Preventive Visits, Wellness Visits Meet Different Needs for Patients

Sometimes people casually use the terms “preventive care visit” and “wellness visit” interchangeably when they’re talking about going to see their doctor for a yearly check-up. The terms, however, are defined differently by the Centers for Medicare and Medicaid Services (CMS) and by many commercial insurances. 

CMS calls a preventive care visit an Initial Preventive Physical Examination (IPPE), which is also sometimes known as a “Welcome to Medicare visit.” This one-time visit is covered if done within the first 12 months of your enrollment in Medicare Part B coverage. The visit includes:

• Assessment of functional ability and safety level
• Discussion of end-of-life planning
• Education, counseling and referrals based on results of initial assessment, which could include a written plan or checklist for your follow up healthcare.
• Measurement of height, weight, body mass index, blood pressure, and other factors 
• Medical history review
• Review of depression risk factors/potential
• Social history review
• Visual acuity screen

A yearly wellness visit, is an annual check-up that you get once you have had Part B for more than 12 months, according to CMS. 

Many commercial health insurance plans also encourage these annual visits, according to Premier Physician Network You can visit your physician for a wellness check once every 12 months. The visit includes:

• A schedule of preventive screenings
• Advice for your personal healthcare future
• Checking for any cognitive impairment
• Creating or updating a list of all your current doctors and medications
• Family history review
• Listing risk factors and treatment options
• Measuring your height, weight and blood pressure
• Medical history review
• Physical exam based on age
• Refill prescriptions
• Review of your social history
• Review of chronic stable medical conditions you have
• Vaccinations 

This kind of check-up is typically included free of charge for each member of your family and is included in health insurance coverage, according to Premier Physician Network.

Making sure your physician’s office is on the same page as you as to which type of visit you are planning when you schedule your appointment is important. For your insurance to cover the visit, it must be coded as either preventive or wellness when billed by your doctor’s office, according to CMS and Premier Physician Network.

Learn more about the difference between a preventive care visit and a wellness visit or find a physician.