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Welcome to Medicare Visit The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) expanded Medicare's menu of preventive benefits by covering an initial preventive physical examination. This benefit, also referred to as the "Welcome to Medicare" visit, is an excellent way for new Medicare beneficiaries to get up-to-date on important screenings and vaccinations, as well as to talk with their health care provider about their medical history and how to stay healthy. All beneficiaries enrolled in Medicare Part B with effective dates that begin on or after January 1, 2005, will be covered for this benefit. Beneficiaries can only take advantage of this one-time within their first six months of Medicare Part B coverage, so it is very important that beneficiaries make an appointment with a health care provider right away. The Welcome to Medicare visit enables the health care provider to comprehensively review his or her patient's health, to identify risk factors that may be associated with various diseases, and to detect diseases early when outcomes are best. The health care provider is also able to educate his or her patient about the Medicare covered services they need in order to prevent, detect, and manage disease, to counsel them on identified risk factors and possible lifestyle changes that could have a positive impact on their health, and to make referrals or follow-up appointments for necessary care. As of January 1, 2007, Medicare will pay for a one-time ultrasound screening for Abdominal Aortic Aneurysm (AAA) for beneficiaries who are at risk. Eligible beneficiaries must receive a referral for the screening as a result of their Welcome to Medicare physical exam which is only available in the first 6 months of eligibility for Medicare. What Medicare Covers The Welcome to Medicare visit is a comprehensive examination consisting of the following 7 components: 1. A review of an individual's medical and social history with attention to modifiable risk factors 2. A review of an individual's potential risk factors for depression 3. A review of the individual's functional ability and level of safety 4. An examination to include an individual's height, weight, blood pressure measurement, and visual acuity 5. Performance of an electrocardiogram (EKG) and interpretation of the EKG 6. Education, counseling, and referral based on the results of the review and evaluation services described in the previous five components 7. Education, counseling, and referral, including a brief written plan such as a checklist for obtaining the appropriate screening and/or other Medicare Part B preventive services Note: The reimbursement for this benefit does not include any clinical laboratory tests. The physician, qualified non physician practitioner, or hospital may also provide and bill separately for the screening and other preventive services that are currently covered and paid for by Medicare Part B. What the Beneficiary Pays The beneficiary pays 20% of the Medicare-approved amount after meeting the yearly Part B deductible. Since this may be the beneficiary's first Medicare covered service, the beneficiary may meet the entire Part B deductible at this visit. Other Helpful Information Various organizations have developed tools to help support providers in the delivery of this important benefit, and to prepare beneficiaries for this visit. Links to these resources are provided below and on the other pages of the Welcome to Medicare section.
Page Last Modified: 08/13/2008 8:30:24 AM
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