The Importance of Regular Healthcare Checkups

Why regular checkups matter

Seeing your doctor only when you feel sick can leave important health changes unnoticed. Routine visits are a chance to review your health history, update your medication list, check blood pressure and other measurements, and plan the screenings and vaccines that fit your age and risks. These visits help you catch conditions early when treatment works best and support everyday wellbeing with clear steps you can follow.

What Medicare covers for preventive visits

The Welcome to Medicare preventive visit

Medicare Part B covers one Welcome to Medicare preventive visit during the first 12 months you have Part B. It is not a full physical exam, and you pay nothing for this visit if your clinician accepts assignment. If additional tests are done that are not part of the preventive benefit, standard costs may apply.

The Yearly Wellness visit

After you have had Part B for more than 12 months, you can get a Yearly Wellness visit once every year. This visit is not a physical exam. It focuses on a prevention plan tailored to you and includes a screening schedule and cognitive assessment. You pay nothing if your clinician accepts assignment. If other tests or services are performed that are not covered under the preventive benefit, you may have costs for those items.

Screenings and vaccines that keep you on track

During preventive visits your clinician uses recommendations from trusted guidelines, including United States Preventive Services Task Force A and B recommendations, to decide which screenings and counseling you need and how often to repeat them. Examples include blood pressure checks, diabetes screening for adults with risk factors, cancer screening schedules, and counseling for tobacco cessation.

Regular checkups also help you stay current on vaccines and other preventive services that lower your risk of severe illness.

Baselines help you and your care team

What a baseline means

A baseline is your personal starting point for measures such as blood pressure, cholesterol, weight, and lab results. Having a clear baseline makes it easier to notice small changes early. Your clinician may compare today’s numbers to last year’s numbers to decide if a new symptom needs attention or if a treatment plan is working. This is one of the most practical benefits of keeping your annual appointments.

Why labs and imaging may be repeated over time

Some tests are done at regular intervals to track trends. For example, cholesterol and blood sugar tests help find heart risks and diabetes before symptoms appear. Imaging is only ordered when it is needed based on your risks or symptoms. The goal is to focus on the right tests at the right time rather than doing everything every year.

Costs, coverage, and common questions

Do I pay for these preventive visits
For the Welcome to Medicare and the Yearly Wellness visit, you pay nothing if your clinician accepts assignment. If additional services are performed that are not part of the preventive benefit, you may have standard costs for those items.

Is a physical exam the same thing as a wellness visit
No. The Welcome to Medicare and the Yearly Wellness visit are focused on prevention planning. They are not full physical exams.

Do plans ever offer rewards for preventive care
Yes. Many Medicare Advantage plans offer rewards and incentives for completing certain preventive activities. Federal rules allow these programs and require that rewards be offered fairly to eligible members and that the value be appropriate for the health activity. Details vary by plan.

How do clinicians decide what services are covered
Medicare covers many preventive services, and the program can add services that meet specific standards, such as strong evidence of benefit from the United States Preventive Services Task Force. Your clinician can check coverage for your situation and create a screening schedule during your visit.

How Understood Care can help

As Debbie describes in the video, our advocates coordinate with your primary care clinician and specialists to confirm when you last had a preventive visit, what tests you are due for, and then we help you get everything scheduled. We can also help you capture available plan rewards for completing covered screenings in Medicare Advantage plans. If you want support getting to visits, understanding results, or setting reminders, we are here to walk with you.

Learn more and get support
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Practical next steps

• Call your clinic and schedule your Welcome to Medicare visit or your next Yearly Wellness visit
• Bring a list of your medications including over the counter medicines and supplements
• Write down your questions and any new symptoms you have noticed
• Ask your clinician to create a screening and vaccine schedule for the next year
• Add your appointments to a calendar and set reminders
• If you have Medicare Advantage, ask your plan about rewards for completing preventive services and how to receive them

When to seek urgent help

Preventive care is for planning and early detection. If you have warning signs such as trouble breathing, chest pain, severe weakness, or sudden confusion, seek immediate medical care. For ongoing planning and coordination, an advocate can help, but emergencies always need urgent medical attention. understoodcare.com/articles/why-advocates-matter-for-your-care‍

FAQ: Making The Most Of Your Medicare Preventive And Wellness Visits

• What is the Welcome to Medicare preventive visit?
  The Welcome to Medicare preventive visit is a one time Medicare Part B benefit you can use during the first 12 months you have Part B. It is not a full head to toe physical. Instead, it focuses on reviewing your health history, checking basic measurements like blood pressure, updating your medication list, and planning preventive care that fits your needs. You pay nothing for this visit if your clinician accepts assignment. If you receive extra tests or services that are not part of the preventive benefit, normal costs such as deductibles or coinsurance may apply.
• What is the Yearly Wellness visit and how is it different from a physical exam?
  The Yearly Wellness visit is an annual Medicare Part B visit available once every 12 months after you have had Part B for more than 12 months. It is not a traditional physical exam. The visit focuses on prevention and planning. Your clinician reviews your medical and family history, updates your medications, checks basic measures, screens for changes in thinking and memory, and creates or updates a personalized prevention plan. This plan includes a schedule for screenings, vaccines, and counseling that match your age, risks, and preferences.
• Do I have to pay for the Welcome to Medicare or Yearly Wellness visit?
  For both the Welcome to Medicare preventive visit and the Yearly Wellness visit, you pay nothing if your clinician accepts assignment. If, during the same appointment, you receive tests or services that are not included in the preventive benefit, such as evaluation or treatment of a new problem, you may have out of pocket costs for those additional services.
• What kinds of screenings and vaccines are usually discussed at these visits?
  During these visits your clinician uses trusted guidelines, including United States Preventive Services Task Force A and B recommendations, to decide which screenings and counseling fit you. Depending on your age, sex, and risk factors, you may review blood pressure checks, diabetes screening, cholesterol testing, cancer screenings, bone density tests, and counseling for topics such as tobacco use. Your clinician also reviews which vaccines you are due for so you can stay protected against conditions like flu, pneumonia, shingles, and COVID nineteen according to current recommendations and coverage.
• What does it mean to establish a baseline for my health?
  A baseline is your personal starting point for important measures such as blood pressure, heart rate, weight, body mass index, cholesterol, kidney function, and blood sugar. When your clinician has a clear baseline, they can compare future results to see if your health is stable, improving, or changing in a way that needs attention. Baselines are especially useful for chronic conditions like high blood pressure, diabetes, and heart disease, because small trends over time can guide treatment decisions.
• Why are some labs and imaging tests repeated over time?
  Some tests are meant to track trends rather than give a one time answer. For example, repeating cholesterol or blood sugar tests helps your care team see whether lifestyle changes or medicines are working. Other tests, such as certain cancer screenings, are done on a schedule based on age and risk. Imaging such as X rays or scans is ordered when there is a clear medical reason, such as new symptoms or known conditions that need monitoring. The goal is to do the right tests at the right intervals, not to repeat everything every year.
• Is a wellness visit the same as a “checkup” or “annual physical”?
  People often use these terms interchangeably, but they are not the same under Medicare rules. The Welcome to Medicare and Yearly Wellness visits are structured preventive visits with specific covered elements and a focus on planning. A full physical exam that includes a detailed hands on examination and testing outside the preventive benefit may be billed differently and can come with out of pocket costs. You can ask your clinic which type of visit is being scheduled so you know what to expect.
• Can my plan give me rewards for getting preventive care?
  Many Medicare Advantage plans offer rewards or incentives, such as gift cards or points, for completing certain preventive activities like wellness visits, screenings, or vaccines. Federal rules allow these incentives as long as they are offered fairly to eligible members, are tied to health related activities, and have reasonable value. The specific rewards and how to claim them depend on your plan. You can call the member services number on your plan card or check the plan website to see what is available.
• How does my clinician decide which preventive services are covered?
  Medicare covers a long list of preventive services, including many recommended by the United States Preventive Services Task Force and other expert groups. To be covered with no cost sharing in Part B, a service generally needs strong evidence that it improves outcomes for people in your situation and must meet Medicare coverage rules. During your Welcome to Medicare or Yearly Wellness visit, your clinician can look up coverage details, review your health history, and build a screening and vaccine schedule that follows Medicare rules and fits your risks and goals.
• What should I bring to a preventive or wellness visit?
  It helps to bring a current list of all prescription medicines, over the counter products, and supplements you take, including doses and how often you use them. Bring any home readings such as blood pressure logs or blood sugar records if you have them. Write down your questions and any new symptoms or concerns you have noticed since your last visit. If you use glasses, hearing aids, or mobility devices, bring them so you can participate fully.
• How can an Understood Care advocate support my preventive care?
  An Understood Care advocate can help you get the most from preventive benefits by checking when you last had a Welcome to Medicare or Yearly Wellness visit, confirming which screenings and vaccines you are due for, and coordinating with your primary care clinician and specialists. Advocates can help you schedule visits, arrange transportation, prepare questions, and keep your medication list up to date. After visits, they can review the plan with you, explain follow up steps in plain language, and help you understand results and reminders. For Medicare Advantage members, an advocate can also help you identify and claim any plan rewards tied to preventive care.
• What simple steps can I take today to stay on track with preventive care?
  You can call your clinic to schedule your Welcome to Medicare visit if you are in your first year of Part B or your next Yearly Wellness visit if it has been more than 12 months. Add the appointment to a calendar and set a reminder. Gather your medications and supplements in a list and bring it to the visit. Write down a few questions or changes you want to discuss, such as sleep, mood, pain, or new diagnoses. If you are enrolled in a Medicare Advantage plan, contact your plan or log in online to see which preventive services are recommended and whether they offer incentives for completing them.
• When should I seek urgent care instead of waiting for a preventive visit?
  Preventive and wellness visits are for planning, early detection, and long term health. If you have warning signs such as trouble breathing, chest pain or pressure, sudden weakness, numbness, severe headache, new confusion, or any symptom that feels like a medical emergency, you should seek immediate care through emergency services rather than waiting for a scheduled visit. For ongoing planning and coordination, an advocate and your primary care clinician can help, but emergencies always need rapid medical attention.

References

• ‍https://www.medicare.gov/coverage/welcome-to-medicare-preventive-visit Medicare
• https://www.medicare.gov/coverage/yearly-wellness-visits Medicare
• https://www.medicare.gov/publications/10110-your-guide-to-medicare-preventive-services.pdf‍
• Medicare
• https://www.cdc.gov/chronic-disease/prevention/preventive-care.html CDC
  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations
• USPSTF
• https://www.cms.gov/medicare/coverage/preventive-services-coverage ‍
• Centers for Medicare & Medicaid Services
  
• https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-422/subpart-C/section-422.134
• ‍eCFR
  
• https://www.govinfo.gov/link/cfr/42/422?link-type=pdf&sectionnum=134&year=mostrecent GovInfo

This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.