Primary Care
Consistent, High-Quality Healthcare Close to Home
A primary-care provider is the doctor or nurse practitioner who patients see as their main doctor for management of their health, disease prevention, and for the diagnosis and treatment of both acute and chronic ailments or injuries. Your PCP can also refer you to a doctor who specializes in treating any particular condition if you should have a medical issue requiring care from a doctor who has more in-depth training.
Medicare Part B Patients: Schedule an Annual Wellness Visit (AWV) for a Personalized Treatment Plan
Patients with Medicare insurance coverage should take advantage of yearly physical exams with their PCP for a personalized health prevention program.
There are eligibility requirements for Annual Wellness Visits (AWV). AWVs are covered by Medicare Part B for patients who have been on this insurance plan for over 12 months and have not received an AWV in the past 12 months.
During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also check your height, weight, blood pressure, and other routine measurements. Part of the AWV involves providing you with a health risk assessment, including a questionnaire that you complete before or during the visit. The questionnaire asks about your health status, injury risks, behavioral risks, and urgent health needs.
Your primary care doctor will review your functional ability and safety level, which includes screening for hearing impairments and your risk of falling. Your doctor must also assess your ability to perform activities of daily living (such as bathing and dressing), and your level of safety at home.
Another purpose of the AWV is to collect information about your medical and family history. When you come for your AWV, take a list of your current providers, durable medical equipment (DME) suppliers, and medications, such as prescription medications, as well as vitamins and supplements you may take.
Your doctor will screen for cognitive impairment, including diseases such as Alzheimer’s and other forms of dementia. Medicare does not require that doctors use a test to screen you. Instead, doctors are asked to rely on their observations and/or reports by you and others.
Provide health advice and referrals to health education and/or preventive counseling services to reduce identified risk factors and promote wellness. Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.
AWVs after your first visit may be different. At subsequent AWVs, your doctor will:
- Check your weight and blood pressure
- Update the health risk assessment you completed
- Update your medical and family history
- Update your list of current medical providers and suppliers
- Update your written screening schedule
- Screen for cognitive issues
- Provide health advice and referrals to health education and/or preventive counseling services
Costs of AWVs
If you qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During your AWV, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider treats you because of specific symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.