You call your doctor’s office to schedule your “annual physical,” but the scheduler mentions a “wellness visit.” Are they the same thing? The answer might surprise you.
What Is an Annual Wellness Visit?
An annual wellness visit is specifically defined by Medicare as a free preventive service focused on keeping you healthy.
The key word here is “screening.” Wellness visits check boxes for important health screenings based on your age and risk factors. Dr. Stewart Decker, clinical wellness officer & medical director, Sky Lakes Wellness Center, explains, “So we might talk about how important breast cancer screening is. And we maybe will talk about colon cancer and prostate cancer screening, but also vision screening and your annual vaccines.”
What Makes Wellness Visits Free?
Medicare covers one wellness visit every 365 days with no copay, but there’s a catch. “To have it count for an annual wellness visit, the clinician has to check all of these screening boxes,” Decker explains.
These screenings might also include hearing tests or cholesterol monitoring. You’ll also complete a health risk assessment asking about your overall wellbeing and any concerns, such as weight or smoking and alcohol habits.
The Physical Exam Confusion
“A lot of people expect to have a physical exam with their annual wellness visit, but it’s not a required portion, so we don’t do it automatically,” Decker notes.
Unlike a wellness visit that focuses mainly on prevention, a physical exam lets you discuss any health concerns, manage ongoing conditions, and get a thorough look at your overall health. If you want your heart and lungs checked, just ask. “We will almost always do what you want us to do in terms of, hey, can you check this out? Can you check that out? But if there’s no problem, if there’s no question that we’re answering by doing this specific physical exam test, we might not spend your time or our time doing the physical exam test.”
When the Bill Arrives
The biggest surprise comes when you try to multitask. Maybe you figure you’ll save time by discussing that nagging shoulder pain during your “free” wellness visit.
“Medicare is more clever than that,” Decker warns. “If we end up talking about your shoulder pain and do your annual wellness visit, when we submit that to the insurance… the insurance will say, let’s pay for that annual wellness visit. But that other stuff, that sure sounds like an extra, like a problem-focused visit.” Three months later, you might receive an unexpected copay bill for the shoulder discussion.
Know What to Expect and Avoid Billing Surprises
Understanding the difference between wellness visits and physical exams helps you prepare and avoid billing surprises. Both serve important purposes in keeping you healthy; you just need to know which one you’re scheduling and what to expect.
“Feed two birds with one scone,” as Decker likes to say, by being prepared and asking for what you need upfront.
