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Beginning January 1, 2011, your clients will get an Annual Wellness visit, covered by Medicare every 12 months, starting a year (12 months) after they get their initial “Welcome to Medicare” physical exam. And if your client never had a Welcome to Medicare exam, that’s ok; now they can get their free Annual Wellness visit each year. This is the first time Medicare will cover an annual exam, and there is no cost-sharing (coinsurance or deductible) for this service.

During the visit, your client and health care provider will develop a personalized prevention plan, building off of the initial exam. Note, there are slight distinctions between the first wellness visit and subsequent such visits.

The initial Annual Wellness visit includes:

routine measurements such as height, weight, blood pressure, body-mass index (or waist circumference, if appropriate);
review of medical and family history;
establishing a list of current providers, suppliers, and medications (including supplements);
a personal risk assessment (including any mental health conditions);
a review of functional ability and level of safety;
detection of any cognitive impairment;
screening for depression;
establishing a schedule for Medicare’s screening and preventive services your client qualifies for over the next 5 to 10 years; and,
any other advice or referral services that may help intervene and treat potential health risks.
The subsequent wellness visits include:
measurement of weight, blood pressure, and other measurements deemed appropriate (note: height and body-mass index not necessary, unless your client has had significant weight change);
an update to medical and family history;
an update to the list of providers, suppliers, and medications (including supplements);
a review of the initial personal risk assessment;
detection of any cognitive impairment;
an updated screening schedule; and,
a review and update to list of referral services to help intervene and treat potential health risks.

Elimination of Cost-Sharing for Preventive Benefits
As of January 1, 2011, the Affordable Care Act also eliminates out-of-pocket cost-sharing for most Medicare-covered preventive benefits. This means Medicare will pay 100 percent; your clients will pay nothing. The Part B deductible is also waived.

The following are the preventive services your clients will still have to pay for next year:
Glaucoma screening,
Prostate cancer screening,
Certain alternative tests under the colorectal screening,
Diabetes self-management training services, and
EKG screening.
For these services, your client will have to pay a coinsurance (usually 20 percent of the Medicare-approved amount) and any remaining portion of their Part B deductible.