Wellness

[wenfen]

@151949 ...Good for you that you like your Advantage plan...the one's available in our state use the Worst Doctors & Hospitals...& you must select from a network on in state only. We travel so much that we needed a "national" plan & wanted to choose the best doctors available to us either in our home state or nationally...While we do pay more...in our state at least you get what you pay for & Advantage is not the best solution for us...TY

[Tinkrbl44]

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@wenfen wrote:

@SilleeMee...TY so much for your fast & honest answer.

Yes, I understand the difference between the "Wellness: vs. Complete Physical, as my PCP was very specific as to what was included in both.

He told me that since I had "transitioned" away from private insurance (Anthem BCBS) to Medicare/AARP Medigap Plan F...the complete physical I was used to was no longer covered by either Medicare/Medigap...he actually gave me the Medicare physical & then told/showed me the difference with the complete non-covered one...also said it was "free" for the first time, but I would have to pay an additional annual charge of $350 for the same service this year.

I also know about billing codes, as I used to manage medical practices, but am not as familiar with Medicare/Medigap policies/codes.  I questioned his practice as "legal" & also if I could get my old "complete physical" if he coded it properly?

Should I call his practice, Medicare etc.?  I am confused & don't want to jeopordize my health because of coding issues or Medicare's Awful coverage!!! LOL

TY in advance for all your help with this.

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@wenfen

????     Maybe this was already addressed, but if you have an Advantage plan and then go to a doc outside the network, OF COURSE you are going to pay extra $$$.   

Medicare's coverage isn't awful, but it doesn't cover 100%.     .......  If you don't bother to learn how it differs from regular health insurance, well, that's your fault.  Sounds to me like you had Traditional Medicare and switched to an Advantage plan and are ignoring the differences.   JMO

[151949]

@wenfen  I don't know where you live but in my area almost all the doctors are in almost all the plans available. An advantage of small town living I guess. Plus - since Advantage plans have PPO options you are not required to stay in network if you don't mind paying the out of network co pay which is only about $10 more, yopu can go to any doctor you want.

[maestra]

@Carmie  Plan C and Plan F will no longer be open for new members as of 1/1/2020. That said, while members will be grandfathered in, there will be no new warm bodies to help diffuse the costs of these plans (I met w/SHIIP case manager).PlanC and Plan F premiums will increase- significantly w/no new members.

I will opt for Plan G, even though I will have to pay a deductable for PartB; I'm thinking of the long term and not having to switch to different plans.

I'm meeting again w/the SHIIP case manager next week to get signed up for my Part D; I have dental coverage w/another plan.

[wenfen]

@Tinkrbl44...I don't think you read my post correctly.  I never had an Advantage plan, but rather private pay, Anthem, BC/BS...transitioned to Medicare with a Medigap Plan F (funny you even highlighted that in red!)...So I actually don't have a network.  I can go to any doctor in the entire USA that takes Medicare & my Medigap Plan F policy even covers me out of the country.

Compaired to private insurance (Anthem BC/BS) Medicare is quite restrictive & not the greatest in my opinion, but unfortunatley we don't get a choice with that. Believe me, I truly understand all about insurance as I used to manage medical practices.

My question was why my doctor who chooses not to do the Annual Medicare Wellness  physical because he feels it's ineffective, would be able to charge me extra for a "touch" complete physical that apparantly is not covered by either Medicare or Medigap Plan F.

I got my answer today & it appears I just need to schedule an office appointment rather than "physical" to get the same tests, exams etc. that I require. It's simply a matter of symantics & CPT codings.

While you might not agree with my opinions or misunderstood my actual questions, your rude, inappropriate comments certainly weren't warranted & like you said..."JMO"!!!

[wenfen]

@151949...You're very lucky to have that option.  Unfortunately I live in a very large metropolitan city & the "better doctors & hospitals" do not belong to any Advantage plans. The only other option was Kaiser HMO & again, none of my current doctors or hospitals belong to that, so for me a Medigap policy was the only choice, if I wanted to keep my preferred doctors & hospitals. Sometimes smaller cities & towns have options not possible in larger cities!

[wenfen]

@maestra...Not necessarliy...there are 3 ways that Medigap policies are rated for pricing.

The type of premium pricing method you choose will affect your future costs

A policy that looks inexpensive when you first buy it at age 65 could end up being the most expensive when you hit 80.

Insurance companies use three different ways of setting premium prices. In some states you may have a choice of only one or two.

Community-rated (also called no-age rated). The same premium is charged to everyone, regardless of age. Medigap experts say these plans are the least expensive over time, though not necessarily when you first purchase them.

Issue-age-rated. The premium is based on your age when you buy the policy. It won't go up as you age, but will increase due to cost inflation.

Attained-age rated. The premium starts low but goes up as you get older. Over time, this type of policy is the most expensive.

You should also consider these 3 ratings when you choose your plan C, F or G...Hope that helps!

[151949]

@wenfen  I think you have that backwards - big cities almost always offer options small towns don't. 

When we lived in Pittsburgh my DH's Medicare and You book was about 3 " thick -here in small town in Florida it's about half that size.

[lovesrecess]

we have a medicare advantage plan with Humana; it covers the vaccines. We both had the shingles vax last year; now am told we need a new, different one....does anyone know about this?

[lovesrecess]

it is all about how the Dr's office codes the service they provide on your visit; everything depends on sending them the right code in order to get them to pay; same for insurance companies and Medicare