14 Diseases You Almost Forgot About (Thanks to Vaccines)

Did You Know? Medicare Does Not Cover A Physical Exam

The "Welcome to Medicare" preventive visit is not a physical exam.

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A friend, new to Medicare, asked me whether Medicare covered annual physicals. I told him, "No, it doesn't." The Social Security act clearly prohibits Medicare from paying for annual physical examinations.

A week later, he told me I was wrong. He found proof that Medicare does indeed cover these examinations. "Physical exams, right there, on the HHS.Gov website, in the list of services that Part B covers." (Health and Human Services is an agency of the federal government that administers health and welfare programs, including Medicare.)

I replied that I wasn't wrong, HHS just shortened the title for a preventive service that Medicare does cover.

The Affordable Care Act introduced the Initial Preventive Physical Examination. This preventive service for those with Medicare does not resemble a physical exam. There is no palpation (feeling with fingers or hands), no auscultation (listening to body sounds) and no percussion (tapping body parts), all essential components of a physical examination. And, unlike annual physicals, you only get one visit, within the first 12 months of Part B enrollment.

Because "physical examination" is in the regulatory title, there was and still is considerable confusion. Medicare now calls this service a "Welcome to Medicare" preventive visit.

More about the Welcome Visit

The Welcome to Medicare visit is a review of your medical and social history and counseling about preventive services. Specifically, this visit includes:

Height, weight, and blood pressure measurements

A calculation of body mass index

A simple vision test

A review of risk factors for depression, functional ability and safety level, and current opioid prescriptions

Screening for visual acuity and potential substance use disorders

Education, counseling, and referral based on previous components, and

End-of-life planning (if the patient consents).

Annual Medicare Wellness Visit

Medicare offers a second preventive visit; this one is every 12 months. It may be annual, but this visit is also not a physical exam. The purpose is to update the personalized prevention plan. The components include:

A review of medical and family history

Height, weight, blood pressure, and other routine measurements

Detection of any cognitive impairment

Personalized health advice

Updating the list of current providers, suppliers, prescriptions, and health risk factors, and

Advance care planning.

Both these visits address a plan for screenings, vaccinations, and other preventive services, including:

Flu and COVID vaccinations

The RSV (respiratory syncytial virus) vaccine (now covered with no cost sharing under Part D, prescription drug coverage)

Annual mammogram

Prostate cancer screening, and

Colonoscopy.

Medicare covers many more preventive services designed to help beneficiaries stay healthy, most with no cost sharing. Find the list here.

Take-away points

First, here are a few points about the two wellness visits.

There is no cost for the initial welcome or annual wellness visits.

However, if the physician addresses a medical issue, such as elevated blood pressure, don't be surprised if you get a bill. That's because the visit would be considered diagnostic and cost sharing (deductible and/or copayment) applies.

If you have Original Medicare, see providers who accept Medicare assignment.

If you chose a Medicare Advantage plan, schedule your appointments with in-network physicians, most likely with your primary physician.

And here's what my friend and you need to know about annual physical exams.

Even though Medicare does not cover them, you can still get a physical exam. But know that you may have to pay for parts or all of it. For example, Part B would cover an EKG or chest x-ray for medical reasons, like an abnormal heart rhythm or severe lung congestion, with the usual cost sharing.

Some Medicare Advantage plans offer routine physical exams, generally when performed by the primary care physician. Check the plan's Evidence of Coverage for more information.

Finally, no matter the issue, know that what you read on a website may not be correct. Double check coverage before you proceed.

Check out my website or some of my other work here. 

Preventive Care Guidelines For Women 40 And Older

It may seem like adolescence is the time in a woman's life when most of the biological changes she will experience take place. After all, puberty brings with it hormone fluctuations that can affect both physical and emotional health in various ways. However, as a woman enters mid-life and beyond, she may notice that she has to reevaluate her lifestyle to accommodate the evolution of her body and health.

Preventive health screenings and additional strategies can keep women fit and well as they reach age 40 and beyond.

Annual mammograms

Most doctors now recommend that women get annual mammograms starting at age 40. Mammograms can detect breast cancer early on at its most treatable stage. Manual breast exams conducted at home and by a doctor also can be vital tools.

Colorectal cancer screenings

A colonoscopy is recommended for all women between the ages of 45 and 50 (on the earlier side of that spectrum for African American women). This test can reveal the presence of polyps and cancerous growths.

Vision

Annual eye exams should be a part of everyone's vision care strategy. The American Optometric Association says that, between ages 41 and 60, people may notice differences in their vision. Some changes may happen more frequently, requiring new prescription eyeglasses. Therefore, it helps to visit an eye care professional to take corrective steps. It's also important to note that, as one ages, the vitreous (clear jelly) in the eye can thicken, leading to increased floaters and flashes that should be checked by an ophthalmologist, as they may lead to retinal tears or detachment that can threaten vision.

Cholesterol screening

Heart disease is the leading cause of death among women, says the Centers for Disease Control and Prevention. Cholesterol screening and other cardiovascular screenings can detect the presence of heart disease or indicate a person's risk for it. Annual physical exams likely will include cholesterol checks as well as tests investigating other lipids in the blood.

Vitamin D check

Deficiency in vitamin D is a recognized pandemic. People are not naturally producing enough vitamin D from sun exposure, nor absorbing enough from the foods they eat. Vitamin D deficiency can be a serious concern in adult women, particularly those above the age of 40. Vitamin D deficiency can adversely affect mood, and an article published in 2018 in the Journal of Family Medicine and Primary Care found vitamin D determines the pattern of post-menopausal bone loss and age-related osteoporosis. Verywell Health also says vitamin D is an important nutrient for preventing diabetes, cancer and age-related weight gain.

Routine gynecological screening and Pap/HPV testing

The American College of Obstetrics and Gynecologists say that it is important to visit a gynecologist annually for a woman's health checkup. New guidelines emerged some time ago that indicate it is not necessary to get a Pap test at each visit. The recent guidance indicates women between the ages of 30 and 65 can opt for both a Pap and HPV test every five years; have a Pap test alone every three years; or only get the HPV test every five years. After age 65, cervical cancer screenings can cease if there has never been an indication suggesting the presence of abnormal cervical cells.

Moving into middle age brings about changes. Women should evolve health care plans accordingly to stay as healthy as possible.

American Journal Of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials.

Publisher Elsevier Website http://www.Ajpmonline.Org/ Impact factor 4.110 (2010)

Some content from Wikipedia, licensed under CC BY-SA

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