Both Original Medicare and Medicare Advantage plans offer preventive care benefits, but Medicare Advantage may offer additional services that could help keep you healthier and work better for your budget. Here is everything you need to know about Medicare Wellness Program benefits and how they work with Medicare Advantage plans.

What is Medicare Advantage’s Wellness Program? 

Once you’ve had Medicare Part B for more than 12 months, Medicare offers a free annual wellness visit. This is not to be confused with an annual physical, which is considered preventive care but is not the official annual wellness visit. It is also separate from your “Welcome to Medicare” visit that occurs after 12 months of Medicare enrollment.

The purpose of the Medicare Wellness Program annual visit is to create or update a personalized plan with your doctor to prevent serious illnesses and disabilities. Your doctor gives you a health risk assessment, which is a comprehensive questionnaire that includes information like your family medical history, current prescriptions and health issues you’ve experienced. Your doctor also does a cognitive assessment to determine signs of Alzheimer’s, dementia and other cognitive issues.

Under Medicare Advantage, these assessments are performed by healthcare providers that participate in your plan. Based on your doctor’s recommendations, your wellness program is then tailored to your specific health needs. Because Medicare Advantage plans can be compared based on the type of care and benefits you need the most, Medicare Advantage wellness programs are highly personalized.

The Medicare Advantage wellness program includes several benefits that Original Medicare does not cover, such as fitness programs, nutrition counseling and health screenings that your doctor deems an integral part of your personalized wellness plan.

Preventive Care Benefits in Medicare Advantage

Medicare Advantage plans offer a wide variety of preventive care services. They include but are not limited to:

• Annual physicals
• Vaccinations
• Cancer screenings
• Cognitive health assessments
• Glaucoma screenings
• Cardiovascular screenings
• Diabetes education and testing
• Smoking cessation programs
• Nutrition counseling

Each Medicare Advantage plan has varying degrees of coverage. However, preventive services are free if you see an in-network provider, and the services are covered under Original Medicare with zero cost-sharing. If you’re eligible for these services under Original Medicare, you will not have any copays or coinsurance payments. For services not covered under Original Medicare, you may need to pay copays or coinsurance.

Because there are other subscribers to share costs, Medicare Advantage offers greater accessibility with lower cost burdens compared to Original Medicare for preventive care services not covered under Original Medicare.

The Role of Preventive Care in Promoting Wellness 

Preventive care lives up to its name. Regular exams, screenings and tests for common health issues, and health issues you may be more susceptible to based on personal risk factors like family medical history, can rectify potential health problems before they become serious. For example, if a patient’s cardiovascular disease screening shows signs of heart disease, nutritional counseling and a personalized exercise program can reduce the likelihood of a debilitating heart attack. Cancer screenings can identify cancerous growth in early stages before it can become a painful, terminal chronic illness.

Exams, disease screenings and other preventive care measures can give you peace of mind if you do not show signs of these conditions. You can also fix possible issues before they worsen. This allows for a greater quality of life.

Preventive care also carries major cost savings. The National Institute of Health estimates that the healthcare system can save $1.5-2 billion if more Americans utilize preventive care.

According to the Department of Health and Human Services’ Healthy People 2030 initiative, only 8.5% of American adults over 35 receive recommended annual preventive care services, such as annual physicals and cancer screenings. For adults aged 65 and older, this number sharply declined from 7.9% in 2018 to 5.1% in 2020. Even after accounting for COVID-related delays and roadblocks in accessing preventive care, older adults are noticeably behind younger age groups in receiving recommended routine preventive care.

With copays frequently cited by all age groups as a reason for not seeking preventive care, Medicare Advantage plans can close this coverage gap for older adults. By offering plans with $0 monthly premiums and zero cost-sharing for preventive care services, Medicare Advantage personalized wellness plans provide a simple, low-cost way for seniors to stay in front of any health risks that may arise.

How to Utilize Medicare Advantage Wellness Benefits 

To learn more about preventive care services covered under Original Medicare, Medicare has a comprehensive list of screenings, counseling, shots and other services that are fully covered. Your Medicare Advantage plan administrator will also have their own list of covered services in the plan documents. 

Your healthcare providers may offer additional counseling and assistance regarding your preventive care options and getting the most value out of your Medicare Advantage plan. State health departments and Departments of Aging may have additional resources for free and low-cost preventive care for older adults, in addition to assistance navigating Medicare Advantage and Original Medicare to maximize preventive care benefits.

Considerations and Limitations 

While Medicare Advantage plans offer a wider range of covered preventive care services than Original Medicare, there are limitations to take into account. Subscribers can only visit in-network providers to get their eligible preventive care services covered. Original Medicare offers a larger provider network with fewer geographic restrictions.

Because Medicare Advantage plans are geographically based, these plans might not be a good fit for subscribers who frequently travel out of state or divide their time between multiple states and countries. Medicare Advantage plan availability also varies by location, and not all regions have access to the same plans that offer more comprehensive coverage and lower cost-sharing. However, Medicare Advantage PPO plans offer out-of-network benefits. Urgent and ER care is covered no matter where you travel, and out-of-network providers are covered at a lower benefit level compared to in-network. This makes PPO plans a better fit for subscribers who frequently travel.

Depending on the wellness benefits you specifically need and what is and is not covered under Original Medicare, you may need to assess whether you can maximize the value of your Medicare Advantage plan.

Preventive care saves money and health problems in the long run. Annual checkups, screenings and shots ensure that you live longer and with a more pleasant quality of life. Medicare Advantage wellness plans and preventive care benefits can be customized to your specific risk factors, enabling you to be proactive about your healthcare needs. For more information on Medicare Advantage wellness plans, or to learn about Baylor Scott & White Health Plan Medicare Advantage plans, call 1.800.782.5068 (TTY: 711).