An annual exam is a preventative health exam that includes a review of
health maintenance such as age-appropriate screenings and immunizations.
Your provider will review the status of any ongoing conditions you have.
If these conditions are stable and unchanging - these are included in
your preventative insurance benefit. If the condition is not stable or
changes need to be made to your medications or treatments during an annual
exam - this is billed separately from your yearly “annual”
or preventative exam insurance benefit, and you may receive a bill for
this portion of the visit.
If you have questions regarding your insurance benefits, you should always
contact your insurance provider directly prior to receiving services to
understand your deductible, copays, and other payment responsibilities.
These payers often have an “annual” preventative benefit. These
visits include a hands-on physical examination, a review of health and
social histories, counseling and anticipatory guidance such as nutrition,
weight, contraception, mental health, tobacco and alcohol education. This
visit could also include preventative screenings for conditions such as
diabetes, hypertension, breast cancer, and prostate cancer.
If your provider discusses new problems such as illness, medication changes,
or if a condition is not well controlled and requires changes to treatment
plan, you may receive a bill for this portion of the visit. These are
not included in your annual preventative exam insurance benefit.
Medicare Payers (Includes Traditional Medicare, Medicare Advantage and
Replacement Plans)
Medicare does not cover a traditional “annual” exam such as
commercial payers listed above do. This is a hands-off visit often performed
by an RN on your provider’s care team.
The Medicare Annual Wellness Visit includes a Health Risk Assessment and
other assessments allowing the member’s healthcare team to update
the patient’s records, define a screening schedule, address risk
factors and provide personalized health advice to the beneficiary –
such as health education, counseling services, or programs. Medicare pays
100% of the cost for this exam with no out-of-pocket expense to you.
Your provider may request a follow-up appointment to be made to discuss
ongoing conditions and care plan following your Medicare Annual Wellness
Visit. This is billed as a normal office visit and copays and Deductibles apply.
If you have a commercial payer insurance as secondary to Medicare please
be sure to state this when scheduling with your provider's office as we
may be able to schedule you for a more traditional preventative, annual
exam. This option is not available if you have a Medicare supplemental
insurance.
Contact your primary care provider or speak with St. John's Health
Family Medicine or
Internal Medicine to schedule your annual exam.
