As a Geriatric Care Manager and Elder Care Consultant, I am often asked to help sort through the details of Medicare coverage.  There are so many things to know and to understand:  Parts A & B, Medicare Advantage (Part C) and Part D for prescription coverage.  Earlier in 2011 we began to see the changes under the new health care law.  One of those changes turns out to have been a little confusing.  Here is why:

Beginning in 2011, Medicare started covering an annual physical exam, or so many thought.  But, as it happens, it wasn’t really a physical exam in the true sense.  What Medicare started covering is a “Wellness Visit,” which is definitely different than a physical exam.

The 2011 Medicare Handbook “Medicare and You 2011” labeled it a “physical exam.”  Logically, many Medicare recipients expected a physical exam.  But a wellness visit is less a physical exam and more of a discussion between a doctor and patient, reviewing a patient’s health status and medical risk factors.  The discussion may lead to referrals to specialists or for further tests.

Because of the misleading information in the 2011 handbook, the 2012 handbook is being updated to reflect the true “Wellness Visit.”  It is also recommended that Medicare recipients specifically request a “wellness visit,” if that is what they are seeking.  It is an annual wellness visit that Medicare will cover.  A physical exam is altogether different, and coverage for it is as well.

Kathleen S. Allen, LCSW, LICSW, C-ASWCM, is a Geriatric Care Manager and Elder Care Consultant in the Washington D.C. metropolitan area. She works with seniors and their families, and with organizations and their employees or members to help guide them through the challenges of aging and caregiving.