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It explains eligibility timing, what each visit includes, and key scenarios that may trigger out-of-pocket costs, such as required PCP selection rules, limits on office services per day, non-preventive tests, and additional concerns addressed during the visit. 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An annual physical, also known as a well visit, is a check-up to review your current health and medical history.\u003Cbr>• When are you eligible? Most plans cover one visit per calendar year.\u003Cbr>• Will there be out-of-pocket costs? Some common restrictions could result in out-of-pocket costs:\u003Cbr>o If your insurance carrier requires a PCP selection and you have this service with another provider whois not your PCP.\u003Cbr>o If your carrier covers only one office service per day\u003Cbr>o If your provider performs tests or services during the visit that aren’t covered under the preventive benefit, such as vaccinations, lab work, or EKGs.\u003Cbr>o If you discuss any additional medical concerns during your visit, your provider may need to bill for both the annual physical examination and the evaluation and treatment of those concerns.\u003Cbr>􀂃 This could result in a co‑payment for the evaluation and management portion of the visit, even if the appointment was originally scheduled as a preventive visit. |  |\n| Medicare and Medicare HMO Patients\u003Cbr>Welcome to Medicare Visit (Initial Preventive Physical Exam or IPPE)\u003Cbr>• What is it? A one-time preventive visit to review your health history, learn about preventive services, and create a personalized care plan. This is not a physical exam.\u003Cbr>• Who is eligible? New Medicare Part B (Outpatient and physician services coverage) patients.\u003Cbr>• How often? One time within the first 12 months of Medicare Part B enrollment\u003Cbr>• Will there be out-of-pocket costs? No, you owe $0 if your provider accepts Medicare.\u003Cbr>Annual Wellness Visit (AWV)\u003Cbr>• What is it? A yearly visit with your doctor to create or update your personalized prevention plan. This is not a physical exam.\u003Cbr>• Who is eligible? Medicare patients with Part B for more than 12 months.\u003Cbr>• How often? Every 12 months after your Welcome to Medicare Visit or last AWV.\u003Cbr>• Will there be out-of-pocket costs? You may have to pay coinsurance, and your Part B deductible could apply if your provider performs tests or services during the visit that aren’t covered under the preventive benefit.\u003Cbr>􀂙 Medicare does not cover routine physical exams |  |\n\nAcknowledgement and Financial Consent  \nI wish to proceed with the visit and understand that my benefit plan may not cover all services provided to me. I have read and understand the above.  \nPatient Signature Date","cbCaimJ2KIFWnvBW","https://ap.wps.com/l/cbCaimJ2KIFWnvBW","pdf",167165,"English","# Annual Physical Examination and Pediatric Wellness Visit\n## Medicare and Medicare HMO Patients\n# Acknowledgement and Financial Consent","[{\"question\":\"What is an annual physical (well visit) and what information is reviewed?\",\"answer\":\"An annual physical, also called a well visit, is a check-up to review current health and medical history.\"},{\"question\":\"When are most patients eligible for an annual physical visit, and can out-of-pocket costs apply?\",\"answer\":\"Most plans cover one visit per calendar year. Out-of-pocket costs may result when insurance rules, service limits, or non-preventive tests/services occur, or when additional concerns are billed separately.\"},{\"question\":\"What is the Medicare Welcome to Medicare Visit (IPPE), and who is it for?\",\"answer\":\"It is a one-time preventive visit for new Medicare Part B patients to review health history, learn preventive services, and create a personalized care plan, and it is not a physical exam.\"}]","Annual Physical, Pediatric Wellness, and Medicare Visits Consent Form - Information and Financial Consent | PDF",1789620418]