Assessment or an Annual Wellness Visit, it is important to bring ALL your medication AND supplement bottles with you to your appointment. Reconciling your medication list helps us to know what you are currently taking, who is giving it to you - so that medications are not duplicated, or contraindicated. Don't know when your last wellness visit was? Call our office and we will gladly help you schedule your next visit.