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Is the Medicare Annual Wellness Visit Mandatory?

Medicare Annual Wellness visit

Is the Medicare Annual Wellness Visit Mandatory?

If you’re on Medicare, you may have heard about the Annual Wellness Visit — but is it something you have to do?

The short answer: No, it’s not mandatory.
However, it is completely covered by Medicare and is a great opportunity to check in on your health and work with your doctor on a personalized prevention plan — at no cost to you.


What Is the Medicare Annual Wellness Visit?

This visit is not the same as a full physical exam you may have had under previous insurance. Instead, it’s a preventive check-in with your primary care provider to review your current health, assess potential risks, and create a customized wellness plan just for you.

You qualify for this visit once every 12 months if you’ve had Medicare Part B for over a year.


What Happens During the Visit?

During your Annual Wellness Visit, your doctor will:

  • Check your height, weight, and blood pressure

  • Review your medical and family history

  • Go over your current medications

  • Ask questions about your ability to manage daily activities

  • Screen for memory issues, depression, or hearing loss

  • Help you identify health risks and set up a plan to stay healthy

Your doctor might also schedule you for other preventive screenings like mammograms, diabetes checks, or vaccinations.


How Is This Different from a Physical?

A physical exam is more in-depth and often includes lab work and a full-body checkup. Medicare does not cover a traditional physical, but it does cover the Annual Wellness Visit at 100% — as long as your provider accepts Medicare.

If, during the wellness visit, your doctor addresses a new issue or ongoing condition, that part may be billed separately as a diagnostic service and could require coinsurance or deductibles.


Medicare Advantage and the Wellness Visit

If you’re enrolled in a Medicare Advantage plan, your visit is still covered at no cost. Some Advantage plans may even offer more thorough physical exams — check your plan details to find out.


Tips for Your Appointment

Before your visit, prepare by:

  • Filling out any forms your doctor sends in advance

  • Bringing a list of medications, including over-the-counter supplements

  • Writing down your top health concerns or questions

  • Bringing a trusted friend or family member if needed

Make sure to ask your doctor’s office to schedule the visit specifically as a “Medicare Annual Wellness Visit” to avoid billing mistakes.


Need Help Navigating Medicare Preventive Services?

Understanding what Medicare covers can feel confusing. That’s where we come in.

Patricia Saint Louis, RN, is a licensed health insurance broker who can walk you through your Medicare benefits, help you schedule preventive care, and make sure you’re not missing out on services that keep you healthy — all at no cost to you.

📍 Visit: 216 N 3rd St, Suite B, Leesburg, FL 34748
📞 Call: 352-260-0202

You don’t have to figure this out alone — let us help you get the care and peace of mind you deserve.

Categories Uncategorized

Does Medicare Cover Weight Loss Drugs?

Senior weight loss medications, will medicare pay?

Did you know that more than 100 million Americans are obese, and more than 22 million Americans are severely obese. Being obese is expensive, as Obese people spend nearly $2,000 more in annual medical costs than people who are considered to be of a healthy weight, and people who are severely obese spend about $3,000 more than people who are deemed to be of a healthy weight. People are obese for many different reasons, whether it be conditions like diabetes, unhealthy eating habits, etc., and one way that we see people curb this issue is with the use of weight loss drugs like Ozempic. 

 

Knowing these facts on obesity, those who are obese or severely obese must understand their insurance coverage due to some of these financial setbacks caused by obesity and the heavy costs of some of these weight loss drugs. A big question that may come up for seniors who are obese or severely obese is whether or not Medicare will cover these weight-loss drugs for them. 

 

The key component in understanding whether or not Medicare will cover these drugs is understanding the different parts of Medicare, alongside which plan you have. Below is a quick summary of the parts of Medicare

 

  • Part A: Medicare Part A, also known as hospital insurance, primarily covers inpatient care. This includes stays in a hospital where you are formally admitted, care in a skilled nursing facility following a qualifying hospital stay, hospice care for individuals with a terminal illness, and some limited home health care services. It is intended to help with services related to serious health events that require a stay in a medical facility or specialized end-of-life care.
  • Part B: Medicare Part B covers outpatient medical services and preventive care. It includes doctor visits, outpatient procedures, lab work, diagnostic tests, imaging services like X-rays or MRIs, and certain types of home health care. Preventive services such as flu shots, annual wellness visits, and screenings for conditions like cancer and diabetes are also included. In addition, Part B provides coverage for mental health services, durable medical equipment (like walkers or wheelchairs), and ambulance transportation when medically necessary.
  • Part C: Medicare Part C, commonly referred to as Medicare Advantage, is an alternative to Original Medicare (Parts A and B). These plans are offered by private insurance companies approved by Medicare. While they are required to provide at least the same coverage as Original Medicare, many Medicare Advantage plans include additional benefits not typically covered, such as prescription drugs, dental, vision, hearing, wellness programs, and gym memberships. These plans often use network-based models like HMOs or PPOs, which means members may need to use providers within the plan’s network.
  • Part D: Medicare Part D provides coverage for prescription drugs. This part of Medicare is also offered through private insurance companies and helps to cover the cost of medications prescribed by a healthcare provider. Each Part D plan has a formulary, or list of covered drugs, which is organized in tiers that determine how much you pay for each medication. Coverage typically includes drugs for common conditions such as high blood pressure, diabetes, and high cholesterol, along with certain vaccines and specialty medications. Plans also include rules like prior authorization or step therapy for specific drugs.

 

Now that we know all the different parts of Medicare, it is important to understand that although weight loss surgery and behavior counseling would fall under Parts A and B, weight loss drugs wouldn’t, however, they could fall under Parts C and D. Knowing all of this is important as well so you can make the right decision when it comes to choosing your Medicare Plan. 

 

The question now is, will Parts C and D cover your weight loss drugs, and the answer is maybe. Medicare covers FDA-approved medications for those with diabetes, heart conditions, or other conditions affecting weight gain. These include Mounjaro, Ozempic, Rybelsus, Victoza, and Trulicity, which are good for those who qualify. Some notable drugs not covered include Saxenda, Wegovy, and Zepbound. Any drug prescribed only for obesity or weight loss is excluded from Medicare coverage under current law. This puts those who aren’t diabetic, as well as weight loss drugs that are classified as cosmetic, in a tough spot. 

 

While for some learning that they won’t be able to use Medicare to cover purchase of weight loss drugs may be a massive letdown, hopefully there can be some comfort taken in some alternatives that may be covered by Medicare, like weight loss surgery, behavioral counseling for obesity, diabetes management programs, and nutrition programs.

 

Another option for those struggling with the costs of weight loss drugs is the many different drug discount programs, like AARP, GoodRx,  and WellRx. Seniors can also look into different drug manufacturer coupons to help them curb costs.

 

Ultimately, if and when you have questions, it is always best to look at your drug plan to see what benefits you have associated with your plan. If you have further questions, it is recommended that you speak to a doctor or a trusted Medicare advisor, such as Patricia Saint Louis, at 352-260-0202

Categories Health insurance

Why Work With a Medicare Broker?

Why work with a Medicare broker?

Why Work With a Medicare Broker?

Choosing a Medicare plan can feel overwhelming. Between Original Medicare, Medicare Advantage, Part D prescription plans, and Medicare Supplements (Medigap), there’s a lot to sort through — and the wrong choice can end up costing you more in the long run.

That’s where working with a licensed Medicare broker comes in. A broker is your personal guide to understanding your options and making confident, informed decisions.

Unbiased Guidance — Focused on You

Unlike agents who only work with one insurance company, Medicare brokers represent multiple carriers. That means they’re not trying to push a specific plan — they’re focused on finding the best fit for your needs and budget.

Whether you’re looking for lower copays, more prescription drug coverage, or access to specific doctors, a broker helps match you with the right plan for your unique situation.

No Cost to You

One of the biggest myths about Medicare brokers is that you have to pay for their services. In reality, working with a broker costs you nothing. Brokers are compensated by insurance companies, not by you — and your premiums are the same whether you enroll directly or through a broker.

That means you get free expert help without any added cost.

Personal Help, Not Call Center Confusion

When you call a big insurance company, you’re often just a number in a queue. But when you work with a local broker like Patricia Saint Louis, RN, you get one-on-one support from someone who takes the time to get to know you.

Patricia combines her professional background as a Registered Nurse with years of experience in health insurance to help clients understand their benefits, avoid costly mistakes, and get the care they deserve.

Support Beyond Enrollment

A good broker doesn’t disappear after you choose a plan. Patricia is here to help you year-round — whether it’s reviewing your coverage annually, solving billing issues, or answering questions as your health needs change.

Medicare Is Complicated — You Don’t Have to Figure It Out Alone

From enrollment windows to plan networks and drug formularies, Medicare is full of fine print. A broker helps you understand the details so you can feel confident in your choices — and avoid common pitfalls like late enrollment penalties or surprise out-of-pocket costs.


📍 Ready to Get Expert Help with Medicare?

If you’re approaching 65, losing employer coverage, or just need a second look at your current plan, Patricia Saint Louis, RN is here to help — right here in your local community.

Visit: 216 N 3rd St, Suite B, Leesburg, FL 34748
Call: 352-260-0202

No pressure. No confusion. Just personalized Medicare guidance you can trust.

Categories Health insurance

2025 Medicare Part D Changes due to the Inflation Reduction Act

Medicare Part D changes in 2025

Big Changes to Medicare Part D in 2025: What You Need to Know

Starting in 2025, the Inflation Reduction Act introduces major changes to Medicare Part D that are designed to make prescription drugs more affordable and easier to manage for beneficiaries. One of the most significant updates is a $2,000 annual cap on out-of-pocket drug costs, which will also eliminate the infamous “donut hole” (coverage gap).

Here’s what’s changing — and how it may affect you:


Key Changes Coming to Medicare Part D in 2025

💵 $2,000 Out-of-Pocket Maximum

Medicare Part D enrollees will not spend more than $2,000 per year on covered prescription medications. This cap includes all deductibles, copayments, and coinsurance.

🚫 Goodbye Donut Hole

The coverage gap — where beneficiaries used to pay a higher share of drug costs after reaching a certain spending limit — will be completely eliminated in 2025.

🔄 New 3-Phase Coverage Structure

The old four-phase model is being simplified. Beginning in 2025, Medicare Part D will have three distinct phases:

  1. Deductible Phase – You pay 100% of drug costs until your deductible is met (standard deductible is $590 in 2025).

  2. Initial Coverage Phase – After meeting your deductible, you and your plan share the cost of covered drugs.

  3. Catastrophic Phase – Once your out-of-pocket costs reach $2,000, you enter this phase, and your drug costs drop significantly.

🏥 Plan Responsibility & Government Support

Plans will now bear more of the cost during the catastrophic phase, with additional support from federal subsidies. This reduces the financial burden on beneficiaries.

💊 Manufacturer Discounts

Drug manufacturers will now be required to offer discounts during the initial coverage phase, helping to lower overall drug prices even further.

📅 Monthly Payment Option (MPPP)

Medicare will introduce the Medicare Prescription Payment Plan (MPPP), allowing enrollees to spread their out-of-pocket drug expenses over monthly payments, offering better budget flexibility.

💉 Vaccine Coverage Still Free

As of early 2023, out-of-pocket costs for ACIP-recommended and travel vaccines have already been eliminated for those with Part D — and that benefit continues into 2025.


How These Changes May Affect You

  • Lower Out-of-Pocket Drug Costs: The $2,000 cap and new discount structure should reduce total yearly spending for many beneficiaries.

  • ⚠️ Possible Premium or Deductible Increases: Some plans may adjust premiums or deductibles in response to the new cost-sharing structure.

  • Simplified Coverage Model: The updated three-phase design makes it easier to understand how your medication costs are calculated and when you’ll hit your yearly cap.


These 2025 updates aim to make Medicare Part D more affordable, predictable, and easier to navigate. If you’re unsure how these changes may impact your specific plan or medications, working with a licensed Medicare broker like Patricia Saint Louis, RN can help you make the most of your coverage.

📍 Visit Patricia at: 216 N 3rd St, Suite B, Leesburg, FL 34748
📞 Call: 352-260-0202

Categories Health insurance

Ten Common Medicare Mistakes to Avoid

 

Navigating Medicare can be overwhelming, especially if you’re unfamiliar with its many rules, deadlines, and plan options. Failing to understand key aspects of Medicare can result in financial penalties, gaps in coverage, or being stuck with a plan that doesn’t fit your needs. Here are ten of the most common Medicare mistakes people make—and how you can avoid them.

  1. Not Enrolling on Time During the Seven-Month Birthday Window-Turning 65

One of the biggest and most costly Medicare mistakes is missing your initial enrollment period. This period spans a total of seven months—three months before the month you turn 65, the month of your 65th birthday, and three months after. Failing to enroll in Medicare Part A and/or Part B during this window can result in significant and permanent late enrollment penalties. These penalties are added to your monthly premiums and remain for the rest of your life, making it essential to sign up on time, even if you don’t need all the benefits right away. You can, however, delay Medicare if you are covered under an Employer’s Health Insurance plan or your spouse’s Employer’s Health Insurance plan as long as the employer has 20 or more employees.

  1. Not Enrolling in Part B After Becoming Unemployed

If you delay enrolling in Medicare Part B because you’re still working and have employer-provided health coverage, that’s fine, as long as the employer has 20 or more employees. However, once your employment (or your spouse’s) ends, you have a limited window to sign up for Part B—specifically, within eight months of losing group health coverage. Missing this special enrollment period can lead to late penalties and a delay in coverage. Even if COBRA is offered, it does not count as creditable coverage for Medicare.

  1. Not Enrolling in a Drug Plan (Part D)

Even if you’re not currently taking prescription medications, enrolling in Medicare Part D is highly recommended. This optional plan provides drug coverage and can prevent substantial out-of-pocket costs in the future. If you delay enrolling in Part D and don’t have other creditable drug coverage, you’ll be penalized with a higher premium when you finally do enroll. The longer you wait, the higher the penalty—so it’s best to enroll when you first become eligible, even if you choose the most basic plan.

  1. Not Enrolling in a Supplement or Advantage Plan

Original Medicare (Parts A and B) covers only about 80% of your medical expenses. That remaining 20% can be a major financial burden, especially if you have ongoing health needs or experience a medical emergency. To fill in these gaps, many people opt for a Medicare Supplement Plan (Medigap) or a Medicare Advantage Plan (Part C). While supplement plans help cover out-of-pocket costs like deductibles and coinsurance, Advantage plans often include additional benefits like dental, vision, hearing, and even gym memberships. Failing to enroll in either can leave you exposed to high medical bills.

What Are the Medicare Deductibles for 2025?

If you’re enrolled in Medicare, it’s important to understand what your out-of-pocket costs may look like in 2025 — starting with your deductibles.

Medicare Part B Deductible (Medical Insurance)

For 2025, the Part B deductible is $257, up from $240 in 2024 — a $17 increase.
This deductible must be met before Medicare begins paying its share for covered services. Once you’ve paid the deductible, Medicare typically covers 80% of approved costs, and you’re responsible for the remaining 20%.
Part B covers services such as:

  • Doctor visits

  • Outpatient care

  • Home health services

  • Durable medical equipment (like walkers, oxygen equipment, and diabetic supplies)

Medicare Part A Deductible (Hospital Insurance)

The Part A deductible in 2025 is $1,676, an increase of $44 from the 2024 amount of $1,632.
This deductible applies when you are admitted to the hospital and is charged per benefit period, not annually. A benefit period begins when you’re admitted and ends once you’ve been out of the hospital or a skilled nursing facility for 60 consecutive days. This means you could pay the Part A deductible more than once in a year if you have multiple hospitalizations.

Your Part A deductible covers the first 60 days of inpatient care in each benefit period. If your hospital stay extends beyond 60 days, coinsurance charges will begin to apply starting on day 61. Days 61-90 are $419 per day, Days 91+ are $838 per day.

  1. Not Being Aware of Your Benefits

Many people don’t take full advantage of the benefits included in their Medicare plans. Whether it’s preventive services, wellness visits, telehealth options, or discounts on health-related services, your plan may offer more than you realize. Carefully reviewing your plan each year—and asking your broker to explain any confusing terms—can help you get the most value from your coverage.

  1. Not Checking Your Insurance’s Drug List (Formulary)

Medicare Part D plans have a formulary—a list of covered medications. These formularies vary by plan and are subject to change annually. If you don’t check that your prescriptions are included in your plan’s current formulary, you could end up paying more or losing coverage for a medication you need. Always review your plan’s drug list during the Annual Enrollment Period (Oct. 15 – Dec. 7) to ensure it still meets your medication needs.

  1. Not Checking What Doctors Are In-Network

Medicare Advantage plans have networks of doctors, hospitals, and healthcare providers. If you fail to confirm that your preferred doctor or hospital is in-network before enrolling, you may face higher costs or be unable to see your provider at all. To avoid surprises, always confirm your providers are in-network before signing up for a plan and check each year to make sure that hasn’t changed.

  1. Doing an Automatic Renewal Without Reviewing Changes

While automatic renewal may sound convenient, it can lead to serious issues if you don’t review your plan annually. Medicare plans can change their costs, coverage, provider networks, and drug formularies every year. By simply letting your plan renew without checking for updates, you might miss out on better coverage or lower premiums. Reviewing your options during the Annual Enrollment Period gives you the chance to make changes that better fit your evolving health needs.

  1. Not Considering Your Individual Needs Compared to Your Spouse

It’s common for couples to assume they should enroll in the same Medicare plan, but this can be a costly mistake. Everyone’s health needs, preferred doctors, medications, and budget differ. One spouse might need extensive prescription coverage, while the other may prioritize access to specific specialists. Medicare Advantage plans are highly individual, and you’ll get better results by choosing a plan based on your own health needs and preferences, not your partner’s.

  1. Not Working with a No Cost, Licensed Medicare Broker

Medicare is complicated, and trying to navigate it alone can lead to costly and avoidable mistakes. That’s why it’s wise to work with a licensed Medicare broker. Brokers help you compare plans, understand your options, and enroll in the plan that’s best suited for you. And the best part? Their services are completely free to you. Patricia Saint Louis, RN is a licensed Medicare broker, providing expert guidance and personalized support. She is licensed in multiple states, including Florida, Georgia, Michigan, North Carolina, Ohio, Pennsylvania, Texas, Tennessee, New Jersey, Virginia, Louisiana, Maryland, and Washington state.

Conclusion

Avoiding these ten Medicare mistakes can save you money, time, and stress. By planning ahead, staying informed, and getting professional help when needed, you’ll set yourself up for long-term healthcare success. Medicare doesn’t have to be overwhelming—with the right guidance, it can be a powerful tool to protect your health and finances.