Ask the Doctors

Dear Doctor: I am a senior citizen on Medicare. I don't have a "regular" doctor, but rather, I go to a clinic when I have a problem. What is covered in the annual Medicare physical? What should I, as a patient, know and do?

Dear Reader: Let's face it -- health insurance can be complicated and confusing, and Medicare is no different. We hope we can offer a bit of clarity regarding Medicare's annual physical exams, the details of which often leave our own senior patients with plenty of questions.

In the 12 months after you enroll in Medicare Part B, you're eligible for something known as a "preventive care" visit. During this appointment, you'll tell your doctor your personal medical history as well as your family history. She or he will record your height, weight and blood pressure, and will calculate your BMI, or body mass index. You'll get a vision test, and you'll be evaluated for risk of depression and any other potential safety issues.

Certain screening tests and vaccinations may be ordered at this time. Because details vary depending on each specific case, be sure to ask your doctor whether additional costs will be incurred. You may have to pay coinsurance, and the Medicare Part B deductible may apply.

During this initial visit, you'll also have a chance to discuss advanced health directives, sometimes known as a living will. You will receive a written plan that details a future schedule of screenings, vaccines and any other preventive services your medical history has indicated may be necessary.

Each subsequent year, Medicare entitles you to an annual physical evaluation that is less comprehensive than what we think of as a full physical. Known as a yearly wellness exam, it focuses on what a physician can see, hear and feel during an exam, such as heart rate, blood pressure, weight, BMI, heart and lung sounds and visible symptoms. However, the wellness exam does not include blood tests like complete blood count, kidney, liver and thyroid function, diabetes and cholesterol screenings, or a check of vitamin D levels, which we include in annual physical exams in our practices. These can be ordered, but depending on the test, there can be additional costs.

To get the most out of any physical exam, we recommend that patients bring the following:

-- Complete medical records, including immunization records, results of recent screening tests and information on any surgeries.

-- A list of all medications and supplements you are currently taking, including dosage, history of use and any side effects you may have experienced.

-- Comprehensive medical family history, including diseases like cancer, asthma, diabetes, memory disorders or dementia.

This last part is important because if your doctor determines that you are at particular risk of a certain disease or condition, you may be eligible for additional screenings and more frequent screenings. However, this typically requires a referral.

Lastly, we would encourage you to find and build a relationship with a primary care physician. This will give you a medical "home base," a doctor who knows you and your medical needs, as well as a partner in your ongoing care and an advocate for your best quality of life.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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