Wellness

[namaste000]

Here is the info on tdap:

If you step on a rusty nail (for example) and need the shot for that...then yes it is covered by originial medicare (parts A and B)

However, if you are getting a tdap  booster (for example, you are a new grandmother and need the booster so you don't pass anything on to your newborn-6 mos old grandchild) then the shot is not covered under Medicare Parts A and B but is covered under your medicare drug plan.

More info: In 2015 I was the grandma described above.  For the tdap shot to be covered, I had to pick it up in the pharmacy in the medical bldg of my primary care dr.  Someone from the pharmacy escorted me upstairs to my appointment and handed the vaccine to my dr's nurse.  At my dr visit, I was given the tdap (drug covered by my Part D drug plan) ...administration of drug was billed and not covered!

[Cakers3]

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@Bella2022 wrote:

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@Cakers3 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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@on the bay@goldensrbest

The wellness visit is the "Welcome to Medicare" visit (oh yay) where you go over Medicare with your physician.  That is covered with no charge. 

Your annual visit, or annual physical visit, is covered but depending upon what advantage/supplemental plan you might have your co-pay could be applicable. Some plans have no co-pay.

The coding is key but you also have to make sure what type of visit you are seeking and ask for it.  Never assume that anybody in billing is on top of the game.  Never.

And I speak from personal experience. 

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I wouldn't  say or something stupid like that, it's about your health!!

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@Bella2022@goldensrbest  I think she is confusing the "Welcome to Medicare" visit with her annual check-up.  They are two different scenarios.

Unless she does both at the same visit,  they are still covered; the "Wellness-Welcome" is no charge at all but if she combines it with her annual check-up then that is still covered but a co-pay may apply.

I hope she understands about the vaccines, too.

[zanna]

I don't have any answers as I am 18 months from retirement.  I am learning a ton about Medicare and wanted to thank everyone here for educating me.  So much to know!

[hoosieroriginal]

Really seems silly not to cover an annual exam each year.  I would think the insurance would appreciate more wellness visits than people waiting until they are really sick before seeing a doctor.  There should be regular checkups, bloodwork, to keep people over 65 healthy and aware what is going on.  I've just never understood their mentality.

[SeaMaiden]

What good is a ONETIME wellness checkup????  So you are healthy that one time and stay healthy year after year?? I do not get it?

 I do not know of an insurance plan that does not cover YEARLY  wellness checkups.  Please explain  how medicare charges you for coverage but does not cover a yearly exam? 

[on the bay]

Oh no @Bella2022-

I wasn't saying an annual physical is stupid at all. I agree, its about health. I am saying that the wording and confusion is stupid. I get really mad at how confusing medicare is and insurance so much so that even the ones in billing don't understand it all!

And I agree with @Cakers3 that we should never assume that someone in the doctor's office billing knows what they are doing or talking about.

I've been saved much money by knowing my own insurance and correcting them when they didn't.

It should not be so complicated and I'm sure that many are charged when they don't need to be.

one thing I know, we can always ask the dr's office for something to be re-coded so that it is paid, whenever this is possible!

Sometimes it is just a coding mistake as well, so we should always question a bill that we aren't sure we should pay.

And again, I wonder how many people are unable to do this every time. That is what makes me upset.

It should not be left up to esp all those who are older, ill, and or don't have the time to figure it all out and get all the confusion straight.

[Cakers3]

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@on the bay wrote:

Oh no @Bella2022-

I wasn't saying an annual physical is stupid at all. I agree, its about health. I am saying that the wording and confusion is stupid. I get really mad at how confusing medicare is and insurance so much so that even the ones in billing don't understand it all!

And I agree with @Cakers3 that we should never assume that someone in the doctor's office billing knows what they are doing or talking about.

I've been saved much money by knowing my own insurance and correcting them when they didn't.

It should not be so complicated and I'm sure that many are charged when they don't need to be.

one thing I know, we can always ask the dr's office for something to be re-coded so that it is paid, whenever this is possible!

Sometimes it is just a coding mistake as well, so we should always question a bill that we aren't sure we should pay.

And again, I wonder how many people are unable to do this every time. That is what makes me upset.

It should not be left up to esp all those who are older, ill, and or don't have the time to figure it all out and get all the confusion straight.

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@on the bayYou are so right.  I had 4 (!) issues with billing and had to file a claim with my advantage plan each time.  Each time it was found in my favor, as I knew it would. 

Including my eye doctor's person billing under the wrong Tax ID which lead to the claim initally being denied because the doctor could not be found "in network". 

You have to do your homework; it isn't always pleasant but assuming that everyone else has your back can leave a person being billed for something they don't have to pay. 

We have to be aware of all our benefits; and if dealing with your insurance company do it online through their communication center; most have them.  That way you have it in writing what is and is not covered or what your $$ part may be.

Plan ahead; it will save a lot of headache down the road.

[millieshops]

In my nearly 11 years on original Medicare, I've decided the most important thing is to know how it works along with whatever supplement and drug plan you have.  When I have questions, most of the time I speak with a rep from my supplement company just because that has proven easier overall for me.  They've been able to answer all my questions and have even interceded when a provider tried repeatedly to bill me extra for a service on which that part of their bill had already been denied. 

Medicare has been a great insurance for me, but it's like any financial piece of life -  it has great points and not so good ones -  and it does require attention and effort from us.  Just another proof getting old is not for sissies.

[Cakers3]

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@millieshops wrote:

In my nearly 11 years on original Medicare, I've decided the most important thing is to know how it works along with whatever supplement and drug plan you have.  When I have questions, most of the time I speak with a rep from my supplement company just because that has proven easier overall for me.  They've been able to answer all my questions and have even interceded when a provider tried repeatedly to bill me extra for a service on which that part of their bill had already been denied. 

Medicare has been a great insurance for me, but it's like any financial piece of life -  it has great points and not so good ones -  and it does require attention and effort from us.  Just another proof getting old is not for sissies.

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@millieshops  I agree about speaking to a rep but I also cover our bases by getting the answer to my question in writing under our accounts through their communication center; not our regular email.

We've been given different answers by different reps at times on the phone.

Our sales rep won't handle claim issues, either.  Once she has the account that's it for her. 

I know the books from Medicare and/or the insurance companies are there to read but I have found that some questions I have are not answered.  I always prepare before my appointment so that when a "surprise" bill arrives I have my back up.

[SilleeMee]

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@SeaMaiden wrote:

What good is a ONETIME wellness checkup????  So you are healthy that one time and stay healthy year after year?? I do not get it?

 I do not know of an insurance plan that does not cover YEARLY  wellness checkups.  Please explain  how medicare charges you for coverage but does not cover a yearly exam? 

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When you sign up for Medicare then your first and only one-time "Welcome" wellness visit is covered and then after the first year you get one regular wellness visit per year covered by Medicare. The difference between these two is that the "Welcome" one basically involves getting your history down on the records so that your next year's visit can follow through, hopefully, to prevent anything unhealthy from happening or from getting worse...preventive is the key word here. @SeaMaiden

Wellness visits/exams are not the same as physical/annual checkups.