Wellness

[Cakers3]

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@goldensrbest wrote:

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@on the bay wrote:

@goldensrbest-

I remember reading about this and how confusing it was!

There is something like a wellness visit that is covered but an "annual physical" is not or something stupid like that! Its all in the wording.

I would call medicare to make sure or your doctor's office but sometimes the person answering the phone doesn't even know for sure.

You also could ask your doctor's office to change the coding of this visit so it can be covered!

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I called medicare ,and doctor ,yes the first 12 months ,your only allowed a medicare welcome ,not a wellness apointment ,crazy.

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@goldensrbest  I'm confused at what you are being told.  I had an annual visit 2 months after enrolling in Medicare.  The visit included a variety of blood tests, too, all paid for.  I only paid my $5 co-pay.  Also a referral for a colonoscopy, mammogram, and bone density scan and all  took place 4 months after enrollment.

However, I also had an advantage plan.  Do you have just straight Medicare without any advantage/supplemental plan???

[Moonchilde]

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@Cakers3 wrote:

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@goldensrbest wrote:

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@on the bay wrote:

@goldensrbest-

I remember reading about this and how confusing it was!

There is something like a wellness visit that is covered but an "annual physical" is not or something stupid like that! Its all in the wording.

I would call medicare to make sure or your doctor's office but sometimes the person answering the phone doesn't even know for sure.

You also could ask your doctor's office to change the coding of this visit so it can be covered!

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I called medicare ,and doctor ,yes the first 12 months ,your only allowed a medicare welcome ,not a wellness apointment ,crazy.

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@goldensrbest  I'm confused at what you are being told.  I had an annual visit 2 months after enrolling in Medicare.  The visit included a variety of blood tests, too, all paid for.  I only paid my $5 co-pay.  Also a referral for a colonoscopy, mammogram, and bone density scan and all  took place 4 months after enrollment.

However, I also had an advantage plan.  Do you have just straight Medicare without any advantage/supplemental plan???

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I have Medicare and a supplement, and whether I went under my long-term doctors or my newer doctor since I've moved, I've never been responsible for anything "not covered." But I've also never gone to a doctor and asked for a Wellness exam, or a Yearly Physical by name, or had any doctor's office term or bill anything that way.

In my experience, few doctors let anyone - Medicare or employer's insurance - get by with a yearly visit like they used to do, because these days co-pays help keep the practice afloat and the more visits you make, the more it helps their bottom line.

So most people are "under care" to some degree because you only get Rx refills for 3-6 months at a time, not 12 as in the past, and/or you may be being monitored with blood tests, or a combo of both.  So when they go to the doctor the first time under Medicare it's just billed as a regular visit. If tests are deemed necessary due to a complaint, they're covered. They may not be covered if your doctor orders them more frequently than what Medicare has decreed is the standard of care - Pap smears, mammograms for example.

Even when I started seeing a new doctor upon moving, it was just a "new patient visit." Any doctor's billing service should know how often Medicare tests are covered - and for major ones, so should the doctor. Just for my own peace of mind, when I started in with him I was always asking if Medicare paid for this or that, how was his office going to bill, and that I only ever wanted testing that Medicare paid for - if a certain test might not be paid for, or wouldn't be, I want to know before the test is done and let's discuss, not when I get a bill ;-( This was until I got comfortable enough to assume this large multi-physician practice had its doo together and wasn't going to routinely screw up without caring - as some do.

[goldensrbest]

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@Cakers3 wrote:

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@goldensrbest wrote:

I had my first visit to the doctor in july ,under the medicare plan i turned 65 last december,i got papers from them yesterday ,saying my annual visit,and two vaccines were not covered,shingles,and tentanus, dipthera, i have test i need done ordered by doctor,will these be covered ,how to know.What did i do wrong?

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@goldensrbestThis shot is covered by Medicare.  See Medicare.gov-it is the tdap vaccine.

Are you on just Medicare or do you also have an advantage or supplemental plan?

Your annual visit should be a co-pay or no co-pay determined by what type of coverage you have.

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I have no supplemental plan,or advantage.

[Moonchilde]

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@goldensrbest wrote:

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@Cakers3 wrote:

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@goldensrbest wrote:

I had my first visit to the doctor in july ,under the medicare plan i turned 65 last december,i got papers from them yesterday ,saying my annual visit,and two vaccines were not covered,shingles,and tentanus, dipthera, i have test i need done ordered by doctor,will these be covered ,how to know.What did i do wrong?

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@goldensrbestThis shot is covered by Medicare.  See Medicare.gov-it is the tdap vaccine.

Are you on just Medicare or do you also have an advantage or supplemental plan?

Your annual visit should be a co-pay or no co-pay determined by what type of coverage you have.

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I have no supplemental plan,or advantage.

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If you only have Medicare Parts A and B, and you have no supplement or MA plan, and no Part D prescription coverage (?) you're always going to owe. Even for covered costs, you'll always be billed at least the 20% of the bill that isn't covered without a supplement. If you have no Part D Rx coverage, that's why the tdap wasn't covered.

If you don't have these coverages by your own choice, you're going to be potentially shelling out huge sums of your own money for the rest of your life. If you can't afford the premiums, you may well qualify for aid to pay those premiums, or Medicaid of some kind.

Only the very wealthy/self-insured can afford not to have the Parts B and D supplements.

[goldensrbest]

@Moonchilde,I have part a &b,and drug coverage, no supplememtal ,or advantage , maybe i need medi gap, i simply don't understand this medicare at all ,though i try to.

[Caligurll]

I have an advantage plan, and my eye exam is $15 co-pay and then I get a $150 credit towards a pair of glasses, every two years.

[goldensrbest]

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@Caligurll wrote:

I have an advantage plan, and my eye exam is $15 co-pay and then $150 credit towards a pair of glasses, every two years.

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Would you mind telling me what you have,and monthy what is the cost?

[Cakers3]

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@Moonchilde wrote:

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@goldensrbest wrote:

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@Cakers3 wrote:

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@goldensrbest wrote:

I had my first visit to the doctor in july ,under the medicare plan i turned 65 last december,i got papers from them yesterday ,saying my annual visit,and two vaccines were not covered,shingles,and tentanus, dipthera, i have test i need done ordered by doctor,will these be covered ,how to know.What did i do wrong?

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@goldensrbestThis shot is covered by Medicare.  See Medicare.gov-it is the tdap vaccine.

Are you on just Medicare or do you also have an advantage or supplemental plan?

Your annual visit should be a co-pay or no co-pay determined by what type of coverage you have.

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I have no supplemental plan,or advantage.

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If you only have Medicare Parts A and B, and you have no supplement or MA plan, and no Part D prescription coverage (?) you're always going to owe. Even for covered costs, you'll always be billed at least the 20% of the bill that isn't covered without a supplement. If you have no Part D Rx coverage, that's why the tdap wasn't covered.

If you don't have these coverages by your own choice, you're going to be potentially shelling out huge sums of your own money for the rest of your life. If you can't afford the premiums, you may well qualify for aid to pay those premiums, or Medicaid of some kind.

Only the very wealthy/self-insured can afford not to have the Parts B and D supplements.

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@Moonchilde  It is also my understanding that if you opt not to have Part D and eventually do choose a Part D plan you will be assessed a monthly % fine for all the time you didn't have a Part D.

@goldensrbest  Moonchilde is correct-Medicare alone is going to cost you much more than a simple advantage plan, which usually include Part D prescription.

Supplemental plans are more expensive and from what we learned they do not carry Part D-you have to subscribe to that apart from the supplemental plan.

I would advise you to attend one of those Medicare seminars; that is what we did.

It was sponsored by insurance brokers but they will do all your homework for you and come up with a reasonable plan for your needs, and even take care of your enrollment in either an advantage or supplemental plan.

And even though we didn't enroll through the broker, it still didn't cost us a penny.

The insurance company pays their fees for their time.

We learned a lot more than we expected to learn; and free appetizers.  LOL

[Moonchilde]

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@goldensrbest wrote:

@Moonchilde,I have part a &b,and drug coverage, no supplememtal ,or advantage , maybe i need medi gap, i simply don't understand this medicare at all ,though i try to.

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@goldensrbest, if you don't get some type of medigap coverage - either Medicare Advantage or a Supplemental policy, you will always have to pay the 20% of charges that Medicare doesn't pay, and as much as 35% depending on the doctor.

Most doctors who accept Medicare will accept what Medicare pays as their full payment. But Medicare also allows doctors to charge as high as 15% more - and you'd have to pay that too, with the doctors who do that. Right now, there are two supplements that will pay that extra 15%.

You might be hospitalized, and need a specialist. The very best specialist, and/or the doctor your other doctors want to work with, might charge the 15% more, on top of the 20% Medicare doesn't pay anyway. So for all of his bill, you'd have to be paying 35% of it, not just 20%, if you don't have a Supplement. It's good not to need to worry about that.

Your best bet is to make an appointment with an insurance broker who specializes in Medicare. Tell him your physical condition - how healthy (or not) are you, how many medications you take, whether you have strong preferences about seeing certain long-time doctors (or not), etc. Medicare Advantage might be good for you - or it might not. Only talking to the expert will help you decide.

I thought I wanted a MA plan, then discovered there isn't one where I live. Now that I have a regular supplement, I can see any doctor at will - not just the MA doctors and often needing a referral to see a specialist. But MA plans can offer some benefits that supplements don't. Let the insurance agent do the research for you.

[Caligurll]

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@goldensrbest wrote:

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@Caligurll wrote:

I have an advantage plan, and my eye exam is $15 co-pay and then $150 credit towards a pair of glasses, every two years.

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Would you mind telling me what you have,and monthy what is the cost?

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@goldensrbestI have Kaiser and it is about $200 a month (the northern California rate, for retirees from the Federal government), in addition to my Medicare (right now $405 every three months).