Anthem Opinions Co-Owner Surprised by Medicare Coverage

Does Medicare Cover

an Annual Physical Exam?

Are you experiencing what I just did ?

I am wondering if any of you…..my medicare friends have had similar experiences under medicare.

Today was my annual physical.  I have both Medicare and a supplement.

The doctors office said….the annual physical is not covered by medicare. 

She said in the past (2 years ago) it was covered,  but now only a wellness visit to fill out a questionnaire is covered after the first year physical.  

Now….my supplement will cover the physical but it did seem strange to me.  

The office manager said that their office previously thought that other than the first year physical, Medicare covered one per year thereafter.  Now she said that following the first year…only the questionnaire visit is covered.
  

Any blood tests, EKG or other tests are not covered. She said the doctor's office was sloppy and they wound up not getting paid as they had anticipated and ate the loss.

Again, my supplement will cover the physical for me.

 Below is my internet search on the subject.

http://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html

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Preventive visit & yearly wellness exams

How often is it covered?

Medicare Part B (Medical Insurance) covers:

A "Welcome to Medicare"

"Preventive visit"

You can get this introductory visit only within the first 12 months you have Part B. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including certain screenings, shots, and referrals for other care, if needed. It also includes:

• height, weight, and blood pressure measurements
• A calculation of your body mass index
• A simple vision test
• A review of your potential risk for depression and your level of safety
• An offer to talk with you about creating advance directives.
• A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.

This visit is covered one time.

You don’t need to have this visit to be covered for yearly "Wellness" visits

 Yearly "Wellness" visits: 

If you've had Part B for longer than 12 months, you can get this visit to develop or update a personalized prevention help plan to prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It also includes:

•  A review of your medical and family history
•  Developing or updating a list of current providers and prescriptions
• Height, weight, blood pressure, and other routine measurements
• Detection of any cognitive impairment
• Personalized health advice
• A list of risk factors and treatment options for you
• A screening schedule (like a checklist) for appropriate preventive services. Get details about coverage for screenings, shots, and other preventive services.

This visit is covered once every 12 months (11 full months must have passed since the last visit).

Who's eligible?

All people with Medicare are covered.

Your costs in Original Medicare

You pay nothing for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply.

However, if your doctor or other health care provider performs additional tests or services during the same visit that aren’t covered under these preventive benefits, you may have to pay coinsurance, and the Part B deductible may apply.

Note:

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover.

If this happens, you may have to pay some or all of the costs.

It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

ANY INSIGHT THAT ANY OF YOU HAVE WOULD BE APPRECIATED.

Allen Weintraub

Anthem Opinions