Are you discussing Medicare’s Health Risk Assessments?

Contact Sales@LeClairGroup.com with your questions or to request an appointment.


The Centers for Medicare and Medicaid Services (CMS) requires a health risk assessment (HRA) to be included in the Annual Wellness Visit. The purpose of the Medicare health assessment is to identify health needs and risk factors so beneficiaries can be directed to appropriate care, ultimately improving outcomes and reducing costs.

The Center for Disease Control and Prevention defined the minimum requirements for the health risk assessment in “Framework for Patient-Centered Health Risk Assessments” to include:

  • Demographic data and personal health history
  • Self-assessment of health status
  • Psychosocial risks, such as stress, depression, and pain
  • Behavioural risks, such as tobacco and alcohol use, nutrition, and physical activity
  • Activities of Daily Living (ADLs), including dressing, bathing, and walking
  • Instrumental ADLs, including shopping, housekeeping, managing own medications, and handling finances

When clients sign up for a Medicare Advantage plan, there will be an HRA in the application. Whether the member said yes or no to any of the questions, they will receive a follow-up call or letter from their insurance company. The purpose of Medicare Advantage, supported by HRAs, is to focus on wellness and prevention. The HRA is to identify health concerns or medical issues that can be prevented or treated earlier.

Some carriers even send a gift after the member has completed their HRA. During sign up or annual review, remember to remind your clients to expect this call. With robocalls and scammers an abundant issue in today’s world, many members–who were not expecting their HRA call–did not recognise the opportunity for a gift and to improve their overall health.

What agents should be telling their clients:

  • Medicare Advantage focuses on wellness and prevention
  • The HRA is an important part of maintaining good health
  • HRAs are mandated by the Centers for Medicare Services (CMS)
  • They will receive a letter or phone call asking them to complete the assessment
  • The call or assessment will take around 20 minutes

Remind your clients to always be aware of scam calls from people trying to take advantage of requirements such as this to obtain information from them. Tell clients that the best way they can protect themselves if they find themselves in a suspicious conversation is to ask rather than answer questions when they receive a call. Any genuine company representative will already have their information, so they should ask the caller if they have on file their date of birth, address, and type of coverage. It is important that your clients do not provide these details first, as doing so could compromise their private information.