Medicare and Annual Wellness Visits

Including a Glossary of Helpful Terms

Taking time to schedule an annual visit with your Primary Care Physician (PCP) could be life-changing because prevention is often the key to living longer, healthier lives.

Even if seniors are feeling well or taking very few medications, getting an Annual Wellness Visit can help your PCP identify symptoms and conditions early.

Q: Does Medicare require patients to visit their PCP annually?

A: Medicare does not require patients to visit their PCP annually. However, they do encourage patients to schedule an Initial Preventive Physical Examination (“Welcome to Medicare Visit”) within the first 12 months of part B enrollment to review medical and social health histories as well as preventive services education.

Medicare also encourages an “Annual Wellness Visit” every 12 months to develop or update a personalized plan for prevention of illness and perform a health risk assessment. During an Annual Wellness Visit, vitals are obtained, but a complete physical exam is not performed.

Q: Are “annual physicals” covered by insurance providers, including Medicare?

A: Medicare covers the Welcome to Medicare Visit and the Annual Wellness Visit, with no co-pay or deductible, but Medicare does not cover routine annual physicals during which more detailed exams are performed and which often include routine lab and screening tests.

Some supplemental insurance plans may cover routine annual physicals, with applicable co-pays and deductibles. Medicare will cover services for specific diagnoses with necessary labs/testing, but co-pays and deductibles will apply.

Q: What tests are typically part of an annual physical?

A: Tests are determined based on a patient’s age, medical history, family history, risk factors and presenting complaints. Often, labs are ordered to monitor blood sugar, electrolytes, kidney and liver function, blood counts, cholesterol, and thyroid function. Screening for osteoporosis, breast cancer, colon cancer, cervical cancer, prostate cancer, and lung cancer are also discussed and ordered as appropriate.

Q: Are these tests usually covered by insurance?

A: Many preventive services are covered by health insurance plans; however, patients are encouraged to check with their insurance companies before completing any lab or testing to see if it is covered, and how much out-of-pocket cost there will be.

Q: For people who are looking for a PCP, is there a trusted online resource for checking to see how a physician is rated?

A: There is a lot of information available online, but the most reliable, trustworthy resources would be a patient’s insurance company review or local hospital websites. These sources have firsthand information about physicians who have gone through rigorous credentialing processes and are highly recommended.

A Glossary of Helpful Terms Regarding Medicare and Checkups

Annual Physical An annual physical exam is an assessment of your body’s overall health. The primary purpose is to look for health problems.

During the exam, your doctor uses his or her senses to evaluate how your body is performing. Based on the evaluation, your doctor may ask you to have tests to determine or rule out possible health problems.

 The list below shows some actions your physician may take during a physical exam.

  • Visually check your body for signs of existing health issues
  • Look into your eyes, ears, nose, and throat for potential problems
  • Listen to your heart and lungs to detect irregular sounds
  • Touch parts of your body to feel for abnormalities
  • Test your motor function and reflexes
  • Complete pelvic and rectal exams
  • Measure your height, weight, and blood pressure

Medicare does not cover an annual physical. The exam and any tests your doctor orders are separate services, and you may have expenses related to these depending on your Medicare plan.

Annual Wellness Visit A Medicare Wellness Visit is an overall evaluation of your health and well-being. The primary purpose is prevention and involves either creating or updating your individual prevention plan. Medicare covers a Wellness Visit once every 12 months (11 full months must have passed since your last Wellness visit), and you are eligible for this benefit after having Medicare Part B for at least 12 months.

During the exam, your primary care provider combines information from the visit with your medical record to assess your risk for common preventable health problems, such as heart disease, cancer, and type 2 diabetes. Based on the evaluation, your doctor creates your individual prevention plan with a checklist of screenings you need to have.

The list below shows actions your provider may perform during a wellness exam.

  • Review your health risk assessment (questions you answer about your health)
  • Confirm your medical and family history
  • Document your current prescriptions and providers
  • Measure and document your height, weight, and blood pressure
  • Look for signs of memory loss, dementia, or frailty
  • Record your health risk factors and treatment options
  • Provide personalized health advice
  • Develop a schedule for the preventive services recommended for you

Medicare Part B covers an annual wellness exam and several preventive screenings with no copay or deductible. However, you may have to pay a portion of the cost for some recommended tests or services.

Copay An amount you are required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription medication. This is generally a flat dollar amount rather than a percentage.

Coinsurance An amount you are required to pay as your share of the cost for services after you pay any deductibles and is usually a percentage.

Deductible The amount you are required to pay for health care or prescriptions before Medicare, your prescription drug plan, or any other insurance will pay.

Preventive Services Health care to prevent or detect illness at an early stage. Preventive services include pap tests, certain vaccines, and screening mammograms.

Routine Labs and Screenings Testing or services recommended by a health care provider that allow potential health problems to be prevented or addressed early enough for a better overall outcome of a patient’s health.

Supplemental Insurance Plan (also known as Medigap) refers to numerous private health insurance plans used to supplement Medicare. Medigap insurance provides coverage for many of the co-pays and some of the co-insurance related to Medicare covered services

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Advanced Beneficiary Notice (ABN) A waiver that a physician or supplier should give a Medicare beneficiary when providing an item or service for which Medicare is expected to deny payment.

If you do not receive an ABN before you get the service from your physician or supplier, and Medicare does not pay for it, then you probably do not have to pay for it (unless it is a statutory exclusion).

If the physician or supplier does provide you an ABN that you sign prior to receiving the service, and Medicare does not pay for it, then you will have to pay your physician or supplier for it.

ABNs only apply if you have Traditional Medicare. They are not applicable if you are in a Medicare Managed Care Plan or Private Fee-for-Service Plan.

Coordination of Benefits (COB) Method for determining the responsibilities of two or more health plans that have some financial responsibility for a medical claim.

Explanation of Benefits (EOB) Statement from your health insurance detailing what costs will be covered for medical care or services received. This generally will include the total cost of the care received as well as any out-of-pocket expenses that the patient may incur.

Statutory Exclusion Services or supplies never covered by Medicare. Some examples are dental services, routine foot care, and cosmetic surgery.

Schedule an annual visit with your primary care physician today. 

To find a St. Joe’s primary care physician visit https://www.stjoeshealth.org/find-a-doctor/

Staying Fit Tips

It can be hard to stick to a fitness routine during the holidays. Here are some tips to keep you healthy during a busy time typically filled with sweet treats.

  • Stay hydrated and drink lots of water. There are large canteens and apps that can help remind you.
  • Avoid skipping meals, especially breakfast. If you eat a balanced diet throughout the day, you won’t be so tempted to eat extra sweets.
  • Be active – take a walk or simply move around your house or take the stairs.
  • Get a good night’s rest and avoid stress
  • Enjoy yourself and unleash your inner child. If you want treats, try smaller portions.

There you go – a few simple tips to keep you fit and having a great time with family and loved ones. Have a happy and safe holiday!

P.S. If you’re concerned about your health or staying healthy during the holidays, talk to your primary care physician. Don’t have primary care physician? Find one today .


6 Tips for Thriving during the Holiday Season

Along with laughter and good cheer, the holidays often bring busier schedules, an abundance of indulgent food and drink and increased financial stress, all of which can have a negative effect on our physical and mental health.

The good news is looking at the holidays through the six pillars of Lifestyle Medicine gives us the opportunity to rethink those holiday traditions that don’t contribute to our whole-health and focus instead on prioritizing self-care so that we can truly thrive this holiday season.

1. Manage Stress Better

Stress can play a part in headaches, high blood pressure, heart problems, diabetes, skin conditions, asthma, arthritis, depression and anxiety. Chronic stress coupled with acute stressors that we may experience during the holidays leave the body overstimulated with high levels of basal cortisol which in turn increases inflammation and causes or worsens disease.

Lifestyle Tip: Tools like regulated breathing, positive thinking, meditation, gratitude, and exercise can help manage stress and fight inflammation when used every day.

2. Eat Smarter

Food truly is medicine.  Beyond the physical benefits that a healthy diet affords us, food also effects our mood. It can be especially challenging to make healthy food choices during the holidays. 

Lifestyle Tip: Remind yourself to eat slowly and savor each bite, especially when it comes to calorie dense foods. Be truly present when sharing a meal with those you care about by disconnecting from electronics.

3. Sleep More Soundly

Getting a good night’s sleep is one of the most important things we can do for our overall health and well-being.  Sleep deprivation leaves the brain exhausted, and chronic sleep deprivation is strongly correlated with behavioral health issues, such as depression, anxiety and substance use.

Lifestyle Tip: Set yourself up for a restorative night of sleep by preparing the right way. Strive to set and stick to a sleep routine that allows for 7-8 hours of sleep per night in a cool, dark place and try to disconnect from screens two hours before bedtime.

4. Connect with Others

Social connections and relationships affect our physical, mental and emotional health. Research shows that the single most important predictor of human happiness and long life is having strong social connections. There is evidence that health related measures like blood pressure and heart rate improve even with short, positive social interactions. Technology can improve social connectedness in some cases but research also finds that those who use social media the most are at a higher risk for depression.

Lifestyle Tip: Try chatting with the person in line next to you while doing your holiday shopping, or smiling as you pass others in the hallway – these positive micro interactions scattered throughout your day can have a big impact. If you use social media, be mindful of how you use technology to support the social connections in your life.

5. Move More

Consistent regular exercise benefits us both mentally and physically. Moving our bodies, especially in nature, can do wonders for our whole health. In fact, studies show that being active for as little as 10 minutes per day can positively impact our mood.

Lifestyle Tip: Even as the days get shorter and colder, make it a priority to move naturally throughout the day doing things you love; walk with friends, ride a bike, dance, or play with the children and pets in your life.

6. Avoid Risky Substances

We know that reducing the intake of items like alcohol, vaping and smoking improve our physical health, but they can also have an impact on our mental health and happiness.  When we are not using substances, we are more able to be present in the moment and notice the positive things around us.

Lifestyle Tip: Take a moment to be aware of when you might be using these substances to alter your reality and focus instead on working to identify positive strategies to cope with life’s daily stressors.

Ready to take the next step?

Our Lifestyle Medicine team is here to support you on your journey to better health. Connect with one of our Board-Certified Lifestyle Medicine Specialists today.

How to Talk with Family and Friends About the COVID-19 Vaccine

As health care professionals, we have a responsibility to be public health leaders in our communities. An important way to fulfill that responsibility is by respectfully sharing accurate and science-based information about the vaccine—especially with those who might be hesitant.

Public discourse around COVID-19 vaccines has become highly charged, with widespread misinformation creating confusion and fear. To make your conversations on vaccines productive, it is helpful to remain empathetic and non-judgmental, and to listen to people’s concerns. You can also guide people to trusted sources, such as the Centers for Disease Control or their primary care physicians.

Below are some answers to commonly asked questions you can share with the people in your life:

Information about the vaccine is changing all the time. Why should I trust it?

As a novel virus, the COVID-19 virus was one we hadn’t encountered before. We’re learning more about it as time goes on, and it would be irresponsible to not update recommendations as new findings come to light. In addition, developments such as the COVID-19 Delta variant can cause recommendations to change, as the situation itself evolves. What has remained consistent since vaccines were first approved for use is that they:

  • Are safe and effective, especially against serious illness, hospitalization, and death
  • Can help prevent long-term complications of COVID-19

Why should I get the vaccine instead of relying on immunity from COVID-19 infection?

While COVID-19 infection provides some antibodies, immunity from COVID-19 vaccines is two to three times higher than natural immunity and can greatly lower your risk of reinfection. The vaccines also provide additional protection against virus variants.

If you have not yet had COVID-19, the vaccine can help prevent you from getting infected or seriously ill in the first place, lowering your risk of long-term complications.

My vaccination status doesn’t impact anyone else. Why is it anyone’s business?

In a pandemic, especially one with a virus as easily transmissible as COVID-19, our vaccine status does impact others. Vaccination does more than protect us from infection or serious illness; it makes us less likely to spread the virus to others. This layer of protection is especially important for those who are immunocompromised or who are unable to be vaccinated.

In addition, being vaccinated against COVID-19 lowers the risk of serious illness and hospitalization. The COVID-19 pandemic has placed enormous stress on health care systems, pushing resources and staffing to new limits. The vaccine lowers the chances we will need to use precious resources.

Getting vaccinated against COVID-19 serves the greater good, allowing us to protect ourselves and those around us, and to help bring an end to the pandemic through broad-scale immunity.

How do we know the vaccines are safe when they were developed so quickly?

The COVID-19 vaccines went through all the same safety studies and protocols as other vaccines. However, due to the urgency of the situation and unprecedented global funding, steps that may have been delayed for years were able to occur in rapid succession or simultaneously, greatly speeding up the process. In addition, COVID-19’s broad spread around the world allowed data on the vaccines’ effectiveness to be gathered quickly, as the protective impact of vaccines was rapidly apparent.

I’m currently expecting, and the vaccines make me nervous. Is it safe to receive the COVID-19 vaccine while pregnant?

Yes, it is safe to receive the COVID-19 vaccine while pregnant. In fact, the American Society of Obstetricians and Gynecologists (ACOG) strongly recommends that pregnant people be vaccinated against COVID-19, as the risks of COVID-19 infection while pregnant are so high. Pregnant people who are unvaccinated face much higher rates of serious illness, hospitalization, and death from COVID-19. COVID-19 infection also increases the risk of preterm delivery and stillbirth, making vaccination important for the baby’s health as well.

The COVID-19 vaccines have been shown to be safe while pregnant, with no associated increase in miscarriages or other pregnancy complications. Getting vaccinated while pregnant can also pass antibodies to the baby, providing protection after they are born. For those who are already vaccinated, ACOG recommends a booster vaccine dose once they are eligible to bolster their protection, as immunity from the initial vaccine series can wane over time.

I’m confused by the new recommendations on booster vaccine doses. Why would I need a booster, and should I get the same vaccine as before?

Booster doses can strengthen your immunity to COVID-19, as the vaccine’s effectiveness naturally decreases over time. This is like many other vaccines, which are given in a series to build more robust immunity. Booster doses are recommended for certain populations, which varies based on the vaccine originally received. A quick guide to booster dose eligibility is available here.

The CDC also approved the mixing of booster doses. For instance, if a person originally received the Johnson & Johnson COVID-19 vaccine, they may elect to receive one of the mRNA vaccines (Pfizer or Moderna) for a booster dose, as the mRNA vaccines have generally been more effective against COVID-19. People can also choose to receive the same vaccine for a booster as their original series.

Since the beginning of the pandemic, scientists and medical experts–including those at Trinity Health–have continued to learn more about the COVID-19 virus, acting quickly to respond to new evidence and stop surges throughout the country. Science is a process of learning and making the best decisions we can with the information we have at the time to protect as many lives as possible.

In addition to sharing the information above, please encourage everyone you know to educate themselves about the vaccine’s safety and efficacy by directing them to the COVID-19 vaccine information page on the Trinity Health website, and to the Centers for Disease Control and Prevention and state vaccine information pages.


Celebrate Holidays Safely
We wish you and your loved ones safe, happy holidays. Follow the CDC’s recommendations on safer ways to celebrate them.

Harvest Bowls

Ingredients 

  • 1 cup quinoa  
  • 2 cups water 
  • 2 cup Brussel Sprouts  
  • 1 acorn squash  
  • 4 tablespoons dried cherries  
  • 1 can chickpeas  
  • 1 tablespoon Ground cumin  
  • 1 tablespoon garlic  
  • 1 teaspoon cinnamon  
  • Parsley  

Directions  

  1. Begin by washing all ingredients. Preheat oven to 375 degrees.
  2. Slice the acorn squash in half and remove seeds. Add olive oil and brush to coat.  
  3. Add a pinch of salt and pepper and place face up on a baking tray. Bake at 375 degrees for 30-40 minutes.  
  4. Slice Brussel sprouts in half and toss in oil and garlic powder. Add to a baking sheet and back for 30 minutes.
  5. In a slow cooker, large stock pot, or Instapot, add all your quinoa and water. Bring to a boil then reduce to a simmer. Cook for 15-20 minutes.   
  6. Rinse and drain chickpeas and pat dry. Add to a bowl and toss with spices. Transfer to cooking sheet and bake for 15 minutes.
  7. When squash is fork tender and rice is cooked through, remove from heat and scoop out insides into a bowl.  
  8. Plate by filling a bowl with cooked quinoa, squash, brussels and chickpeas. Top with cherries and parsley and serve warm. 

Ready to take the next step?

Our Lifestyle Medicine team is here to support you on your journey to better health. Connect with one of our Board-Certified Lifestyle Medicine Specialists today.

Pumpkin Cookies

Makes 12  

Ingredients  

  • 1 cup almond flour  
  • 2 flax eggs  
  • 1 tablespoon cinnamon  
  • ½ cup pumpkin puree  

Directions 

  1. Lay out all ingredients and preheat oven to 350 degrees. 
  2. Make a flax egg with 2 tablespoons of flax meal and 6 tablespoons of water and set aside to gel.
  3. Add flax egg and pumpkin together and stir.  
  4. Add in almond flour and cinnamon. Stir to combine. Thin dough with water or plant milk as needed.  
  5. Scoop 2 tablespoon balls onto cookie tray and top with more cinnamon.  
  6. Bake for 15-20 minutes or until golden brown.

Ready to take the next step?

Our Lifestyle Medicine team is here to support you on your journey to better health. Connect with one of our Board-Certified Lifestyle Medicine Specialists today.

3 Bean Pumpkin Chili

Serves 4 

Ingredients  

  • 1 yellow onion, diced  
  • 1 can kidney beans  
  • 1 can black beans  
  • 1 can pinto beans  
  • 1 can diced tomatoes  
  • 1 cup pumpkin diced  
  • 1 tablespoon, garlic powder
  • 1 tablespoon, chili powder
  • 1 tablespoon, paprika 

Directions  

  1. Begin by laying out and washing all ingredients.  
  2. Dice onion and add to a pot with water or avocado oil and sauté until translucent.  
  3. Add canned beans and tomatoes and bring to a boil.  
  4. De-seed and cube pumpkin. Add to mixture without skin.  
  5. Add seasonings and salt to taste.  
  6. Simmer for 20 minutes or until pumpkin is fork soft.

Ready to take the next step?

Our Lifestyle Medicine team is here to support you on your journey to better health. Connect with one of our Board-Certified Lifestyle Medicine Specialists today.

Falafel Pita with Veggies

Ingredients  

  • 1 can chickpeas  
  • 1 Parsley  
  • 1 head garlic  
  • Ground Cumin  
  • 1/4 cup cooked quinoa  
  • 4 tablespoons tahini  
  • 1 lemon, juiced  
  • Salt and pepper to taste  
  • Cucumber  
  • Radish  
  • Mixed greens  
  • Whole wheat pita  

Directions 

  1. Wash and lay out all ingredients.
  2. Finely mince garlic, onions, and parsley and add to a bowl with the spices.
  3. Add chickpeas, rinsed and drained, to the bowl as well as the cooked quinoa and ½ of lemon juice.  
  4. Mash together and add salt to taste.  
  5. Scoop into balls and set on baking sheet.  
  6. Preheat oven to 375 degrees and bake for 15-20 minutes or until golden.  
  7. Slice veggies thinly.  
  8. Mix tahini and remaining lemon juice to make sauce. Thin with water.  
  9. Remove falafel from oven and place in pita with veggies, greens, and dressing. Enjoy!

Ready to take the next step?

Our Lifestyle Medicine team is here to support you on your journey to better health. Connect with one of our Board-Certified Lifestyle Medicine Specialists today.

Sambar

Ingredients  

  • 2 cups red lentils (dal)  
  • 4 cups water 
  • 1 green pepper  
  • 1/2 medium eggplant  
  • 2 medium carrots  
  • 1/2 yellow onion  
  • 4-6 baby potatoes  
  • 2-3 tablespoons Sambar Spice Blend 

Directions 

  1. Wash and lay out all ingredients.  
  2. Dice onions.  
  3. Add 1 tablespoon spice blend with 2 teaspoons oil and onions to a pot.  
  4. Dice carrots, eggplant and pepper. Add to pot when onions are translucent.  
  5. Add dal and water and bring to a boil. 
  6. Add remaining spices and salt to taste 
  7. Cook 20-30 minutes until soft. Option to blend 1/2 for smoother texture.  
  8. Serve warm.

Ready to take the next step?

Our Lifestyle Medicine team is here to support you on your journey to better health. Connect with one of our Board-Certified Lifestyle Medicine Specialists today.

Get Hairy this Month to Support Men’s Health

St. Joe’s is celebrating “Movember,” an international initiative that asks men to grow moustaches to “change the face of men’s health” and raise awareness for undetected and untreated health risks.

Men on average die six years earlier than women—most from preventable causes. Which means it doesn’t have to be that way. Take action to live a healthier, happier and longer life.

Your health and safety are our top priority. Our team focuses on your care and treats you like you’re our family.

Don’t postpone your check-ups and health screenings – early detection is key for many conditions.

Find a St. Joe’s doctor and schedule an appointment today!