Wellness

[wenfen]

OK..here's the real deal regarding the "Medicare Wellness Physical" vs the "Touch Physician's Physical"

This took much "digging" via phone calls to both the Doc's office, Medicare/Medigap Insurance & fellow Medical field friends...so this information is truly GOLD!!!.

For those of us that were "spoiled" by Cadillac health insurance plans all our lives, Medicare is a real "wake-up call"...for those of you that perhaps have not had insurance for a while or have either Medicaid or limited insurance...Medicare is probably better than what you currently have.  Since I fit into the "Cadillac" Insurance group...finding out that Medicare DOES NOT COVER ONE PENNY of the "annual physical" lots of us are used to, is both upsetting & stressful.

While my Doctor does accept Medicare/Medigap...he only does this for his current patients that were previously private pay & then transfer to Medicare...He like more & more physicians do NOT accept "New" Medicare Patients..& he like most other Doctors charge you "out of pocket" additional fees for anything NOT covered by Medicare.

Is it legal...YES...is it moral...Maybe no...For those of you that do want this annual touch physical...Ask your Doctor lots of questions...What's included for this extra upfront out of pocket fee?  Will I be charged extra for bloodwork, EKG, etc.? Do I have to pay the entire amount on the day of this physical, or will I be charged after my insurance is filed?

Then make your decision if you want to pay for it?  While I feel like I'm being "strong armed" I don't think I have a choice...& will be make the decision to pay it.  I feel that there are way too many hidden diseases that could be easily discovered by the simple bloodtests or EKG & "touch" examinations of PCP or Internal Medicine Docs.

I did hear that President Trump will be announcing some new health insurance information soon.  I sure hope that seniors might be allowed to "opt out" of Medicare & go back to a self pay or private pay insurance plan.  If this forces insurance companies to include pre-existing conditions, it might be an alternative to Medicare?..JMO

[Sadiesadie]

We haven’t been denied anything and I believe in order to cover it the doctor's office calls that check up something else in order to have it covered. Wish I could remember what it is. My husband and I have had no issues.

[NicksmomESQ]

   Pre existing conditions were covered by The Affordable Care Act until it was dismantled!! It also included no out of pocket yearly exams for everyone.

  I’m not on Medicare but I have friends who are.They get complete annual checkups with no problem & no out of pocket expenses.Maybe it depends on the plan you select.

[proudlyfromNJ]

I see my Dr. every 3 months. She is the one I chose when I went on Medicare. Since I am on 4 meds, she wants to see me frequently for bloodwork to make sure the meds are working as they should.

She also has me having a stress text, ekg, thyroid test and a few more a few times a year. (All related to health problems). These tests are all done in her office. I only pay her for when she sees me for results 4 times a year at 10.00 each time.

this works out quite well for me.

[SeaMaiden]

So  I now have Medicare as my primary... but I also have my secondary insurance with Blue Shield.  I pay for both each month... 100 something dollars for the Medicare... and about $400 dollars a month for my secondary Blue Cross insurance. 

I belive when I go to have my physical, my secondary will pick up where Medicare does not cover.   It did with my Cataract Surgery.

This next visit to the doctor will be my first vist with Medicare AND Blue Cross. So I will see how I am treated... and what happens.

[maestra]

@wenfen I'm sorry that this is a wake-up call, but most people havent had Cadillac insurance and this has been their reality...or worse-no insurance.

I had that happen to me many years, even working FT jobs that offered few benefit; I was a single mom so often I had no choices.

[maestra]

I'm beyond happy to be going on Medicare. ACA has cost us a small fortune, but we cant be covered otherwise due to pre-existing conditions.

[NickNack]

I can tell no difference in the annual exam I got two years ago and the Medicare Wellness Check that I get now.  I've had two so far.  Blood tests were done each time.  I was not charged anything by the doctor's office.

I've been to specialists, too, and they readily accepted my Medicare, and I was only charged my co-pay.  I'm not sure it's legal for the doctor to charge over and above what Medicare covers if they accept it.  They don't charge over and above regular insurance, and they don't pay the entire amount the doctor's office charges either.  I'm very happy with my Medicare coverage.

I have been taking my father to his doctor's apppointments for over two years, and I also take care of his bills.  Medicare covers his appointments just fine, too, and he has blood work and tests done.

[PINKdogWOOD]

@proudlyfromNJ  Not at all sure how you are perhaps lucky and so blessed with one fabulously generous Doctor to see you for your wellness/physicals, do all of the proper tests (at our age), and can have a Dr who can do all you need for only a mere $10.00 per visit. Lucky You I guess!!!

[wenfen]

FYI...For those of you that "get complete coverage" for a "Touch Physical"...You are probably on an Advantage plan...stay in network...go to a limited group of doctors/hospitals etc. There are  also Co-payments & deductibles...It is also limited to just the city/state in which you live.

I am speaking strictly of Supplimental plans to Medicare...they must follow the exact rules/regulations/restrictions of Medicare & pay additional 20% upcharges & various other charges/fees...but NOT a penny for the touch physicals..

Doctors that use CPT codes for "office visits" vs "annual physicals" can "get around" the surplus charges...Medicare does do annual audits, so sometimes this is discontinued.

Regarding the person with BCBS supplemental insurance...like me, you're in for a big surprise...your first "welcome to Medicare...complete touch physical" WILL be paid, including blood tests & EKG...after that it won't be...call your insurance company for verification.

Yes...the pre-existing coverage was great, I wish it was available when my husband was laid off & had to travel 300 miles weekly to another job just to get us "Cadillac Insurance"...that's why I was looking forward to Medicare, so we couldn't be denied coverage & if you get your supplemental insurance during the initial 6 months period, you can't be denied or underwriten for pre-existing coverage.

But while Medicare is a guaranteed plan...that doesn't make it great. What's so shocking is that there are many out of pocket fees, in addition to plan D & monthly supplemental insurance payments that we took for granted either under company paid or COBRA insurance.

That's why there are so many options...everyone has a different need or ability to afford coverage..one is not better than the other.

I'm strickly posting what my personal experience has been for those that have chosen supplemental policies...not judging or criticizing anyone or anything else!