topic Re: Medicare Question in Wellness

Medicare Question

VaBelle35 — Mon, 31 Oct 2016 22:40:12 GMT

My mother is 84. She was telling me that gynecological stuff is no longer covered.

At what age do they cut you off from that? I mean, if you have issues, don't you need to get it checked out?

I'm stunned at this.

She pays for it out of pocket (they are more than financially comfortable). I just find this so odd.

But yet my Uncle gets his toe nails cut and medicare pays for that.

Re: Medicare Question

chrystaltree — Mon, 31 Oct 2016 23:01:32 GMT

What does she mean by "gyn stuff" ?

Re: Medicare Question

Deblife — Mon, 31 Oct 2016 23:02:10 GMT

I believe your mother is wrong. I am on medicare and I'm 67 almost 68. Medicare plus my subliment pays for any gyno visit. We still have issues in old age.

Re: Medicare Question

Winkk — Mon, 31 Oct 2016 23:08:52 GMT

I don't see why they wouldn't. Just because a woman gets old doesn't mean she can't have gyn issues. I'm 72 and my visits are covered.

Re: Medicare Question

jannabelle1 — Mon, 31 Oct 2016 23:11:37 GMT

I believe that Medicare covers a Pap smear and pelvic exams every 24 months, unless she is a high risk for cervical cancer. You can go to their website to verify that.

Re: Medicare Question

151949 — Mon, 31 Oct 2016 23:19:44 GMT

@Jannabelle wrote:
I believe that Medicare covers a Pap smear and pelvic exams every 24 months, unless she is a high risk for cervical cancer. You can go to their website to verify that.

I believe this is correct - my advantage plan only covers a PAP every 2 years instead of one year.Since I've had a complete hysterectomy I don't get them at all anymore but for those who do - it is every 2 years.

As for the Uncle getting his toenails cut - wounds on the feet can be extremely serious for anyone with compromised circulation to the feet, that is WHY medicare covers this for those patients.So they don't end up with amputations.

Re: Medicare Question

Mmsfoxxie — Mon, 31 Oct 2016 23:34:35 GMT

If your Pap smear is unclear, your doctor will have you come in 6 months. Being new to Medicare, I waited 7 months but my doctor said he put a code in that they would pay for. Normal paps are every 2 years.

My mother was not getting paps under Medicare after 75. They don't care about you after that.

ETA: Checking with Google, it says abnormal paps are every year. Maybe mine was allowed because it was the first one under Medicare.

Re: Medicare Question

Eliana — Mon, 31 Oct 2016 23:32:41 GMT

Medicare will pay for a pap once every 24 months. Make sure you wait the full 24 months.

Re: Medicare Question

KarenQVC — Mon, 31 Oct 2016 23:47:26 GMT

My former OB-GYN stopped taking Medicare because it didn't pay enuf. That COULD be the issue.

Re: Medicare Question

colliegirls — Mon, 31 Oct 2016 23:57:50 GMT

I better be covered when I am old and want my hoo hoo vacuumed out!

Re: Medicare Question

VaBelle35 — Tue, 01 Nov 2016 00:14:34 GMT

Thank you all. She had an abnormal pap and an undetermined mass at her check up and the follow up tests and procedures (vaginal ultrasound and susequent D&C and labs) were not covered. She and her husband are on top of their coverage and care (my mother did medical billing before she retired), so I think if it should be covered, she would push for it with either the doctor or the insurance company. My mother is not shy ;o)

She is fine, though. It was not cancer, so she is happy to pay the bills. I just find this so odd that they don't cover it. She has excellent secondary coverage from retired federal government/pension, so she rarely has to pay for anything.

Re: Medicare Question

Gram W — Tue, 01 Nov 2016 00:29:52 GMT

I am 72. I have Medicare Advantage and it pays for my yearly checkup, mammograms and paps. I have had questionable results and they paid for those at 6 months. I have a copay for the regular check ups. They have paid for blood work when needed also. When in doubt ask questions. There are thousands of codes and a wrong code will cause nonpayment. I have family who work in a hospital. She said the pages and pages of forms and codes for every little step are a nightmare. If your order is right but someone down the line changes a digit in the code by mistake it makes a royal mess. My obgyn said the same thing. They had to hire 2 more people just to fill out required papers per govt and insurance regulations. The nurse apologized but she said the new forms require all patients be asked if they are sexually active. I just smiled and asked her what does the govt consider active. She had no idea as there are no guidelines how to handle asking this. It is getting bad when the govt wants to get in your bedroom. So far the info for 2017 is not getting better. I just worry how bad as my meds are expensive. This year I went in the donut hole the end of July. Not good.

Re: Medicare Question

software — Tue, 01 Nov 2016 01:41:43 GMT

Better hope for a Dyson TSV!!

@colliegirls wrote:
I better be covered when I am old and want my hoo hoo vacuumed out!

Re: Medicare Question

chlema — Tue, 01 Nov 2016 01:41:52 GMT

Do you think the guidelines have changed maybe? I know the recommendation now is that after 75 you no longer have to get mammograms. When I told my doctor this he said "Right, they just want you to die". I think they still cover the tests, just say no longer necessary - in their opinion.

Re: Medicare Question

software — Tue, 01 Nov 2016 01:43:11 GMT

If you are not sexually active, you would not benefit from STD testing, for example.

@Gram W wrote:
I am 72. I have Medicare Advantage and it pays for my yearly checkup, mammograms and paps. I have had questionable results and they paid for those at 6 months. I have a copay for the regular check ups. They have paid for blood work when needed also. When in doubt ask questions. There are thousands of codes and a wrong code will cause nonpayment. I have family who work in a hospital. She said the pages and pages of forms and codes for every little step are a nightmare. If your order is right but someone down the line changes a digit in the code by mistake it makes a royal mess. My obgyn said the same thing. They had to hire 2 more people just to fill out required papers per govt and insurance regulations. The nurse apologized but she said the new forms require all patients be asked if they are sexually active. I just smiled and asked her what does the govt consider active. She had no idea as there are no guidelines how to handle asking this. It is getting bad when the govt wants to get in your bedroom. So far the info for 2017 is not getting better. I just worry how bad as my meds are expensive. This year I went in the donut hole the end of July. Not good.

Re: Medicare Question

VaBelle35 — Tue, 01 Nov 2016 01:54:05 GMT

I think that Medicare doesn't cover it and she had to meet her deductible on her supplemental insurance first. They probably haven't met their deductible for this year. They are incredibly healthy and on no meds.

She proabably met her deductible after both procedures. I know my vaginal ultrasounds are a lot of money. But they are covered after deductible.

Re: Medicare Question

Mmsfoxxie — Tue, 01 Nov 2016 03:53:30 GMT

Gals, I'll repeat....they don't cover pap exams after a certain age and that age is around 75. This is what I was told when I asked how come they didn't catch my mother's cervical cancer before stage 4. She was in a nursing home and we didn't we up with that part of her care, unfortunately.

I agree with the other poster. When you get old, they don't consider your life as important for preventative care.

My paps have been abnormal for several years so I have gotten Pap smears every 6 months. Sometimes I've waited 7 months but I now know that when dealing with Medicare, you have to keep on schedule or you have to pay it yourself.

Instead of things getting easier as you age, it gets more difficult. Oh, well.

Re: Medicare Question

VaBelle35 — Tue, 01 Nov 2016 10:39:48 GMT

@Mmsfoxxie Both my father's mother and her sister had cervical cancer. But to be fair, neither ever had well woman exams. My grandmother's first well woman exam was when she was diagnosed. She had both children by a midwife, at home. Her sister never married, never had children, so I guess in her mind she never needed to go. They were of the generation that you only went to the doctor if you were sick and they only had a cardiologist.

Because your gyn history runs follows your paternal grandmother's history, not your mother's history, my gyn has me going for all kinds of extra tests (like pelvic ultrasounds annually) and cancer markers. If I would let her, she would rip my cervix out now.

Re: Medicare Question

Mmsfoxxie — Tue, 01 Nov 2016 11:44:08 GMT

@VaBelle35, thanks for that information about grandmothers. In a way, that makes me feel better about my abnormal smears. I thought it might be a precursor for me getting cervical cancer. My gyne is not clear enough for me. My mother wasn't one to have exams either which is why I guess it didn't occur to the family to see that she got them after she went to the nursing home. She lived with me for ten years and I took her to opthamologist for her glaucoma, audiologist for hearing and psychiatrist for her mental issues which got really difficult after I started working. I never thought to take her for a female exam. My mother was on Medicaid so when I took her to the clinic, they listened to her concerns and dealt with them there except for the specialists I mentioned earlier.

I feel so blessed to have enough resources to do what I need for myself and be of sound mind, especially the sound mind part, lol. I have 3 grown sons and they all live far away. It's just hubby and me to do for each other. And you know what? That's fine because I don't want to take over my kids lives and be disruptive and dependent on them to care for me. There were times when dealing with my mother that I felt so overwhelmed that I cried. No pity party here, just being truthful.

Re: Medicare Question

patbz — Wed, 02 Nov 2016 01:03:50 GMT

I religiously go to Gynocologist every 12 months since my mother had ovarian cancer at 78. I am 72 and my annuals are covered but I think Paps are biennial (Dr. mentioned she wasn't giving me one this as there were no negative indicators and it isn't covered annually). I would have gladly paid out of pocket if necessary.