Understood Care
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.
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.
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.
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.
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.
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.
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.
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
https://understoodcare.com/care-types/care-coordination
https://understoodcare.com/care-types/appointments
https://understoodcare.com/care-types/transportation-help
https://understoodcare.com/healthcare-info/talking-with-your-healthcare-provider
Sign up or call for help scheduling and reminders
https://app.understoodcare.com
Call 646 904 4027 to reach an advocate
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. https://understoodcare.com/healthcare-info/why-advocates-matter-for-your-care
This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.
We know navigating Medicare and care needs can feel lonely, but you don’t have to do it alone.
Our caring team takes care of the paperwork, claims, and home care so you’re always supported.
