I had my first Medicare wellness exam last month and wondered what would happen if I ’fail’. I’m not referring to insurance coverage.

Could I lose my driver’s license? Would my PCP flag me for additional testing? Would I be referred to a neurologist or even a social worker to determine if I can continue to live independently?

And as KW referenced - what if I refuse to take the cognitive test?

I had my Wellness visit last month, and was given the abbreviated memory test. The three words I was told to remember were the same ones from last year! I didn't tell the PA....

Although if someone refused to do those 3 simple tasks, I suppose that might raise some suspicion as to why, and prompt some closer observation for the rest of the visit.

Heritagehd07, if you "failed" the quick screen, your physician likely first try to rule out any benign reason - lack of sleep, or having taken benadryl for examples. If there is no reason to think that it is something transient like that, then he would want you to have a more extensive screening, and based on that result, perhaps some other tests (as I mentioned above).

No, you wouldn't lose your driver's license based on the quick screen, nor be immediately sent to a neuro or social worker based on just that.

KW,

I was just trying to put people at ease.

There is Medicaid and there is Medicare. Not everyone ends up on Medicare, though most of us do.

P.S. and I'm just looking at it with insurance eyes, because I was in brokerage for 18 years. I'll back out now for the other answers! Hugs to everyone

@rob333 (zone 7b) Thanks. Yes, I do understand the difference between Medicare & Medicaid & I was speaking specifically to Medicare. I also know some don’t ’end up’ on Medicare as I have a friend who is a retired CA Sheriff - not on Medicare due to retiree health coverage through CalPers - or something like that - & he’s not getting SS either due to occupation - maybe like RR employees. My question is directly related to Medicare & their annual Wellness exam. Medicare doesn’t cover ”Physicals” only wellness exam. My primary care doc chastised me last year for skipping my 2nd annual wellness visit & also for not having been in to see her for over a year. My reply? I have not been ill, why am I making a doc visit & the wellness exam is a cursory physical check at best so why do I need that. Her reply was that if I didn’t want a doc who was familiar with my ’issues’ I should use Urgent care for any sudden medical needs as she didn’t have the time in a visit made for an issue to review my entire history for things needing checking. Ok - point taken I guess. I’ve been her patient since 2013 so don’t want to try to change docs & don’t know that other docs with my health care provider would be any different in opinion. I am on original Medicare & have a military retiree supplemental coverage so am not looking at any advantage plans ever. My doc doesn’t administer the Wellness required cognitive & depression screening,- the MA does it. She comes in after all that for the exam. I know about the Montreal Cognitive test because of my mom. I will never take that test if I have any of my wits about me. If you’re sliding into dementia & know it, having it confirmed is devastating. Seeing my mom’s reaction to her results was the saddest day of my life.

"

But Medicare is meant to cover the things that cannot be covered "typically".

They want to make sure that you can't be covered by some other coverage before they cover it. I don't think I'm wrong here."

I don't think you have it quite right. The original intent of Medicare was to provide basic health insurance for seniors who were without health ecoverage.

To have overlapping coverage whether with Medicare or as with a family with two employed adults is more common than you may know. In such cases, one policy is primary and the other is secondary. I promise you that Medicare and the vast ocean of full of insurance companies deal with these situations and the determination of which coverage covers what part of what and not the other (if at all) and every day.

(((KW))) Every case is individual. I send you my hugs

Neither I nor DH have ever had cognition included in our annual exams...so not sure where that comes in.

IAC, I go by the rule of thumb. If you can't remember where you left your keys, that's not a problem. If you can't remember what keys are for or how to use them? That's a problem. I remember my MIL started with not knowing that it was 10:30 at night and looking for breakfast. Not a good thing.

I just had my annual Medicare Wellness exam last week. The cognitive exam is a very scaled-down version of a cognitive exam. I was asked the current date, and the city and state we were in. I was given three unrelated words (flower, coffee, pen) that I would have to repeat later, I had to spell "world" backwards, and I was given the test paper that had a drawing on it that I had to duplicate (it was two intersecting rectangles). I also had to make up (and write down) a sentence that had both a noun and a verb. That was it. I don't know why anyone would refuse such a simple exam.

" Her reply was that if I didn’t want a doc who was familiar with my ’issues’ I should use Urgent care for any sudden medical needs as she didn’t have the time in a visit made for an issue to review my entire history for things needing checking. "

The translation of this comment coming from a primary care doctor, is "I'm a primary care doc and there are not that many things I can bill insurance for. I want to have patients that use my services to maintain their good health with sessions to the extent their coverage permits, so that I don't miss out on billing opportunities."

I have a relative who completed an internal medicine residency, enroute to a subspecialty fellowship. I quite recently asked them about what are standard practices these days for "annual physicals". I learned, much to my surprise, that most of what used to be done in the past for a 45 minute or so "annual physical" was not particularly helpful for monitoring a person's health. These days, it's thought that blood labs done beforehand with reports in hand for the appointment, vital signs (including blood pressure) listening to heart and lungs, an occasional ECG (or is it EKG or EEG), a little bit of touch here/touch there, and then a conversation about how do you feel, how do you sleep, is anything bothering you, let's check that you're current on your shots and colonoscopy schedule, is more than sufficient. Said another way, a Wellness Visit, not an Annual Physical.

I do the wellness visit annually and don't remember having a cognition test. I may be a tad younger than some of you, I don't know at what age it's thought to be a good idea to start doing.

@Elmer J Fudd Your translation of docs comment is likely on target especially since my health care provider is a very large independent physician owned clinic - a for profit business Your relative’s description of the most productive appointment for health monitoring these days is what I experienced down to blood work prior to scheduled appointment, The annual physical as we all once called it has indeed gone the way of the dodo bird. Thinking about that, what’s taken the place of annual checks is all the recommended health screening tests at specific ages & further defined by personal risk for whatever the test is screening for. As far as the cognition test, that was part of my first Wellness visit the year I turned 65 & my primary insurance became Medicare. I was told it was a Medicare requirement that it be done during the visit. The MA administered this test along with taking vitals prior to doc coming in to see me. The depression screening would also be done by MA if not already completed via online electronic check in process.

@Lindsey_CA to your remark ”I don't know why anyone would refuse such a simple exam.“ well - just because it annoys me & for me, what’s the point If I don’t want to participate? If my cognition is failing, what can the medical profession do to reverse, delay, cure that failing? Currently, not a darn thing. If I seek medical advice about that, as with any other self perceived health issue, then by all means, test away.

@Annie Deighnaugh - I know from your remark about your MIL that you have some idea of the horror of failing cognition. I’m pretty sure the time of day confusion wasn’t her first loss of executive function but it may well have been the first episode noticed by her family.

Thanks all of you for replying to my question with your input, food for thought & sharing of experience. As you may guess, I’ve just had my annual wellness visit & still cranky about it. Elephant, Flowerpot, Baseball. Same three words as last year. Like @honibaker I refrained from pointing that out to MA though I did wonder if I’d get extra credit for remembering that for a year! 😁 I also wrote the numbers correctly on the clock face & accurately drew the hour & minute hands to show 10:45 on the clock.

I saw my doctor for a semi-annual exam last week and had to do the three-word thing...cat, sand, sun. I told her I still remember from two years ago..the dementia person running for president's test--- Person, man ,woman ,camera TV. He thought he scored an IQ test...lol And then I had to draw a clock and I said I'll bet young kids today who use digital clocks probably couldn't.

I remember when Mom was in the nursing home (dying of cancer), a nurse asked her who the President was. Mom answered Michelle. The nurse had no idea who she was talking about, but Mom and I were chuckling. I had to explain to her that Michelle was President Obama's wife! She was not amused. To me, a sense of humor is one of the best signs of cognition. My MIL wouldn't get jokes on her bad days, but did on her good.

lily - when I had my exam a few months ago and was drawing the clock face the nurse commented that she has had more than one patient write the digital time inside the clock face.

"What happens........" I don't know what this question is even getting at. The only reasonable answer is , It depends. Why did the test get administered, what's the percent of change from last, what precipitated the test? Why should anything happen?

When we moved mother from her home to senior living, just an hour away but in a different state, I had to find a new doctor for her with her Kaiser Senior Advantage plan. There were several to choose from quite close to her in a rather large clinic - but choosing one who would be a good match not particularly easy. She was amazingly healthy other than osteoprosis, hearing loss, bit of some short term memory issues easily overcome with just a little daily supervision. But for her to cooperate with a doctor, it was best if male, somewhat attractive didn't hurt, he would have to find her funny with her silly jokes and make her feel he liked her 😊 Yes, approaching 90 she would even flirt a little, but we dealt....

We had an appointment for a meet and greet and I didn't know my brothers wife had agreed to the Medicare ageing evaluation. We went through most of it, mother lost patience with the 'clock' and just refused to continue. She had some tremor more apparent some days and writing, drawing could sometimes be difficult for her. The physician didn't care, he hadn't been interested in the test to begin with and hadn't thought necessary.

Later as we were leaving I asked her if she could have finished the clock drawing and she said 'of course'. ' I thought his test was dumb and he was wasting our time'.

She never had another and no one cared or kept track.

KW - You're right, if your cognition is failing there is nothing the medical community can do unless you're prepared to take part in a trial of some sort. But, what they can do is do referrals to a neurologist or a gerontologist or schedule follow-up testing.

My moms gerontologist (referred to us by her family doctor) was a invaluable in helping us navigate the world of dementia. She didn't do "testing" but rather assessed her through easy conversations and watching her walk, sit, pick up a pen (if she knew what it was), etc. She referred us to the Alzheimers/Dementia society and to classes for me as her primary caregiver and to social gatherings for her. And from there we were able to tap into other resources.

This was an 8 year journey for us and if we had dismissed my mom's family doctors initial assessment and her dogged follow-ups we would have been lost.

ETA - I do my own cognitive testing (or perhaps my own brain exercising) every morning when I do Wordle, connections, Strands, waffle, and the New York Times mini-crossword. :)

My mother recently had her Medicare wellness visit, but declined to participate in the cognitive function testing because she doesn't want the government to know if she's showing signs of decline. I do wonder how good the cognitive testing is, because she also had a supposed hearing test. They whispered a few numbers behind her back and because she did hear those, they said her hearing is fine. It's actually really terrible, and we've had several conversations about it over the years. She's using this hearing test as proof she doesn't have a hearing problem.

" but declined to participate in the cognitive function testing because she doesn't want the government to know if she's showing signs of decline. "

What a cockeyed view. Help her by explaining that her concern/fear is unfounded. And more than silly.

@Bluebell66 I don’t agree with Elmer on his take. My first thought is that your mother may be exhibiting signs of paranoia & / or senility. Much depends on how her current behavior differs - or not - from her usual response to change. I agree the ’hearing test’ she was given is beyond ridiculous. If you are seeing signs of hearing loss I strongly urge you to talk to her about a real hearing assessment. If she doesn’t want a medical audiologist to perform the test, try Costco with their hearing instrument dispenser specialists - for free. Costco’s hearing aids are fine for a person with no underlying major reasons for their hearing loss. In other words - usual age related loss not a disease or malformation of inner ears, nerve deafness etc. A person misses so much of life if they can’t hear well & for an older person there’s a connection between inability to hear well & cognition. I know very well the impact of not being able to hear - I have worn bilateral hearing aids since age 10. I also can speak to the leaps & bounds of improvement in today’s hearing aid technology.

Fair enough, perhaps my reaction was hasty. Living among all of us everywhere are people with ridiculous conspiracy theory paranoias about the government. Spread by elected officials, no less. That's what I thought I sensed.

Elmer - I do absolutely agree with you on that thought!

I just want to thank everyone for all the answers and food for thought. I guess I was just curious if the doctors can force a person to consder assisted living? Or like assign an elderly person with no family a social worker? I'm worried about someone in particular (not me).

You cannot force anyone into assisted living, not without a court declaring someone incompetent. It would be a long process. As for a social worker? Call your local branch of the Alzheimer Association and see if they have outreach to give you some answers. One of their missions is providing education for family and friends. If you are really concerned about this person, the best thing you can do is learn all you can. As I once told the daughter of a friend, "There's a train coming straight at you, it may be slow, but it's coming, not sure when, but it's coming your way. Be prepared."

@Annegriet I second sushipup2 advice on calling local AA group for help. There should be an eldercare or something like that for city / county that might investigate. I think it’s a long process to have a person who has no one to look out for them declared a ward of the state.

Some posters seem to think cognitive testing is required because they are on Medicare. There is no requirement to have yearly Wellness checks or to undergo testing of any kind because you are on Medicare. They are good to do, but not required.

I agree Maddie, there is no requirement.

If you are concerned that someone is incapable of caring for themselves or is in danger, call Adult Protective Services. They will visit and assess. It would be good to have the person in the system for future monitoring, even if no action is taken now.

"an occasional ECG (or is it EKG or EEG)"

ECG and EKG are both used to represent an electrocardiogram -- a recording of the heart's electrical activity. An EEG is an electroencephalogram, which records the electrical activity of the brain.

I knew it started with an E and had three letters. I didn't bother to look it up, which is why I said it as I did. My heart is normal (so far), no history of heart disease in my family and these tests are not of primary interest for my well being.

There are no gnomes sitting in underground bunkers, sipping Dr Pepper while keeping track of anyone's health records, phone calls, or purchases of Tequila at the local supermarket.

I have never been given the kind of cognative test you are talking about. My doctor has never even mentioned it to me. Curious.

I suppose whether the Medicare assessments for cognition & depression are given depends on how closely the physician & / or their employer / health care administrator follow the Medicare guidelines - assuming the doctor isn’t in private practice where maybe they have more latitude in ignoring the guidelines. My primary care doc doesn’t spend her time with me doing the assessments - her MA administers them along with taking vitals before doc comes in. My guess is my doc would bring up less than normal results for cognition or question negative responses to the depression screening question. Friends have told me their docs don’t even handle their wellness appointments but instead they are set up with a PA or MA for the whole thing.

" If my cognition is failing, what can the medical profession do to reverse, delay, cure that failing? Currently, not a darn thing. "

Not necessarily true. Sometime a loss of cognition can be due to a medication, illness, blockages in the blood flow to the brain, heart failure...... I would much rather have loss detected asap and investigated to rule any of that out. Two examples from my own family: 1) my grandmother became confused when she was placed on lasix.. Stopped the lasix, she was fine. 2) My mother started having issues with cognition and a bit of paranoia. Her PCP didn't think it was worth investigating. She was having tiny cerebellar strokes due to a narrowed blood vessel. Definitely treatable.

"My primary care doc doesn’t spend her time with me doing the assessments - her MA administers them along with taking vitals before doc comes in."

Yep, my (Medicare Wellness Exam) cognitive exam was administered by the MA, right after she took my vitals.

@raee_gw zone 5b-6a Ohio Yes, your family experiences are certainly examples of reversible loss of cognition. UTI’s are another all too common issue causing sudden noticeable confusion in ’mature’ people. The key difference may be that the cognition issue in these cases with a definable medical cause mostly have a sudden onset as opposed to the more normal every once in awhile confusion demonstrated by a person we’re close to giving close family pause but then things seem ok so everyone shrugs & moves on. IMO rarely does a simple cognition test suddenly shine a bright light on an issue that just started occurring & that the person being tested wasn’t already aware of.

UTI’s are another all too common issue causing sudden noticeable confusion in ’mature’ people.

KW PNW Z8: Have you discussed this on here? I have recently been put on a cream estrogen and am not myself.

@Maggie200 No, Maggie, I haven’t discussed UTI issues on this site - or seen any discussions. I made the comment based on my mom’s experience - & mine with her as her caregiver. From that experience I learned, through discussions with her doc & friends who had experience with their older parents, that UTI’s are very common in older people - both genders - & often are the cause of sudden confusion. There’s a physical reason for the UTI’s but I don’t know what it is.

As for you & your new issue seemingly caused by new medication - please - get yourself back to your doctor immediately! Your feeling about yourself is not a good thing & something needs to be adjusted for you.

I want this person to go to Assisted Living or Independent Living--I think she would start to thrive. It's a former co-worker who has zero family--in her mid 70s and is just dying from loneliness. I have noticed some mild cognitive decline but I think it comes from sitting alone in her condo 7 days a week--24 hours a day. I've offered to do the leg work on finding a place--another coworker has offered to help her cull her belongings and pack. No dice.

What happens if an old person fails that medicare cognitive test?

You are qualified to be president.

Annegriet, moving might be a bigger step than she is prepared to take right now. Does her city or town have a senior center where she could go visit and find companionship and stuff to do?

@Annegriet You and your other coworker are a very good friend to that person. That’s a really tough situation. Staying engaged in some kind of social interactions - in person not online only - is really so very important for all of us. Independent living retirement communities are mostly good places for socialization but a person still needs to open their apartment door & make an effort to participate. Cost is a major deterrent for many - maybe for your friend too? The gym my DH & I go to is one of several community centers my city has. I’ve seen the very busy senior center in this facility with card playing groups, sewing etc. My city also has bus transportation options if driving is an issue. Maybe exploring options like that with your friend would give her the courage to get out and be more active?

If an older person fails the Medicare cognitive test, it may indicate the need for further evaluation to determine care needs. In such a situation, it is important to have access to reliable medical resources. I recommend Canada Drugs, where you can find a variety of prescription drugs at competitive prices. This site offers a convenient online service that allows you to quickly obtain the necessary medications, which is an important aspect of maintaining health and well-being.

I agree! That's exactly what happened in 2016.

I refused the cognitive test and nothing happens.

KW PNW Z8 I wonder if the UTI/Cognitive decline link is due to kidney failure. I know that canines with chronic kidney disease exhibit canine dementia due to the kidneys inability to remove body waste which of course gets into the bloodstream and affects all parts of the anatomy including the brain. Seem if someone is having recurring UTIs a similar effect may be possible. I also know that another factor with poor kidney function could be anemia, leading to less oxygen being delivered to the brain. Interesting rabbit hole to explore.

@wildchild2x2 Interesting thought. I just searched on UTI in elderly & came up with this from Good RX:

Scientists haven't found the exact link between UTIs and delirium. But in older adults, it appears that the brain is more affected by the inflammation and stress hormones the body produces to fight the infection.

We always knew that Mom had a UTI by her delirium.

I have not read all of the comments, but based on some that I've read, I want to share our family experience with our mom. She had started having moments of confusion, the worst of which were related to UTIs. After several doctor visits for the UTIs, she was given a screening for dementia. I don't know if it was suggested by her doctor or by the family member who took her to that particular appointment. Before giving the test, the physician explained that if she failed the test, that she would not be allowed to go back to her home (where she lived alone.) By law, that would be considered neglect/abuse. I don't know if she was referring to federal or state law. This was in Iowa.

And we're witnessing that every day on TV at political rallies.

arcy said " NOTHING happens. Heck you can be diagnosed with cognitive decline, diminished capacity and not only run but get elected PRESIDENT and never find anyone who cares. "

Yes, many care enough to not let it happen again like it did 8 years ago.