Seniors May Not Rush In For Medicare Wellness Exams

In 2005, the federal government began offering coverage for a physical exam to seniors new to Medicare. At the time, the American Cancer Society called the “Welcome to Medicare” checkup a “significant opportunity for improving the health of Medicare beneficiaries” and said “seniors have much to gain from a visit that will promote healthy lifestyles and disease prevention.”

Apparently, most seniors didn’t agree.

Fewer than 10 percent of eligible seniors have used the prevention benefit, according to the Centers for Medicare and Medicaid Services. That’s led some to question how many seniors will take advantage of the latest Medicare prevention benefit that takes effect in 2011: an annual wellness exam.

“I don’t think people will be running to do this,” said Judith Stein, executive director of the Center for Medicare Advocacy. While she applauds the new benefit, she said seniors may not see the value without a strong recommendation of their doctor.

The wellness visit, which was included in the new health law at a projected cost of $3.6 billion over next 10 years, has several advantages over the “Welcome to Medicare” exam. The new benefit can be used every year and it is free. Medicare patients had a 20 percent co-pay on “Welcome To Medicare” exam-although that is eliminated starting Jan. 1.

Doctors also have another reason to promote the wellness exam, which would include the usual checks of vital signs, height, weight, establish a schedule for screenings for patients and seek to identify cognitive impairment, functional ability and depression. They will get reimbursed an average of $172 for it compared to $136.80 for the “Welcome to Medicare” physical, according to the American Academy of Family Physicians.

Dr. Roland Goertz, president of the academy, said most doctors find ways to provide preventive care within patient sick visits. “You had to be creative, but with this new benefit it will give more status to the value of prevention,” he said.

Nonetheless, patients may not understand the need for checkup when they’re feeling well, he said. “It will take a culture change,” he said.

Dr. Barry Straube, chief medical officer for the Centers for Medicare and Medicaid Services, said he’s confident more seniors will take advantage of the wellness exam. While he said it could be a boon to physician practices, he’s not sure doctors will promote it within their busy practices.