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What is the difference between a physical and a wellness exam covered by Medicare?

1 answer | Last updated: Feb 18, 2015
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What is the difference between a physical and a wellness exam covered by Medicare in 2011?

Caring.com User - Joseph L.  Matthews
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Joseph L. Matthews is a Caring.com Expert, an attorney, and the author of Long-Term Care: How to Plan & Pay for It and...
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A Medicare wellness examis a special type of physical exam specifically designed by Medicare for the needs of people 65 and older. Beginning in 2011, a Medicare beneficiary is See also:
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entitled to one "Welcome to Medicare" initial wellness exam within the first 12 months after first enrolling in Medicare Part B, and then one wellness exam every year thereafter. Medicare pays 100 percent of the approved charges for these exams (unlike many doctor services, for which it only pays 80 percent).

The wellness exam itself is much like any other annual physical except that it focuses not only on what the patient's current condition is but also on what screenings (such as for cancers) and other preventive services (such as vaccinations) the patient might also need and for which Medicare pays the full cost. Also, unlike most regular physical check-ups, the wellness exam must include an assessment for the detection of cognitive impairment -- meaning the early signs of Alzheimer's or other dementia. Part of the wellness exam is also the preparation by the doctor of a written plan noting the screenings and other preventive services the patient should obtain. Finally, during wellness exams doctors are encouraged by Medicare to discuss end-of-life planning with their patients, which includes an advance health care directive (also called a living will or power of attorney for health care).


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