“Welcome to Medicare” preventive visit?

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Seasonal
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“Welcome to Medicare” preventive visit?

Post by Seasonal »

In light of the many posts about doctors charging for a new patient visit in addition to the annual preventive visit that insurance must cover without any copay, etc., I wonder if that also applies to the Welcome to Medicare visit under traditional Medicare. Here's what Medicare says:
You pay nothing for the “Welcome to Medicare” preventive visit if your doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply.

However, you may have to pay coinsurance, and the Part B deductible may apply if:

- Your doctor or other health care provider performs additional tests or services during the same visit.
- The preventative benefits don't cover these additional tests or services.
https://www.medicare.gov/coverage/welco ... tive-visit

EDIT: Based on many responses, I have not made it sufficiently clear that I'm concerned about a "new patient" charge that seems common for new patients, rather than charges that might arise for other aspects of an office visit. The typical new patient charge does not appear to cover anything not included in the standard Welcome to Medicare visit.
Last edited by Seasonal on Wed Aug 04, 2021 7:17 pm, edited 1 time in total.
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RickBoglehead
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Re: “Welcome to Medicare” preventive visit?

Post by RickBoglehead »

Yes.

I got a letter from my doctor before my annual physical that went into deep detail about how a physical is not a preventative visit, and that if I didn't want a physical I needed to tell them before the visit began, and that Medicare would not cover a physical.

But I'm not on Medicare yet.

Also applies to Medicare's "Yearly Wellness Visits", which also aren't physicals. However, they may include a cognitive test for Alzheimer's or dementia, and other mood disorders.

https://www.medicare.gov/coverage/yearl ... ess-visits
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FreddieFIRE
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Re: “Welcome to Medicare” preventive visit?

Post by FreddieFIRE »

Seasonal wrote: Wed Aug 04, 2021 1:20 pm In light of the many posts about doctors charging for a new patient visit in addition to the annual preventive visit that insurance must cover without any copay, etc., I wonder if that also applies to the Welcome to Medicare visit under traditional Medicare. Here's what Medicare says:
You pay nothing for the “Welcome to Medicare” preventive visit if your doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply.

However, you may have to pay coinsurance, and the Part B deductible may apply if:

- Your doctor or other health care provider performs additional tests or services during the same visit.
- The preventative benefits don't cover these additional tests or services.
https://www.medicare.gov/coverage/welco ... tive-visit
Are you seeing a new doctor?
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Seasonal
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Re: “Welcome to Medicare” preventive visit?

Post by Seasonal »

RickBoglehead wrote: Wed Aug 04, 2021 1:32 pm Yes.

I got a letter from my doctor before my annual physical that went into deep detail about how a physical is not a preventative visit, and that if I didn't want a physical I needed to tell them before the visit began, and that Medicare would not cover a physical.
What is a physical that's not a preventive visit?

I believe Medicare and insurance cover the items listed as A or B by the US Preventative Services Task Force. https://www.uspreventiveservicestaskfor ... mendations
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Seasonal
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Re: “Welcome to Medicare” preventive visit?

Post by Seasonal »

PVolker wrote: Wed Aug 04, 2021 2:20 pmAre you seeing a new doctor?
Yes.
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FreddieFIRE
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Re: “Welcome to Medicare” preventive visit?

Post by FreddieFIRE »

Seasonal wrote: Wed Aug 04, 2021 2:29 pm
PVolker wrote: Wed Aug 04, 2021 2:20 pmAre you seeing a new doctor?
Yes.
It sounds just like non-Medicare insurance situations.
However, you may have to pay coinsurance, and the Part B deductible may apply if:

- Your doctor or other health care provider performs additional tests or services during the same visit.
- The preventative benefits don't cover these additional tests or services.
As many of us have learned, that basically means that if you discuss anything with your new Doctor other then height/weight/vitals/exercise/eating right/etc. they'll code it as something in addition to a preventive/wellness visit.
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Seasonal
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Re: “Welcome to Medicare” preventive visit?

Post by Seasonal »

PVolker wrote: Wed Aug 04, 2021 2:34 pm
Seasonal wrote: Wed Aug 04, 2021 2:29 pm
PVolker wrote: Wed Aug 04, 2021 2:20 pmAre you seeing a new doctor?
Yes.
It sounds just like non-Medicare insurance situations.
The only thing I can think of that a new doctor visit would include that isn't part every preventive visit is a history, but the Welcome to Medicare page says to bring history information.
PVolker wrote: Wed Aug 04, 2021 2:34 pm
However, you may have to pay coinsurance, and the Part B deductible may apply if:

- Your doctor or other health care provider performs additional tests or services during the same visit.
- The preventative benefits don't cover these additional tests or services.
As many of us have learned, that basically means that if you discuss anything with your new Doctor other then height/weight/vitals/exercise/eating right/etc. they'll code it as something in addition to a preventive/wellness visit.
That is what the words from the Medicare website would appear to say.
Broken Man 1999
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Re: “Welcome to Medicare” preventive visit?

Post by Broken Man 1999 »

For the folks new to Medicare, there is a booklet mailed to newbies Medicare and You that should be read carefully. It is available online, as well.

If you don't wish to read the rules, you may get ugly surprises.

Broken Man 1999
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Big Dog
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Re: “Welcome to Medicare” preventive visit?

Post by Big Dog »

Why not turn it around and tell the doc's office specifically, 'that I only want an appt for Welcome to Medicare exam/visit' so it is covered 100%.
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Seasonal
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Re: “Welcome to Medicare” preventive visit?

Post by Seasonal »

Broken Man 1999 wrote: Wed Aug 04, 2021 5:05 pm For the folks new to Medicare, there is a booklet mailed to newbies Medicare and You that should be read carefully. It is available online, as well.

If you don't wish to read the rules, you may get ugly surprises.

Broken Man 1999
The booklet does not appear to say anything about Welcome to Medicare that is not covered by the link I provided in the first post of this thread. What else in the booklet is relevant?
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Seasonal
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Re: “Welcome to Medicare” preventive visit?

Post by Seasonal »

Big Dog wrote: Wed Aug 04, 2021 5:55 pm Why not turn it around and tell the doc's office specifically, 'that I only want an appt for Welcome to Medicare exam/visit' so it is covered 100%.
This is a good idea and I plan to. However in the past, before being covered by Medicare, that strategy has not worked as well as I had hoped, including the new patient problem, despite not mentioning any issues. I'm wondering how common the problem is and if anyone had other suggestions.
Lalamimi
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Re: “Welcome to Medicare” preventive visit?

Post by Lalamimi »

we have a Plan G, so its all covered, but the Welcome to Medicare visit does not cover much. The doctor "adds on" tests. Its supposed to be a starting point for health care later.
Last edited by Lalamimi on Wed Aug 04, 2021 6:32 pm, edited 1 time in total.
Rex66
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Re: “Welcome to Medicare” preventive visit?

Post by Rex66 »

If that’s the way you are going to play it then why go at all?

Since you are going to say no to every question why bother?

Don’t be surprised if it doesn’t work out by trying to save money.
UpperNwGuy
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Re: “Welcome to Medicare” preventive visit?

Post by UpperNwGuy »

Medicare does such a wonderful job covering all my visits to various specialists that it surprises me how stingy they are with a basic annual physical examination. You would think that they would place more importance on preventative medicine, and that's what an annual physical really is no matter what Medicare says.
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ram
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Re: “Welcome to Medicare” preventive visit?

Post by ram »

Big Dog wrote: Wed Aug 04, 2021 5:55 pm Why not turn it around and tell the doc's office specifically, 'that I only want an appt for Welcome to Medicare exam/visit' so it is covered 100%.
The local clinic encourages patients to do exactly what you said. The visit is then scheduled with a RN and it is of course free.

As another poster said you should read the rules.
Ram
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Seasonal
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Re: “Welcome to Medicare” preventive visit?

Post by Seasonal »

Lalamimi wrote: Wed Aug 04, 2021 6:31 pm we have a Plan G, so its all covered, but the Welcome to Medicare visit does not cover much. The doctor "adds on" tests. Its supposed to be a starting point for health care later.
It covers the preventive matters and tests that the US Preventative Service Task Force has found is backed by research. As far as I can tell it does not cover tests that many doctors are fond of, but which research has found are not useful in the absence of symptoms or other specific issues.

Of course, if the exam turns up any issues, I'd expect follow-up and may well have to pay for it. What I'd like to avoid is a "new patient" charge without the doctor doing anything not already covered by Welcome visit or excluded from the Welcome to Medicare visit coverage.
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Seasonal
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Re: “Welcome to Medicare” preventive visit?

Post by Seasonal »

Rex66 wrote: Wed Aug 04, 2021 6:37 pm If that’s the way you are going to play it then why go at all?

Since you are going to say no to every question why bother?

Don’t be surprised if it doesn’t work out by trying to save money.
I plan on saying no to any question for which the answer is no.

Otherwise, see viewtopic.php?p=6157060#p6157060

EDIT: Based on past experience with annual preventive care visits or more expansive physicals, a lipid panel might be useful and I need a doctor to authorize that. Plus there's always the unknown.
Last edited by Seasonal on Wed Aug 04, 2021 7:11 pm, edited 1 time in total.
Topic Author
Seasonal
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Re: “Welcome to Medicare” preventive visit?

Post by Seasonal »

ram wrote: Wed Aug 04, 2021 6:49 pm
Big Dog wrote: Wed Aug 04, 2021 5:55 pm Why not turn it around and tell the doc's office specifically, 'that I only want an appt for Welcome to Medicare exam/visit' so it is covered 100%.
The local clinic encourages patients to do exactly what you said. The visit is then scheduled with a RN and it is of course free.

As another poster said you should read the rules.
See my response to Big Dog, above.

I have read the rules and quoted or linked to those that seem relevant. What other rules are you thinking of?
Big Dog
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Re: “Welcome to Medicare” preventive visit?

Post by Big Dog »

Seasonal wrote: Wed Aug 04, 2021 7:05 pm
Lalamimi wrote: Wed Aug 04, 2021 6:31 pm we have a Plan G, so its all covered, but the Welcome to Medicare visit does not cover much. The doctor "adds on" tests. Its supposed to be a starting point for health care later.
It covers the preventive matters and tests that the US Preventative Service Task Force has found is backed by research. As far as I can tell it does not cover tests that many doctors are fond of, but which research has found are not useful in the absence of symptoms or other specific issues.

Of course, if the exam turns up any issues, I'd expect follow-up and may well have to pay for it. What I'd like to avoid is a "new patient" charge without the doctor doing anything not already covered by Welcome visit or excluded from the Welcome to Medicare visit coverage.
Again, why not make your interests clear when you book the appointment, or at least ask before you go in so there are no surprises. (And primary care doc that accepts Medicare patients knows the rules.)

btw: in addition to the standard preventive matters and blood work, the 'exam' also includes a cognitive review. The doc is supposed to assess if you still have all your marbles, or need help in making decisions. :P
Duzz78
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Re: “Welcome to Medicare” preventive visit?

Post by Duzz78 »

Seasonal wrote: Wed Aug 04, 2021 1:20 pm Here's what Medicare says:
You pay nothing for the “Welcome to Medicare” preventive visit if your doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply.

However, you may have to pay coinsurance, and the Part B deductible may apply if:

- Your doctor or other health care provider performs additional tests or services during the same visit.
- The preventative benefits don't cover these additional tests or services.
https://www.medicare.gov/coverage/welco ... tive-visit
A Welcome to Medicare is not the same at all like physical exams you have had in the past. It does not include urine and blood lab tests. It does not include an EKG. If your doctor performs those during this visit, Medicare will not pay for them and you will be responsible for the bill. Your doctor can write a referral to have blood and urine tests done. They will need to be done another day.

On your link, it will tell you the 10 things this visit will cover. Among them listed is a vision test, taking your BMI, and a discussion about advanced directives and end-of-life documents.

This is just how the government set up this "Welcome to Medicare visit" to work and why they warn people that they may have to pay coinsurance and the Part B deductible may apply. Bottom line, Medicare does not pay well, so doctors will be more apt to do more to get more money.


The doctor will code your visit accordingly. It is all about the coding. A new patient visit usually will be coded as 99203 (low complexity) or 99204 moderate complexity). A follow visit or established patient will be coded as 99213 (FUO, low complexity) or 99214 (FUO, moderate complexity). A new patient codes requires the following three key components: history, exam, medical decision making. An established patient requires only two of those three. Those codes also determine what Medicare will pay, what the doctor can charge. For 99203, you may end paying around $35. For code 99213, around $16.

So if you discuss other than or the doctor does more than the 10 items listed, and the doctor does includes all three components, the bottom line, you may and most likely will be responsible for a coinsurance.
DetroitRick
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Re: “Welcome to Medicare” preventive visit?

Post by DetroitRick »

For all the discussion I've read about this "Welcome To Medicare" visit, this for me was one of the biggest non-issues since starting Medicare this February. But I don't have the new patient issue that the OP raised, as I've been seeing same GP for last 20 years. I don't know the answer to that issue. Two other friends of mine went through the exact same things in starting Medicare last year. Issues = 0.

The differences between what occurred during my "Welcome To Medicare" visit and physicals received in the last 20 years were trivial. They were almost identical. Billing is different, though. Of course, the content of physicals can vary between doctors. So others might experience things differently. Even routine bloodwork was ordered and completed during my visit. They were billed separately, included proper diagnostic codes, and were paid at 100% by Medicare in my case (I had met my small Part B deductible by that point anyway).

And while I'm cognizant of Medicare not covering preventive physicals, I'm also looking at my MSN where my visit was actually coded: "Initial preventive physical; face-to-face visit, services limited to new beneficiary (G0402)". That's right off the Medicare Summary Notice, verbatim. Again, normal lab work was all performed and paid for too, billed separately under a different claim #, with diagnostic reasons for the work done. No big deal. The extras done during my welcome visit were trivial boilerplate questionnaires, but then my physician already knows me to some extent.

Big picture, don't sweat it, just take a few simple preparatory steps:
1)know what Medicare covers and doesn't cover. The link provided by the op in initial post is good enough. The big risk in all this is something is done that is not medically necessary and then not covered by Medicare. For things covered at 100% (Wellness Visit, diagnostic lab work with the right coding), no big deal. Copays and deductibles for other things that could arise - these are minor costs compared to most normal insurance (pre-Medicare). They are even more minor if you carry a Medicare Supplement.
2)Be explicit in making your appointment, and in registering when you show up. Every general practice knows what a "Welcome to Medicare Visit Is". Just don't schedule "my annual preventive physical" and then fail to tell the office you are on Medicare. Unless you are the only Medicare patient in the practice, they will all have run across this before.
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Re: “Welcome to Medicare” preventive visit?

Post by hvaclorax »

I don’t like wellness visits. My primary physician told me they rarely turn up any problems. Chemical dependency, alcohol abuse, depression, abuse physical or mental,or suicidal ideation. I insisted they use E&M codes for billing. This is evaluation and management and they make good money using them. No need to embellish with anything else. My MD told me the wellness codes are encouraged by the employer. Not because of medical decision making. So, maybe you should ask your provider to explain why these are helpful or necessary. Respectfully, HVAC
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