On National Public Radio, there used to be two brothers, “Click” and “Clack,” who would talk about cars. Their show, Car Talk, was funny, and you could learn a lot about improving the health and lifespan of your car. One of their recommended methods for keeping your vehicle in top shape was to take preventive measures before the dreaded “check engine” light ever came on. A little time up front could save a lot of time, and money, later.
Similarly, preventive healthcare is important for keeping our bodies running at their best and helping reduce the risk of disease and disability. Chronic diseases, such as diabetes and osteoarthritis, not only dramatically affect quality of life but are also leading reasons behind America’s exorbitant healthcare costs. Preventive care, which typically includes screening, testing, patient counseling, and immunizations, helps prevent illness and can identify health problems early, when interventions are most beneficial.
According to my good friend and colleague Stephen Shortell, PhD, MPH, MBA, a health policy expert and former dean of the UC Berkeley School of Public Health, preventive care is important not just for the individual but for the population as a whole, particularly when it comes to preventing the spread of infectious diseases. “There are really no downsides to preventive care,” he likes to say.
The term preventive care may bring to mind an annual physical, where your doctor does things like check your heart and lungs and examine your throat, eyes, and ears and then makes certain recommendations. The Affordable Care Act, however, added a new aspect to preventive care because federal law now requires most private insurers and Medicare to cover the cost of an annual preventive care visit. For individuals on Medicare Part B, this is known as the annual wellness exam.
The idea of a “wellness visit” may seem odd to many of us, in part because of the way our uniquely American healthcare system runs. As Steve points out, we have an illness system in the U.S., not a health system. We wait for people to get sick or injured and then come for care, and we don’t really provide incentives for engaging in preventive care.
The annual wellness exam provides an opportunity for patients and healthcare providers to discuss prevention strategies, such as which vaccines you need and when, and for your provider to assess your overall risk for certain health issues. In contrast to a doctor’s visit for a specific problem, during wellness visits, healthcare providers are more likely to spend time providing counseling related to diet and mental health, offer routine screening labs (such as cholesterol and glucose tests), or order preventive procedures such as mammograms and immunizations. It is at these visits that a provider may also assess whether there are signs of dementia or depression.
Patients should leave their wellness exam knowing that their healthcare provider has created a personalized prevention plan aimed at keeping them healthy or identifying problems before they become serious. You can think of it as kind of like that maintenance schedule your mechanic has for your car.
While the annual wellness exam itself is fully covered by Medicare Part B, unfortunately it is not quite as simple as it sounds. First, to qualify, you have to have been on Medicare Part B for 12 months, and you cannot have a wellness exam within 12 months of your “Welcome to Medicare” exam (which is a much more comprehensive visit). Most importantly, be aware that many healthcare providers combine the free wellness visit with a physical exam, which is not covered by Medicare.
So while the wellness portion of the exam is covered by Medicare, if your healthcare provider recommends a laboratory or screening test that is not considered part of the wellness exam (such as a test specific for an ongoing chronic condition or suspected problem), or if you bring up a new medical issue to discuss, you may incur a charge or be required to pay the full amount of that test. It is akin to when you schedule a maintenance visit for your car and during that routine visit, the auto mechanic finds something wrong and has to charge you extra to fix the problem.
If you’re concerned about potential unexpected costs when you call to make your wellness visit appointment, make sure to inform the office staff that you are scheduling for that in particular, and ask about potential costs of any recommended tests. You can double check whether recommended tests or procedures are covered by going to the Medicare website. The bottom line, however, is that while our healthcare system has a long way to go, any step in the direction of increasing prevention is a step in the right direction.
