The annual meeting with a doctor is not the same as an exam.
Nearly 55 years ago, Medicare revolutionized the way older Americans would get their health care. But few services in the popular program are totally free — except for the annual wellness visit.
Since 2011, Medicare has paid for enrollees to meet with their doctor and talk about how they're doing, discuss what screenings, vaccinations, blood tests and other diagnostic exams they should have, and plan the best way to monitor the patient's health needs.
But research shows that an overwhelming majority of Medicare patients aren't using their benefit. A 2018 study in the journal Health Affairs found that as of 2015 — the latest year for which data was available — only 19 percent of enrollees had a wellness visit. That same report found that more than half of physician practices that see Medicare patients weren't routinely offering the wellness visit.
Some doctors say that the wellness visit is widely misunderstood. It is not, professionals stress, the same thing as an annual physical. And experts say patients may be confused when they are billed for services that take place at the same time as their wellness visit.
"I think the wellness visit was misnamed,” says Audrey Chun, a geriatrician and associate professor of geriatrics and palliative medicine at Mount Sinai's Icahn School of Medicine in New York City. Even though Medicare calls this annual conversation a “wellness visit,” many people refer to it as a “wellness exam.” “It should have been called an annual counseling session or something like that,” Chun says.
She says that during the wellness visit, doctors should ask some basic questions to determine what, if any, medical screenings and tests a patient needs and whether there are any warning signs that a physician should keep an eye on. Some questions include: Have you noticed any changes in your memory, vision or hearing? Are you up to date on your immunizations and screenings? Is your home safe from the risk of falls? How is your emotional health — are you depressed or lonely? Do you have a health care proxy and any other advanced care wishes?
Patients, Chun adds, should make sure to bring a list of any medications they take and any other doctors they are seeing to a wellness visit. And write down anything that is bothering you, including any changes you've noticed in your health over the past year. Medicare has a specific list of areas the provider must cover in a wellness conversation in order for the government to pay for the visit.
Patients face no copay or other costs associated with the wellness conversation, but they should expect to be charged for any medical services.
"These charges can come as a surprise to patients,” says Ishani Ganguli, an assistant professor of medicine at Brigham and Women's Hospital in Boston and coauthor of several articles on the Medicare wellness visit. Ganguli says that in her practice, patients are given a paper that explains what charges they may expect.
What's often missing, she says, is any communication between doctor and patient about finances. “I even have a very hard time,” Ganguli says. “It seems so unpleasant to me, and I don't want to lessen the dignity of our interaction by bringing up the price. It feels very crass.” But, she says, she welcomes patients’ bringing up the subject because that leads to an open conversation.
Ganguli also says that, like the wellness visit, the term “annual physical” is also misunderstood and outdated.
"There's not much evidence that older adults need a full physical — a head-to-toe exam,” which Medicare doesn't pay for, Ganguli says. Patients who have chronic conditions, such as diabetes, high blood pressure or other maladies, are likely to already see their physician at least once a year to monitor medication and treatments.
Chun agrees. A full-blown annual physical, she says, is a “shotgun approach” to health care, and in the case of some tests, especially those that require radiation, they can harm more than help the patient.
"A physical exam should be based on your conditions, based on your age and on any symptoms you might be having,” Chun says. “These exams should be personalized."