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
https://understoodcare.com/care-types/care-coordination
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Sign up or call for help scheduling and reminders
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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.

FAQ

• Why do regular checkups matter if I feel fine?
  Regular checkups are a chance to catch changes early, even before you notice symptoms. At these visits your clinician reviews your health history, updates your medication list, checks blood pressure and other measurements, and plans screenings and vaccines that fit your age and risks. This helps prevent problems or find them when treatment works best.
• What is the Welcome to Medicare preventive visit?
  The Welcome to Medicare visit is a one time preventive visit covered by Medicare Part B during your first 12 months of Part B. It is not a full physical exam. It focuses on your medical history, basic measurements, and planning preventive care. If your clinician accepts assignment, you pay nothing for this visit. If extra tests or services are added that are not part of the preventive benefit, normal costs may apply.
• What is 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. It is not a full physical exam. Instead, it focuses on a personalized prevention plan, a screening schedule for the coming year, and checks like a cognitive assessment. If your clinician accepts assignment, you pay nothing for the wellness visit itself, but you may pay for additional tests that are not part of the preventive benefit.
• What kinds of screenings and vaccines are reviewed at preventive visits?
  During preventive visits, your clinician uses evidence based recommendations, including United States Preventive Services Task Force A and B recommendations, to decide which screenings you need and when to repeat them. Common examples include blood pressure checks, cholesterol and diabetes screening for people with risk factors, certain cancer screenings, and counseling for tobacco cessation. These visits also help you stay up to date on vaccines that lower the risk of severe illness.
• What is a baseline and why is it important?
  A baseline is your personal starting point for key measures such as blood pressure, cholesterol, weight, and lab results. When you have a clear baseline, your clinician can compare today’s numbers to prior results and spot small changes early. This makes it easier to tell if a new symptom is important or if a treatment plan is helping.
• Why are some labs or imaging tests repeated over time?
  Some tests are repeated at regular intervals to track trends. For example, cholesterol and blood sugar tests help detect heart risks or diabetes before symptoms appear. Imaging is ordered when needed based on your risks or symptoms, not automatically every year. The goal is to focus on the right tests at the right time, not to do every possible test at every visit.
• Do I have to pay for preventive visits under Medicare?
  For the Welcome to Medicare visit 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, such as certain tests or procedures done at the same visit, you may have standard costs or copays for those items.
• Is a physical exam the same as a wellness visit?
  No. The Welcome to Medicare and Yearly Wellness visits are focused on prevention planning and screening schedules. They are not full head to toe physical exams. Some clinics may offer a more traditional physical exam as a separate service, which may have different coverage and costs.
• Do Medicare Advantage plans ever reward me for preventive care?
  Yes. Many Medicare Advantage plans offer rewards or incentives for completing certain preventive services, such as annual wellness visits or specific screenings. Federal rules allow these programs and require that rewards be offered fairly and that the value is appropriate for the activity. The exact rewards and rules vary by plan, so it is important to check with your insurer.
• How does Medicare decide which preventive services are covered?
  Medicare covers many preventive services that meet specific evidence standards. New services may be added when there is strong evidence of benefit, such as recommendations from the United States Preventive Services Task Force. Your clinician can review which services apply to you and confirm coverage during your visit.
• How can Understood Care advocates help with preventive care?
  Advocates coordinate with your primary care clinician and specialists to confirm when you last had preventive visits, what screenings or vaccines you are due for, and then help schedule and organize appointments. They can arrange transportation, help you prepare questions, explain results in plain language, and set reminders. If you are in a Medicare Advantage plan, they can also help you capture eligible rewards for completing covered preventive services.
• What practical steps can I take to get started with preventive visits?
  You can call your clinic to schedule your Welcome to Medicare visit or your next Yearly Wellness visit, bring a list of all medications including over the counter drugs and supplements, and write down questions and new symptoms before you go. Ask your clinician to create a screening and vaccine schedule for the next year and add those dates to your calendar with reminders. If you have Medicare Advantage, ask your plan what rewards are available for preventive care.
• When should I seek urgent medical help instead of waiting for a checkup?
  Preventive care is for planning and early detection, not emergencies. If you have warning signs such as trouble breathing, chest pain, severe weakness, sudden confusion, or other urgent symptoms, seek immediate medical care through emergency services or urgent care. For ongoing planning, coordination, and help using preventive benefits, an advocate can support you, but emergencies always need prompt 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.