It’s that time of year when you need to schedule an annual checkup with your primary care provider. You may not realize that the type of visit you schedule could have financial implications. Read on to learn the differences between a physical, wellness exam and care for chronic conditions.
Annual Physicals
How Care Is Provided
Annual physicals are more “physically” extensive exams typically performed by a doctor, nurse practitioner or physician assistant. The provider will visually examine your body, feel/palpate/tap soft-tissue areas and listen to your body’s sounds with a stethoscope.
What to expect during your annual physical
- Height and weight measurement check
- Blood pressure check
- Body mass index (BMI) measurement review
- Medical and family history review
- Risk factor assessments
- Vital sign check
- Physical exams, such as head and neck, abdominal, or neurological exams
In-person or Video Visit?
Given the physical nature, this exam is typically conducted in person.
“In general, even for the healthiest of patients, an annual physical is essential,” says Veronica Smalheiser, ANP-BC, AGNP-C, CVNP-BC, a nurse practitioner providing primary care at Beaufort Memorial Lowcountry Medical Group. “It allows us to visit face-to-face and I can perform a thorough examination. There are many problems that cannot be addressed or uncovered without direct patient contact.”
How Care Is Billed
Medicare does not cover an annual physical exam.
Some commercial insurance plans consider this a preventive care visit, as long as new symptoms or management of an ongoing, or chronic, health problem are not discussed. Many plans completely cover one annual preventive care visit but will require a visit copay if you sought care for new symptoms or ongoing issues.
Read More: 6 Ways to Save on Your Health Care
Wellness Exams
How Care Is Provided
The purpose of a wellness exam or visit is to help you live a longer, healthier life. This type of preventive care focuses on making sure that you’re still in good health and detecting any health problems before they become an issue.
Medicare wellness visits, usually performed by a nurse, include assessments but don’t include the “physical” tests where the provider has to physically touch you. The purpose of the Medicare wellness visit is to paint a picture of your current state of health and to create a baseline for future care.
What to expect during your wellness exam:
- Documenting your height, weight, blood pressure and other routine measurements
- A health risk assessment (questions you answer about your health)
- A review of your medical and family history
- Developing or updating a list of your current providers and prescriptions
- Looking for signs of memory loss or dementia, depression, anxiety, and stress
- Discussion of your risk factors and what lifestyle modifications or treatment options can help
- A screening schedule for appropriate preventive services (as needed)
In-person or Video Visit?
Medicare allows wellness exams to be conducted over telehealth platforms such as BMH Care Anywhere and Beaufort Memorial primary care providers have been providing this convenient option to patients. To schedule a virtual wellness exam, simply call your provider’s office.
Some commercial insurance plans stipulate that wellness exams be conducted in person. If you’d rather use telehealth for your visit, call to confirm coverage.
“A wellness examination focuses on screening evaluations, updating ongoing clinical processes and addressing non-medical issues that may affect your health,” Smalheiser says. “Sometimes this can be done via telehealth. Regardless of how healthy you may think you are, a wellness examination can address many factors as you reach milestones and continue to age.”
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How Care Is Billed
While wellness exams are usually covered by insurance, your insurance might not cover all expenses involved with the visit, such as labs or tests. Most insurance plans pay for one wellness exam each year.
Medicare covers annual wellness visits (once every 12 months) without a copay, and these visits are not subject to a Part B deductible. However, you may have to pay a share of the cost for certain recommended tests or services.
If new symptoms or management of an ongoing health problem are discussed, the visit is no longer considered a wellness visit by many commercial insurance plans. The visit is then considered a sick or chronic condition visit, and copays or coinsurance may apply.
Care for Chronic Conditions
Just because chronic conditions may fall outside of the scope of what your health coverage considers preventive care, that doesn’t diminish the importance of managing those you may have. For your overall long-term health, it is important to keep an eye on how well medications are working and how your current lifestyle affects any chronic conditions, such as high blood pressure and diabetes.
“For routine, ongoing follow up, telehealth can be a bridge until the next in-person office visit,” Smalheiser says. “Routine discussions about ongoing management and the progression of a disease may be sufficiently addressed over telehealth visits.”
For your convenience, Beaufort Memorial primary care providers can take care of most chronic disease management in a virtual visit using BMH Care Anywhere and your smart phone, tablet or computer.
Related Providers
Veronica Smalheiser, ANP-BC, AGNP-C, CVNP-BC
Nurse Practitioner +1 more
Offers virtual visits