Reply
Honored Contributor
Posts: 34,491
Registered: ‎06-11-2011

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.

 

 

 

Esteemed Contributor
Posts: 7,373
Registered: ‎03-09-2010

Re: Medicare Open Enrollment

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

Super Contributor
Posts: 413
Registered: ‎02-25-2020

Re: Medicare Open Enrollment


@CelticCrafter wrote:

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


Please explain.

Man plans. God laughs.
Esteemed Contributor
Posts: 7,373
Registered: ‎03-09-2010

Re: Medicare Open Enrollment


@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.

Honored Contributor
Posts: 34,491
Registered: ‎06-11-2011

Re: Medicare Open Enrollment

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

Esteemed Contributor
Posts: 5,430
Registered: ‎03-09-2010

Re: Medicare Open Enrollment

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. 

* A woman is like a tea bag. You can't tell how strong she is until you put her in hot water. *
- Eleanor Roosevelt
Esteemed Contributor
Posts: 6,271
Registered: ‎03-15-2010

Re: Medicare Open Enrollment

[ Edited ]

@Pearley 

 

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.

Honored Contributor
Posts: 34,491
Registered: ‎06-11-2011

Re: Medicare Open Enrollment


@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.

Esteemed Contributor
Posts: 7,373
Registered: ‎03-09-2010

Re: Medicare Open Enrollment

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? 

Honored Contributor
Posts: 34,491
Registered: ‎06-11-2011

Re: Medicare Open Enrollment


@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.