You may only go to your health care provider when you’re injured or not feeling well, but it's important to see your provider regularly for preventive care services. An annual wellness visit with your primary care provider (PCP) is an appointment for you to get age-appropriate screenings that can identify health concerns early. Most insurance plans cover preventive care services, so there’s often no cost to you. Here’s what you need to know about annual wellness visits.
What Does an Annual Wellness Visit Involve?
An annual wellness visit gives your PCP an opportunity to perform a physical exam and allows you an opportunity to ask questions, review health changes from year to year, and build a trusting relationship with your health care provider, who is familiar with your health history.
One of the benefits of annual wellness visits is that they’re tailored to your age and gender. Your provider may review your immunization history to ensure you are up to date with your vaccinations. These may include the seasonal flu vaccination, Tdap, COVID-19 vaccinations or boosters, or the shingles vaccine (Shingrix) if you’re 50 years of age or older. Your PCP may also perform certain screenings, including cancer prevention screenings, depending on your age and risk factors. Preventive cancer screenings may include:
- Cervical Cancer Screening for Women
- Ages 21 to 29 – Pap test every three years
- Ages 30 to 65, depending on your insurance plan and your health –
- Every three years with a Pap test
- Every five years with an HPV test
- Every five years with both a Pap test and an HPV test
- Breast Cancer Screening for Women
- Ages 40 to 49, or women at higher risk – Screening mammograms as recommended by your provider
- Ages 50 to 74 – Screening mammograms every two years
- Colorectal Cancer Screening for Men and Women
- Regular screenings for men and women ages 45 to 75
- Talk with your provider about colorectal cancer screening options
When you have a specific concern or injury that falls outside of the scope of an annual wellness visit, you will need to schedule a separate appointment to avoid having to pay any out-of-pocket costs, including a deductible or coinsurance
. Ask your health care team if a separate appointment is needed when scheduling your annual wellness visit.
Get to Know the Medicare Annual Wellness Visit Requirements
Understanding definitions is so important when it comes to Medicare. There is a difference between an annual physical exam (or physical) and an annual wellness visit. The difference comes down to the intent of the visit. An annual physical exam focuses on identifying any health problems by physically assessing your body and how it is functioning. Medicare annual wellness visits
are intended more for prevention. These visits are an opportunity to develop and update your personalized health plan based on your current health and risk factors to help you prevent illnesses or other health issues. Individuals who are enrolled in Medicare Part B for more than one year are eligible for an annual wellness visit. At these appointments, you and your provider may:
- Answer questions from a health risk assessment
- Discuss your medical and family history
- Review current prescriptions you take and providers you see
- Take routine measurements including height, weight, and blood pressure
- Receive personalized health advice
- Check for signs of dementia, Alzheimer’s disease, or other memory loss or impairment
- Document risk factors and treatment options
- Create a screening schedule or checklist of preventive services that may be right for you
- Perform a fall risk assessment
- Perform a pain screening/assessment
- Review your ability to perform activities of daily living
- Discuss advance care planning
You may be responsible for coinsurance or deductibles if you receive any additional tests or services at these appointments. Be sure to ask your provider any questions you have about how health care services may be covered.
Get started on your path to good health and make your appointment today for an annual wellness visit. RMHP Members can find a PCP in your plan’s network using our helpful online provider directory.