Wellness

[NickNack]

Thanks everyone.  I'll call my doctor's office tomorrow and speak with someone in the insurance department.

[HerRoyaLioness]

An annual physical exam IS NOT FREE - a wellness exam IS covered, but they are two very different things in Medicare.  (Usually Medicare HMO's will cover an annual physical)

Blood work will depend on why you are getting it done and if your Medicare will cover it for that reason.

Codes cannot be changed because you are on Medicare or to get the charge paid. There are times we do use different codes than for commercial insurances because of Medicare requirements, but what was done and why is what has to be coded, per dr dictation.

Also, please don't think that your drs office can know every benefit of the hundreds of insurances out there.  It's impossible.  

Be sure to Tell them you are on Medicare, there will be certain basics things they can let you know.  But it is up to you to know your benefits, but even Medicare reps get confused and give wrong information.  Add to that they change things all the time. 

 If something is not a covered benefit under Medicare a Medicare supplemental ins will not cover it either, so be careful there too.

You really have to be your own advocate with Medicare these days.

[151949]

I have a medicare advantage plan and all my bloodwork so far has always been covered minus the $5 co pay.

[151949]

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@Kachina624 wrote:

I have a Medicare Advantage plan + supplemental and never pay a cent for anything.   I see my doctor every 3 months and always have blood tests done. 

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It is not possible to have both a medicare advantage plan AND a medicare supplement at the same time. You have one or the other.

[Yardlie]

@NickNack ... If you have a Medicare Advantage Plan, I'm sure your lab work will be covered. Possibly, your plan has a co-pay. Mine doesn't for lab work. Good luck!

[Havarti]

The first year wellness exam (covers more) is different from all the annual exams that follow, you only get one in a lifetime so take advantage of it. It covers a little more.

You never want to refer to the annual exam as a “physical” because physicals are not covered by Medicare and using that term can give the free reign to bill you for more. Say you want a “med check or med review (as in medicine you are taking) that opens the door to get more testing done that is covered. Most prescriptions require you to see your doctor in person annually for renewal. Necessary/related blood work is usually covered when you have a med check.

When you see your doctor, when you see any doctor, always tell them at each and every meeting that if they are doing or recommending anything that is not covered by Medicare you want to know before it is done. Often, you will be told they don’t know what your coverage covers, but ultimately it is all about how it is coded and that is totally up to them. Most doctors know how to code the basics so it will be covered. The actual Medicare Wellness Exam is really more about talking to you about your medical health plan for the coming year and not so much a hands-on exam. You need to bring up Medicare covered things that can help your doctor do the tests in a way that are covered. Often, a future appointment will be made for the tests.  If you work with them, they usually will work with you and guide you. They know more about what is covered than they admit but they always have to claim they don’t just in case. They are not independent doctors anymore…they work for a big company that has all kinds of rules they must follow. Look up on the Medicare site what is covered so you begin to learn how to words things appropriately.

Here are a couple of sites to check out:

https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html

This is about the yearly wellness exam after the first year:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AWV_C...

[NickNack]

Thank you for that information and the links @Havarti.

[Kachina624]

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@151949 wrote:

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@Kachina624 wrote:

I have a Medicare Advantage plan + supplemental and never pay a cent for anything.   I see my doctor every 3 months and always have blood tests done. 

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It is not possible to have both a medicare advantage plan AND a medicare supplement at the same time. You have one or the other.

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@151949 Perhaps a matter of semantics.   The supplement is the Medicare Advantage Plan.   I no longer use the Medicare card; I present a Humana card. I have no co-pay. 

[Carmie]

Advantage Plans are not like Traditional Medicare and a Supplimental Plan.

there is no way anyone on here would know what was covered and what would not be covered.  Every Advantage plan is different and unique,

you should have received a booklet with a chart showing which services are covered and how they will be paid.  You need to take a look at it or call your insurance company and ask them.  Your doctor's office will not know offhand.

you need to show the office your Advantage insurance cards when you go to the office.  They will copy them to your records.

[Havarti]

@NickNack

Another thing worth exploring about your supplemental policy…. What (if anything) does it cover that Medicare does not. 

Even though I went to many of those meeting by various companies before I enrolled in Medicare, I did not grasp the fact for most of the companies they basically cover exactly what Medicare covers and if Medicare does not cover something, neither does the supplemental insurance.  There are some policies that do include extras like some dental, or fitness memberships, or some vision, or even some cover Rx.  But, most of the supplemental policies are just covering the exact same services as Medicare – they just help cover the cost difference – if there is one.  When it comes to an actual medical procedure or test, most only cover exactly what Medicare covers and if Medicare does not cover it you will be billed for the full cost.  I was surprise when I finally figured this out.  It seemed to me that I was paying a lot of money for the supplemental insurance only to cover the exact same thing that was already covered through Medicare. 

One very expensive example of this is being put in the hospital under “observation” for a day or two.  While there are exceptions, most of the time that is not covered by Medicare or the supplemental plans and you can be billed for 100% of the cost - which can run about $5,000 per day (approx) if nothing major is done.  This is proving to be a good money maker for hospitals and many have built new wings strictly devoted to “observation” care.  No one really explains this to you until you get the bill owing thousands of dollars…all out of your pocket, so always continue to ask if Medicare covers it and be very cautious if they suggest staying under “observation”.   I even carry a card I created in my wallet near my insurance & emergency information that states “don’t do anything that Medicare does not cover without consent”.  I am fortunate that my supplemental insurance has not networks, it is good anywhere that Medicare is accepted so I don’t have to worry about being taken out of network in an emergency or being referred out of network and not knowing.  That makes things so much easier and could save me lots of money down the road.  Even one mistake can be very costly.

Medicare and the supplemental insurance is a very complicated process – far more so than it needs to be.  It takes time and patience to figure it out and what is best for a friend or spouse is not necessarily best for you.  Or, what was best for you last year is not necessarily what is best for you this year.  I strongly recommend finding a good independent insurance agent that specializes in this area – they have knowledge of the pros & cons of the various products available in your state (and they do vary significantly by state) and can guide you to the best match for YOU each year.   Ask your friends if they use an independent agent that they like and then you will be ready in the fall when it is time to decide for next year.