Wellness

[Gooday]

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@ccassaday wrote:

First find a insurance agent that can walk you through the plans. They won't charge you anything.  My advantage plan is $35 a month. All advantage plans are different depending on your state. I have a advantage plan because in Indiana you can't get a supplemental until 65. I am on SSDI and disabled. I have been very happy with my plan. I had a very expensive jaw surgery and so far have only paid 3.45. The oral surgeon takes medicare assignment so I haven't paid anything.

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Just to add about an Advantage plan: my husband is 71 years old. He had Medicare and a BC/BS PPO supplement that we paid for but was through his former employer.  Well, 1/1/17 he was dropped and was offered the choice of an Advantage plan through Aetna or BC/BS.  After he talked with former co-workers he decided on the Aetna plan.  $291.00 comes out of his pension check.  The plan has a 0 deductible and 0 out of pocket.  The Rx drug plan is a 90 day mail away through CVS Caremark at a discount rate.

Last November he had a big toe amputation and all the charges (weekly visits to a wound care clinic through the end of March) were covered at 100%.  So far we are very pleased.

I turn 65 next August and I will most likely go with an Advantage plan myself.  I still  have to do my research.  Right now I had to go through the Marketplace and I can tell you the cost is killing me.  I have to put off my 5  year colonosopy check because of the deductible and I had a right hemicolectomy in 2005.  It's been an epic failure in my life.

[goldensrbest]

I took the paper work i got from medicare to the doctors office yesterday, the nurse wanted to see it and look into it ,meanwhile i am trying to find  a Independent medicare supplement broker, i thought if i had ,part ab plus drug coverage i could get along with that , i know they pay 80% of hospital stay ,but  it looks like i need more coverage.

[Moonchilde]

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@Katcat1 wrote:

@goldensrbest,  If you have Medicare don't you also have a supplemental plan with an insurance co.?  I never deal with Medicare only my supplemental insurance co. which handles everything for Medicare and I can call them any time with questions regarding coverage.

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No, she doesn't have a supplement; she needs to buy one. She says she's starting to look now. I think she didn't realize the impact that not having one would have on the wallet.

[Moonchilde]

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@Cakers3 wrote:

@Moonchilde  I'm not sure if one can purchase Silver Sneakers on their own but if your plan offers it, there is no cost to you.

In fact, Silver Sneakers already had us in their system; all we had to do is set up our login and the list came up with all available locations.

The one good thing is that you can go to various locations but: they may not offer all the same programs.

Some only offer the weight machines; others, like ours, offer free weights, machines, and specialty classes just for Silver Sneakers, like SS yoga, zumba, etc.  The pool is availabe to everyone.  There are other specialty short term classes that would have you paying a small fee to join.

Also you can go to a different gym if in the program; you can try out the Y or LA Fitness e.g.

I hear you about the cost of memberships, though.  We backed out of joining the Y last year because of the cost.  Now it's free for us.

Sorry you are not so close to your Y.

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@Cakers3 I think it's only a MA thing - ordinary supplements don't, as a rule, offer that kind of thing - though there might be some company selling them that does - but I've never seen it. The perks usually come with MAs. There is a super fitness center (two branches) in our area (though not "close" - nothing is close, lol) that's Owned by a local hospital and has physical therapists on staff (and a pool) but it costs $200+ a year plus $100+ per month in fees. No thanks.  But then, the Y is about that minus the $200 :-( And apparently these "wedded to the hospital" facilities are run like typical hard-sell shady "gyms" with beaucoup hidden fees and penalties, so no thanks.

[goldensrbest]

I thought if you have part a ,and part b,and drug coverage i would be okay ,as long as i did not get admitted to a hospital, to me buying a medigap policy ,or supplement is for hospital stay.

[wenfen]

@SilleeMee...I know this is an old post...but this just happened to me & you seem knowledage about my question.

I saw my PCP & he gave me the "One time "free" Annual Physical" Using my Medicare & Medigap Plan F, AARP...but told me that in the future he would charge me an additional $350 for my annual physical which includes EKG, complete fasting bloodwork etc.

I got a very nasty letter from Medicare telling me to find another Doctor that took my insurance & sent me a list of potential doctors.

My quesition to you is...is this legal for my Doc to take my Medicare & Medigap Plan F & then charge me additional  $350 per year?: I like him, but not enough to pay him an additional $700 per year for both my husband & my annual physicals.

Thanks in advance for all your help with this.

[SilleeMee]

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@wenfen wrote:

@SilleeMee...I know this is an old post...but this just happened to me & you seem knowledage about my question.

I saw my PCP & he gave me the "One time "free" Annual Physical" Using my Medicare & Medigap Plan F, AARP...but told me that in the future he would charge me an additional $350 for my annual physical which includes EKG, complete fasting bloodwork etc.

I got a very nasty letter from Medicare telling me to find another Doctor that took my insurance & sent me a list of potential doctors.

My quesition to you is...is this legal for my Doc to take my Medicare & Medigap Plan F & then charge me additional  $350 per year?: I like him, but not enough to pay him an additional $700 per year for both my husband & my annual physicals.

Thanks in advance for all your help with this.

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@wenfen,

I would like to help you but I don't know much about what Medicare or Medigap covers and what your physicals include. I would ask your doctor if the additional charge is for something Medicare or Medigap does not cover. Sorry I can't offer you more help. Hopefully someone here will step in and give you their advice. 

ETA:  keep in mind that your first 'wellness visit' is covered by Medicare and this is totally different from annual physicals. Wellness checkups are different from physical checkups. They are billed differently.

[patbz]

Yes, wellness check is different than physical (I found out the hard way).  Fortunately I am very healthy at 74 and have a great Dr ( who is the hospitalist at a major Phoenix hospital) so if he or I spot anything I'll get the necessary referral.

[wenfen]

@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.

[SilleeMee]

@wenfen,

I think your doctor will charge you the $350 for complete physicals because Medicare doesn't cover it. If you don't want to pay for it then you will have to decide to choose an 'exam' that is covered by Medicare which may not include all parts of what a complete physical includes. This is something you probably need to discuss  with the doctor and that will help you decide what tests you really and truly need to have done for your particular health situation. 

I don't believe he is illegally charging you $350. Medicare won't pay that bill so you have to pay it if you want that kind of exam.