topic Re: Medicare Open Enrollment in Community Chat

Medicare Open Enrollment

Pearlee — Fri, 27 Nov 2020 13:50:01 GMT

This is almost as bad as election season being bombarded with annoying telephone calls this time from insurance companies trying to sign me up for their coverage (thank goodness for spam blocker on my phone!) and all the TV commercials (I haven't seen Joe Namath on TV this much since he played foorball).

For the first time since I went on Medicare a few years ago I read the federal government's Medicare Handbook (for 2021 now) with a fine tooth comb from cover to cover. I was shocked to read this on page

51 under "What's Not Covered By Parts A and B" ----

Routine physical exams.

How can that be? I've had an annual physical every year I've been in Medicare and it has been covered! So I got up really early today to call both Medicare and my Medigap insurance to ask about it.

Aha! Routine physical exams are not covered but a wellness exam is! A rose by any other name...

So I should have just slept in and not worried about it!

For open enrollment you really do need a crystal ball or 20/20 hindsight to know what drugs and other medical care you'll need in the upcoming year. All you can do is make your best guesses and hope for the best.

Re: Medicare Open Enrollment

CelticCrafter — Fri, 27 Nov 2020 14:05:23 GMT

A Wellness Exam and a Physical Exam are not the same thing.

Re: Medicare Open Enrollment

caroln242 — Fri, 27 Nov 2020 14:07:11 GMT

@CelticCrafter wrote:
A Wellness Exam and a Physical Exam are not the same thing.

Please explain.

Re: Medicare Open Enrollment

CelticCrafter — Fri, 27 Nov 2020 14:26:12 GMT

@caroln242 wrote:
@CelticCrafter wrote:
A Wellness Exam and a Physical Exam are not the same thing.
Please explain.

Google Medicare Wellness Visit vs. Physical Exam.

Re: Medicare Open Enrollment

Pearlee — Fri, 27 Nov 2020 14:29:43 GMT

Well my physicals must have been coded for billing purposes as wellness exams since Medicare paid for them.

Re: Medicare Open Enrollment

tototwo — Fri, 27 Nov 2020 14:50:39 GMT

Insurance companies pay by a billing code. The billing departments of any doctor's office know what codes to use to get payment. Your doctor might give you a physical exam, but the billing dept will use whatever "physical" or "wellness" code will get payment. It's not fraud.

Re: Medicare Open Enrollment

Witchy Woman — Fri, 27 Nov 2020 15:03:32 GMT

@Pearlee

You are a better person than me! I've never undertaken a deep dive into that info book. Just don't have it in me.

As a former Federal employee, I kept my plan under the Federal Employees Health Benefits Program. They finally have Self and One and I have the Standard Option. It has covered most everything.

Each year, I think about changing, but cannot muster the strength to do so. DH asked me about it and I told him if he was interested in anything other than what we have, he can research it. I wasn't going to do so since I was not going to opt out of FEHBP....ever.

I showed him what I paid and gave him the highlights of our coverage.

Needless to say, our coverage will remain as is.

The first year I was under Medicare, I did look into other plans, but discovered that my current supplemental plan is as good as better than most offered.

After that, I tried not to worry about it.

Re: Medicare Open Enrollment

Pearlee — Fri, 27 Nov 2020 15:12:22 GMT

@tototwo wrote:
Insurance companies pay by a billing code. The billing departments of any doctor's office know what codes to use to get payment. Your doctor might give you a physical exam, but the billing dept will use whatever "physical" or "wellness" code will get payment. It's not fraud.

@tototwo Yes. Exactly. That is what I meant too in my post above yours about coding my annual physical.

Re: Medicare Open Enrollment

CelticCrafter — Fri, 27 Nov 2020 15:44:22 GMT

It doesn't matter what the billing department chooses to code it as, the fact remains that they are two different things. If they weren't two different things they wouldn't have two different names or two different codes would they?

Re: Medicare Open Enrollment

Pearlee — Fri, 27 Nov 2020 16:14:34 GMT

@CelticCrafter wrote:
It doesn't matter what the billing department chooses to code it as, the fact remains that they are two different things. If they weren't two different things they wouldn't have two different names or two different codes would they?

@CelticCrafter I think we have each made our points. I'm done with

Going round and round about wellness vs annual physical. I read about each in the Medicare booklet before I even posted this thread.

Re: Medicare Open Enrollmentt

Carmie — Fri, 27 Nov 2020 17:57:46 GMT

First, those annoying calls from insurance brokers are illegal. They are allowed to send info by mail and only call you if you send a card back asking for more info or call them first.

Second, physicals are not covered by Medicare ( though some Advantage Plans could cover them).

Wellness exams do not cover much..mostly the doctor asks questions, but if you have a preexisting condition like diabetes, high blood pressure or a history or headaches, the doctor can order tests and use the preX diagnosis on the claim to get it to process for payment and often they will code the claim as a follow-up visit to check Meds, etc.

Re: Medicare Open Enrollmentt

Pearlee — Fri, 27 Nov 2020 18:46:02 GMT

@Carmie wrote:
First, those annoying calls from insurance brokers are illegal. They are allowed to send info by mail and only call you if you send a card back asking for more info or call them first.

Second, physicals are not covered by Medicare ( though some Advantage Plans could cover them).

Wellness exams do not cover much..mostly the doctor asks questions, but if you have a preexisting condition like diabetes, high blood pressure or a history or headaches, the doctor can order tests and use the preX diagnosis on the claim to get it to process for payment and often they will code the claim as a follow-up visit to check Meds, etc.

@Carmie Yes in my OP I wrote Medicare does not cover a physical exam. And I wrote I have Medigap (not an Advantage plan) yet Ove had a physical every year that has been covered. Hence the 3explanation for it is the one I've given above.

ETA Some Medigap programs offer "extras" in coverage but mine from Anthem whom I called this a.m does not so my Medigap wasn't what covered it).

Re: Medicare Open Enrollmentt

patbz — Fri, 27 Nov 2020 19:39:13 GMT

As a Federal retiree, obviously I kept my BCBS as supplemental. Its extraordinary; DH has had many health challenges (cardiac and spinal) and we've never paid anything (other than low prescription co pay ). Couldn't be happier!

Re: Medicare Open Enrollment

Cats3000 — Fri, 27 Nov 2020 20:01:34 GMT

@Pearlee The last "physical exam" I had was a pre-op exam for Cataract Surgery. Prior to that, I can't remember the last one I had. Medicare does cover a "Wellness Exam"; haven't had one of those either in ages. My doctors treat me for symptoms as needed.

Re: Medicare Open Enrollment

Carmie — Fri, 27 Nov 2020 20:03:45 GMT

@Pearlee You might think you are having a physical exam every year, but your doctor is not billing for a physical exam.

My bet would be a follow up exam for a condition you have and a med check. Some people do this once a year, for others it is every 3,4 or 6 months depending on their health history.

Re: Medicare Open Enrollment

Pearlee — Fri, 27 Nov 2020 20:50:20 GMT

@Carmie wrote:
@Pearlee You might think you are having a physical exam every year, but your doctor is not billing for a physical exam.

My bet would be a follow up exam for a condition you have and a med check. Some people do this once a year, for others it is every 3,4 or 6 months depending on their health history.

@Carmie Exactly. you are saying in a different way what I stated earlier about the coding.

Re: Medicare Open Enrollment

SeaMaiden — Fri, 27 Nov 2020 21:19:05 GMT

My husband and I have a secondary insurance with Premera Blue Cross. We pay $850 a month for the two of us for that coverage With that we have yearly physicals....blood tests.. etc..... no silly wellness physical BS...

Medicare is our primary....but Blue cross kicks in and covers everything Medicare does not.

I would not depend on Medicare.

Re: Medicare Open Enrollmentt

curled up in bed — Sat, 28 Nov 2020 01:33:32 GMT

I have had United health care supplement (medigap plan C) for over 10 years. For 180.00 a month in addition to Medicare cost, I wouldn't think of changing plans either. No bothering with networks, CO pays Co insurance, deductibles. Out of pocket anything. Even though I'm disabled, I only go for Dr visits once or twice a month, the 180.00 more than pays for itself within one visit, for the year. I've had this discussion with my parents so often, since they are older and go to drs multiple times a week between them. They spend a fortune with all these co-pays etc, I get nervous if one of them had to go in the hospital, what would cost me nothing, would cost them so much. I know they think they're saving money not paying a monthly bill, but in reality they would pay much more with an advantage plan, in the end. I have never paid a cent in 10+ years, have had multiple surgeries, been hospitalized many many times, except my monthly payment, which I build into my budget. I don't like surprises that could put me in debt for years. I'm with you, I'm very happy with my plan!

Re: Medicare Open Enrollmentt

Pearlee — Sat, 28 Nov 2020 13:10:32 GMT

@curled up in bed. I agree with you. I have the most coverage possible(and most expensive) with Anthem's Medigap Plan F which isn't even offered any more to those going on Medicare after Jan 1 of 2020. It even pays my Part B deductible for me every year. I'm healthy so I knew I wouldn't be breaking even on it for a while (which I haven't on medical costs each year) but don't care. I want the best possible insurance that allows me to go to any doctor or hospital anywhere that takes medicare and I don't pay anything.

Re: Medicare Open Enrollment

Lindsays Grandma — Sat, 28 Nov 2020 06:33:24 GMT

I started checking different companies very early this year, way before we really had to. And then it hit me, I stopped looking, stopped checking because it got to be too much. I have my Aetna supplement which I am keeping and yes, it has gone up to $305 a month. I am also keeping my BCBS Prescription plan and that's it. I hate that they do this to us every year.