Medicare (including AWV tips)
Eligibility
- Adults aged 65 years or older who have paid a combined 10 years of taxes in the USA (some exceptions are for those who are disabled (on SSDI, have ESRD, or ALS))
Medicare | Coverage |
|---|---|
| Part A (“After the Hospital”) | Inpatient care, subacute SNF, skilled home health care (after hospitalization), hospice care Blood transfusions |
| Part B (“Before the Hospital”) | Physician services, outpatient care, ambulance services, advance care planning, behavioral health integration services, skilled home health (not after hospitalization), telemedicine, preventative care DME, labs, diagnostic tests, flu/pneumonia vaccines, immunosuppression for organ transplants, chemo) |
| Part C (Medicare Advantage) | Part A and B services delivered through private managed care plans Could include additional services such as vision, dental, wellness Prescription drug coverage may be included Delivered through MA plans (eg, HMOs most common) |
| Part D (Drug coverage) | Prescription drug benefit Includes many recommended vaccines (e.g., Zoster, Tdap) |
Annual Well Visit
- Must be at least 12 months after last AWV
- Coding: Initial (G0438) and Subsequent (G0439)
- Template: .MEDICAREAWV2021
- Health Risk Assessment (included in intake)
- Functional ability and level of safety (included in intake)
- Personalized prevention plan services (use dot phrase .pppsmedicare in patient instructions)