Many Medicare beneficiaries are surprised to see a copay associated with their annual physical. While Medicare does cover annual wellness visits (AWVs), it’s important to understand the distinction between these visits and routine physicals. Here’s what you need to know:
What Medicare Covers
Medicare provides coverage for annual wellness visits, but not for routine physical exams. The AWV is designed to focus on preventive care and is available to all Medicare enrollees after their first 12 months of coverage. These visits are then offered once every year.
The annual wellness visit typically includes:
- A review of your health history.
- Risk assessments.
- Developing or updating a plan to prevent future illnesses.
However, the AWV is not the same as a traditional physical exam. It doesn’t involve procedures like hands-on examinations, blood work, or diagnostic tests. Since the AWV focuses solely on prevention, there are no copays or deductibles for this service.
Why Was a Copay Charged?
Sometimes, doctors may combine the AWV with additional diagnostic services to address specific health concerns. For example, they might order lab tests, blood work, or conduct exams to investigate a health issue. These extra services fall outside the scope of the AWV and are billed separately. As a result:
- The Part B deductible may apply.
- Copays might be charged for these diagnostic services.
At Griset Medicare Solutions, we understand that navigating Medicare benefits can sometimes be confusing. If you have any questions about Medicare coverage or copay charges, we’re here to help. We provide clear, personalized guidance when it comes to Medicare coverage planning and annual reviews.