Wow great timing I have my initial welcome to medicare baseline wellness exam this Saturday. its really comforting to know that a person has an advocate who knows what is covered and is not covered. There is so much disinformation about what is covered and is not covered. I will send you an email as I do have a question that I don't want to discuss in an open forum.
I am addicted to your you tube channel and was watching one after the other. I am 66 and presently still working and covered by health insurance with my employer. I will be retiring this year in June. I was so over whelmed with Medicare choices until I found you. You have explained everything so completely and made supplements easy to understand. I called your number today and talked with 'Chelsea'. I was so sad when I discovered you were not licensed for Connecticut, where I live. Chelsea did give me a phone number for one of your associates. I am still continuing to watch your you tube channel.
Thank you so much for taking the time to give us a call, and leave this comment! Connecticut is one of the only states we don't work in unfortunately but I hope this channel has given you a great starting point when it comes to transitioning to Medicare. Thank you for watching and Happy New Year!
I hate to say it, but the annual wellness visit is pretty lame. A lot of procedures done as part of a traditional physical exam are not approved unless you have some chronic condition which may be applicable. It baffles me how CMS actually believes the wellness visit offers any value to seniors. To be honest, everyone signing up for Medicare should be sent a special manual detailing how different the annual wellness visit is from traditional physical exams. I would have loved to learn this information 4 years ago. Thanks so much for bringing it to the attention of new Medicare recipients.
I absolutely agree. Most people don't realize that the Annual Wellness Visit is mainly a "chat" with your doctor. Anything beyond that you may get billed for.
@@AbtInsuranceAgency Luckily I had a pre-existing condition (HBP) which led CMS to approve the $400 blood test. So my visit only cost me about $60 for the deductible. I learned a whole lot after that first visit.
@@redoscar540 Thanks for this, am currently on SSDI with several conditions until I become 65, then will have guarantee issue for Medigap. I'll go with the best available today (a "G" plan). There was one slightly better which waived the Medicare annual deductible that's no longer open to new enrollees. Although existing members can keep these. While Medicare Advantage (MA) has covered many of my medical needs, to include labs & medicine, am sometimes left with bills that takes a year or longer to pay. The good thing about MA this year was I was able to get a (normally) $500-600 pair of glasses for $100 under the UnitedHealthcare network. Yet given all the more expenses I have to come out of pocket on, will most certainly look for a guaranteed & no physical needed Medigap plan. It's simply important to follow the guidelines regarding signup times (3 months before & 3 months after) one's 65th birthday month. This is a total of 7 months, just like with MA plans. Due to Medicare not providing prescription coverage, will simply have to accept a low cost drug plan (some of which are $0). This can be freely changed during the open signup times every year, or as allowed by plan (best to discuss this with your agent yearly & have complete list when calling). However, it's important to compare one's prescription coverage of plan, to include co-pays. That $20-25 plan may look expensive until making co-pays, where most of these are less & more drugs available on list. Meaning depending on how many prescriptions are needed, one can save the entire year's cost of policy in the first or 2nd month of the year.
How can a doctor know that you have a medical condition such as high cholesterol or a liver problem unless a blood test is done. What this video says is wait till you get sick or have symptoms of an illness before having the doctor do the testing and then Medicare will cover it. So if I have a heart attack then doctor can take a blood test that is covered when it could have been prevented if a routine screen had been done. That is insane. Wellness exam for me was worthless. Doctor asked a few questions, took my blood pressure and that was it. Total waste.
I thought the same thing. So what should be done to prevent this from happening that won’t break the bank? Ie.,should we just go ahead and get a (complete) proper wellness screening?
A few routine blood tests are covered, though not necessarily every year. Cholesterol once every five years, for example. But don't expect your doctor to remember or offer them. PSA for men is offered every year.
Not necessarily true. My doctor ordered an EKG without me complaining about anything. He looked at it and said that though he's not a cardiologist, he doesn't like what he saw. He referred me to a cardiologist and shortly thereafter, I had an open heart surgery. That was in 2012. Medicare is doctor driven. No matter how insignificant a pain or ache you may have, note it and tell your doctor. Every illness has a symptom. Listen to your body.
Communication with the doctor/staff is key to avoiding charges. I discussed the wellness checks with my doctor during my final routine physical while on United Healthcare Insurance. He told me that they do the same check for a Medicare wellness check (minus the blood tests) and submit the proper code. He also advised that the “welcome to Medicare” check is, at least in my case, a waste of time. That may be because I have a long history with my doctor.
I had a complete physical exam every year of my adult life but after 65 I am no longer eligible.😡 Annual wellness visit is an insult not an exam. Just proves how much our government values seniors.😡
I'm confused about something regarding the wellness check. At 5:50 of the video it shows a list of screenings that are covered, does this mean blood tests? ex. cholesterol blood tests, diabetes blood tests (A1C). Also I've watched many medicare videos from other people and I have NEVER heard from them that routine physicals are NOT covered. Thank you!
Routine preventative bloodwork that is a part of an annual physical exam that is not related to an illness or diagnosis is not covered. Ie. A routine physical exam where you have blood tests done to check thyroid, etc … is not covered by traditional Medicare. Bloodwork that is diagnostic and related to an illness or specific condition is covered.
@@AbtInsuranceAgency so If I don't have heart disease or diabetes but just want my cholesterol and blood sugar levels checked every year, they would NOT be covered under the annual wellness check.
Thank you Stephanie, All of your videos that I have watched are very informative and you explain the details in a way that is easy to understand. I live in the state of Washington. Do you service the state of Washington?
We are brand new to Medicare, we are SHOCKED that the annual physical with our physician is not covered. Will our supplemental insurance cover it? Should we appeal to the doctor to see if he will bill it as a “Medicare wellness visit” even though we want a physical? We are healthy, on no prescription meds and want to continue getting annual physicals to stay that way. Medicare only paying when something is wrong is CRAZY!
Medigap plans only cover services covered by Parts A and or B of Medicare. You should talk to your doctor about having them request “diagnostic testing “ separately from your annual wellcheck so that there is a better chance Medicare will cover this testing.
My annual "physical exam" last year cost $662, including a blood test, which was paid for by my Medicare Advantage plan. If Medigap insurance covers only what Medicare approves, then this is a good reason for me not to change to a Medigap policy. My typical medical care for a year is for a physical exam, eye exam, & dental exams & cleanings, none of which apparently are covered by Medicare or Medigap.
Wow, didn’t know this. Thank you. Turn 65 next yr. So, if I have blood work done during a annual wellness exam, part B and a supplement will pay for none of the blood lab bill ? Do Advantage plans generally cover a complete annual physical ?
I find your videos super helpful .So fills with great information ..I am turning 64 next month and want to use your company to set me up with all the tools I need ..I know I am early ..but I want to gather as much info as possible ..I am in Los Angeles .Ca ...What’s your email ?...and what is that billing code for the Wellness Examination..Thanks Kent
I have no idea what the billing code is, but my doctor got more of a payout on my Wellness Exam than my usual monthly visit under Medicare Advantage & did far less.
Thanks Stephanie for the video that gives us a lot info. I like it. One agent told me that if I have supplement plan G with Medicare coverage, then the annual physical exam is covered (I don't need to pay anything). But in your video, you said the annual physical exam is not covered. I'm not sure who is right? Please advise. Thanks in advance.
@@AbtInsuranceAgency Got it. Thanks Stephanie for your advice. The agent also told me that I can enroll part G now 6 months before I turn 65 in Oct. even I haven't enroll Medicare yet (I'm eligible to roll Medicare next month). Is it true? Thanks,
Stephanie, thank you for this video. We had no idea that annual physicals wouldn't be covered by Medicare. We will use the wellness initial enrollment evaluation. One question: am I right that a Medigap policy will not cover any part of an annual physical?
This seems to be a subtle but important point. What I understand from this is that medigap does not provide any additional coverage of medical issues over A and B but instead helps to only mitigate the expenses for medical issues that A and B cover but pass some expense onto the patient for that coverage. Is this correct?
@@tommason8104 hey Tom!! It appears Stephanie may have overlooked your post!! You have a very important question that I am on as well: I would answer if I knew for sure!! Best wishes!!
I am still working past 65 and have full benefits with my employer. Where do I find the details regarding what I should do to keep my employer benefits and also notify Medicare?
Medicare actually doesn't need to be notified you are delaying, as long as you are not collecting social security benefits yet. You will let them know that you had creditable employer coverage when you do go to apply later on. You can keep your employer plan by renewing regularly! However, if you employer has less than 20 employees, then you should apply for Medicare when first eligible.
I cancelled my annual physical in Oct, because I thought it would be covered. Found out my doctor does not Dr a welcome to Medicare visit. I even asked a few people, even my broker. I think she misunderstood me when I asked if I should cancel my annual appt and wait for my Medicare to kick in to have my physical. I have issues and was waiting to get them checked when I went in Dec. High cholesterol being one, along with some other issues. Now I am wondering in I should just cancel and never go see my doctor until I get really sick. I should have blood tests as well as other wellness checks as I have not had some tests for over 3 years. But I guess Medicare would rather fix you after you get cancer or some other disease rather then prevent it. Not feeling good about Medicare right now and mine just started in Nov. I go to my wellness check in Dec or maybe just cancel it as they can't test for anything anyway.
Yes Medicare does not want you to get annual blood work which may discover and prevent a medical issue. I think their goal is for the Medicare recipient to have the heart attack, get the cancer etc to reduce your life span which means less payout of Medicare and social security benefits in the long run.
So I joined July 2022, have not had a wellness exam yet, but did schedule my colonoscopy which I last had 5 yrs ago And was told then to have another in 5 yrs. Reason I sched it plus dad passed from colon cancer. I also would like to schedule a pap and mammogram which again hadn't had one in about 5 yrs also. Do I need to have a wellness exam before I can schedule these last 2, and do I have to schedule a wellness exam if all they are going to do is bp height and weight? Is there a penalty if you don't have a wellness exam?
If you are on prescription drugs and have CPT codes for hypertension, colesterol etc. your labs are covered. I have labs done every year fully covered by Part B and my supplement.
The link below will take you to that brochure: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf Thanks for watching!
In the last four years, I have received four annual exams each with comprehensive blood work, two cataract surgeries, and a colonoscopy. The first cataract surgery was 6 months after the exam, so I had to get a more recent blood test along with an EKG. The second cataract surgery and the colonoscopy both required EKG's but were performed soon after the medical exams so the lab work results were current and considered acceptable. With that said, I have never paid for anything except for the yearly Part B deductible. Original Medicare and my Plan G carrier paid for the rest.
The "wellness" visit is a waste of time if you can walk in there. No blood work, don't check your heart, lungs, or blood pressure. Its a waste of your time and their money. A regular visit for an ailment will get you more answers. Just cough a couple of times and they will check you out.
Isn't a doctor obligated to tell you the price or cost of anything he is giving you? He can give you anything he wants. I thing I'll be asking for a price list when I walk into his office. Maybe the law should recommed
I have a Medigap Plan N. I had a full annual physical in January and have not received a single bill, other than the annual Part B deductible. It all comes down to how your doctor's office codes the insurance form with the various billing codes. ;) I was very careful in explaining that I was on a supplement plan, which did not include a physical. (My doctor does not offer wellness checks ... only full physicals).
Good job Mark!! was the difference in price of Parts N to Part G a big difference? has it made any difference. I am leaning to G but value your advice! TY
@@enufots4621 My appts (labs and physical) are already made a year ahead (after each physical), so I don't have to ask for anything. (However, I would just ask for an annual physical). Doctor's insurance/billing departments know how to work "with the system" when submitting paperwork. So, if you have a supplement and need a physical, just call your doctor's office and ask ... and see what they say.
I’ve watched many of your videos but probably not in the right sequence. I am 64 1/2 so I want to be prepared. Currently self employed but on my wife’s employer health plan. Wondering if her health plan can act as my supplemental plan?
I have an HMO plan through my employer. Am I required to apply for medi care when I turn 65? I would prefer to defer medi care until I retire at age 67. Thank you.
What pray tell is exactly included in ain initial preventive physical examination or annual wellness visit and do I have to visit a low income clinic that is FQHC to get one?
Dora, it's basically the same as a marriage physical today. Depending on your health needs, you already may be going to your primary care doctor every 1 to 6 months, I go every three or 4 times yearly. So my doctor doesn't perform these physicals on me anymore, although did get my initial "Welcome to Medicare" physical. Which was exactly what I described above, like that needed for marriage, to basically ensure you're alive & to get a list of current conditions, if any.
Currently MA, CT, WI and MN. Medigap rules and regulations are a bit different there and I am not licensed in those states right now, but have a great referral partner who does work in these areas!
I have osteopenia & have been for 15+ years (am disabled). It says here that Medicare covers this test. However sometimes, my MA plan will charge a small fee for this test. It's my understanding that the MA plan is supposed to cover (at a minimum) everything that Medicare does, by law. Is this correct?
Certainly makes ZERO sense, as only lab results can determine or rule out many conditions in it's early stages. This also is more cost effective to the patient & the insurer (Medicare in this instance). Welcome to what? Without a Medigap (or MA) plan, that physical is basically no more than that required for marriage. To ensure you are who you say & are alive. I suggest to Abt Insurance Agency about your Medigap options. Especially if just eligible & are guaranteed issue. These are my plans at age 65 & will work a sedentary weekend job (allowed by SSDI rules) to pay for these extras.
@@mizmarie6511 Is this your personal opinion or are you employed in the insurance industry? Yes I agree that it's best to take care of oneself while young to prevent future health issues, but to say "when you turn 65 you are not worth the time or effort" is exactly what many feared about Obamacare ("death panels", which didn't happen). I've had not only Medicare since 2006 from being disabled, but also Medicare Advantage plans (similar to employer insurance) & have been treated kind by both my doctors & insurers.
I think this whole wellness exam is a joke. Please tell me how having a supplemental plan helps you when if Medicare doesn't cover a complete physical then your supp plan won't either. To my way of thinking routine yearly bloodwork is a must. I might as well go to a local health screening yearly and pay for it myself and watch doctors who are you tubers and self treat my symptoms. Many people suddenly find out they have cancer and it is already at stage 4 but they had very minor if any symptoms at all.
Complete blood panel should define a physical exam. Nutrition, vitamin and mineral deficiencies, heavy metal testing and this would shorten the time for diagnosing many health problems.
When you sign up for Medicare you get a list of preventative services that are covered. If you request a service, such as a routine physical, your doctor office should tell you that it isn't covered, but otherwise you should read the information.
My Dr informed me, she basically said what Medicare covers is a hands off physical. All questions, so if you want bloodwork done and want it covered, you need to have a complaint or symptom. It's crazy, all the years I worked, it was mandatory(or you paid more for your health coverage) to have a physical. Then when you most likely will benefit from it, it's not covered.
Medicare Supplement Plans cover what Medicare A and B covers. So if Medicare denies the claim (ie. doesn't cover routine preventative labs) then the Medigap Plan won't pay on it either.
Yes depending on what your doctor ordered. And if Medicare doesn’t cover it, you pay the full billed amount, not the reduced insurance amount. Prior to being on Medicare, if my employer health insurance did not cover something, they reduced the charge to what the allowed amount was under the plan and that is what I would be billed for. Not Medicare, you will be billed for whatever the doctor billed Medicare for which is usually an inflated charge.
Im about to be 65 and I'm not sure about part D . Question : can I withdraw from part D at any time or a year after I got part D ? I will appreciate your answer. Thanks
Noel, yes you can cancel your Part D drug Plan, or simply not pay your Part D premiums and the plan will cancel. However, if you go more than 63 days without creditable drug coverage you will be assessed a penalty if you choose to enroll in Part D again in the future.
Medicare Advantage plans typically covers MORE than the "Welcome to Medicare" physical & is often free of cost. I go so often that they don't do the usual annual on me, because labs are required to monitor Prediabetes & high (or bad) LDL cholesterol levels. Most MA plans also has lots of included educational materials, plus free virtual nurse visits. While these won't be able to issue a prescription, will help a member decide to go to a doctor, or if an over the counter medicine may be helpful. However, please don't call this number for sudden chest pain, headaches or anything one would consider calling 911 over.
Disgusting and discriminatory! Many seniors don’t know this ...they just wonder why their doctor suddenly stopped providing a standard annual preventive checkup! An annual checkup allows your doctor to go through a checklist of exams to catch problems before they happen. Now a senior needs to create their own list and ask for each and every exam and if they forget something or are embarrassed to ask, they pay the price with $ and their health. I'm inviting others to ontact your legislators and alert them! This is not acceptable! Why should there be a game as referred to in this video? Health insurance is not supposed to contain a “gotcha” and people need to stop accepting subpar services. Senior citizens paid for this in payroll deductions AND continued premiums. Insurance always paid for an annual physical. Medicare needs to do the same. Seniors should not be expected to “play the game” to get decent healthcare. Without a standard annual physical to catch problems BEFORE one experiences symptoms, Medicare switches seniors from HEALTHCARE to SICKCARE overnight.
You left a message on my 📱recently, right?! I plan on listening to your full message soon! You might need to call me back if I can’t easily locate your complete message. Will let you know!👍🏻
Wow great timing I have my initial welcome to medicare baseline wellness exam this Saturday. its really comforting to know that a person has an advocate who knows what is covered and is not covered. There is so much disinformation about what is covered and is not covered. I will send you an email as I do have a question that I don't want to discuss in an open forum.
sounds good!
Stephanie and her staff are thoroughly professional and timely. Great agency and people.
Thank you Scott, it's such a pleasure working with you!
So nice to fine a spokesperson who truly simplifies the issues facing the newbies to Medicare!
Thank you!
I am addicted to your you tube channel and was watching one after the other. I am 66 and presently still working and covered by health insurance with my employer. I will be retiring this year in June. I was so over whelmed with Medicare choices until I found you. You have explained everything so completely and made supplements
easy to understand. I called your number today and talked with 'Chelsea'. I was so sad when I discovered you were not licensed for Connecticut, where I live. Chelsea did give me a phone number for one of your associates. I am still continuing to watch your you tube channel.
Thank you so much for taking the time to give us a call, and leave this comment! Connecticut is one of the only states we don't work in unfortunately but I hope this channel has given you a great starting point when it comes to transitioning to Medicare. Thank you for watching and Happy New Year!
My AARP Advantage United Health Care HMO PAID me $25 for annualwellness exam and Cologuard test $50. Pretty cool.
I hate to say it, but the annual wellness visit is pretty lame. A lot of procedures done as part of a traditional physical exam are not approved unless you have some chronic condition which may be applicable. It baffles me how CMS actually believes the wellness visit offers any value to seniors. To be honest, everyone signing up for Medicare should be sent a special manual detailing how different the annual wellness visit is from traditional physical exams. I would have loved to learn this information 4 years ago. Thanks so much for bringing it to the attention of new Medicare recipients.
I absolutely agree. Most people don't realize that the Annual Wellness Visit is mainly a "chat" with your doctor. Anything beyond that you may get billed for.
@@AbtInsuranceAgency Luckily I had a pre-existing condition (HBP) which led CMS to approve the $400 blood test. So my visit only cost me about $60 for the deductible. I learned a whole lot after that first visit.
@@redoscar540 Thanks for this, am currently on SSDI with several conditions until I become 65, then will have guarantee issue for Medigap. I'll go with the best available today (a "G" plan). There was one slightly better which waived the Medicare annual deductible that's no longer open to new enrollees. Although existing members can keep these.
While Medicare Advantage (MA) has covered many of my medical needs, to include labs & medicine, am sometimes left with bills that takes a year or longer to pay. The good thing about MA this year was I was able to get a (normally) $500-600 pair of glasses for $100 under the UnitedHealthcare network. Yet given all the more expenses I have to come out of pocket on, will most certainly look for a guaranteed & no physical needed Medigap plan. It's simply important to follow the guidelines regarding signup times (3 months before & 3 months after) one's 65th birthday month. This is a total of 7 months, just like with MA plans.
Due to Medicare not providing prescription coverage, will simply have to accept a low cost drug plan (some of which are $0). This can be freely changed during the open signup times every year, or as allowed by plan (best to discuss this with your agent yearly & have complete list when calling). However, it's important to compare one's prescription coverage of plan, to include co-pays. That $20-25 plan may look expensive until making co-pays, where most of these are less & more drugs available on list. Meaning depending on how many prescriptions are needed, one can save the entire year's cost of policy in the first or 2nd month of the year.
How can a doctor know that you have a medical condition such as high cholesterol or a liver problem unless a blood test is done. What this video says is wait till you get sick or have symptoms of an illness before having the doctor do the testing and then Medicare will cover it. So if I have a heart attack then doctor can take a blood test that is covered when it could have been prevented if a routine screen had been done. That is insane. Wellness exam for me was worthless. Doctor asked a few questions, took my blood pressure and that was it. Total waste.
I agree!
I thought the same thing. So what should be done to prevent this from happening that won’t break the bank? Ie.,should we just go ahead and get a (complete) proper wellness screening?
Proof that Medicare wants all 65 on up dead in the water as soon as possible. No true tests or blood work allowed. All pure BS.
A few routine blood tests are covered, though not necessarily every year. Cholesterol once every five years, for example. But don't expect your doctor to remember or offer them. PSA for men is offered every year.
Not necessarily true. My doctor ordered an EKG without me complaining about anything. He looked at it and said that though he's not a cardiologist, he doesn't like what he saw. He referred me to a cardiologist and shortly thereafter, I had an open heart surgery. That was in 2012. Medicare is doctor driven. No matter how insignificant a pain or ache you may have, note it and tell your doctor. Every illness has a symptom. Listen to your body.
Thank you, Stephanie. This video was very helpful!
Communication with the doctor/staff is key to avoiding charges. I discussed the wellness checks with my doctor during my final routine physical while on United Healthcare Insurance. He told me that they do the same check for a Medicare wellness check (minus the blood tests) and submit the proper code. He also advised that the “welcome to Medicare” check is, at least in my case, a waste of time. That may be because I have a long history with my doctor.
Very true, communicating with your doctor about it is key!
My doctor took the checklist I was once given & tossed in the trash. Took it as a joke to his intelligence.🤣
And a history worth its weight in gold! I told my dr of 25+ years that he cannot retire! 😊
I had a complete physical exam every year of my adult life but after 65 I am no longer eligible.😡 Annual wellness visit is an insult not an exam.
Just proves how much our government values seniors.😡
@@charlestilley2576Smart doctor.
Very informative video!
I'm confused about something regarding the wellness check. At 5:50 of the video it shows a list of screenings that are covered, does this mean blood tests? ex. cholesterol blood tests, diabetes blood tests (A1C). Also I've watched many medicare videos from other people and I have NEVER heard from them that routine physicals are NOT covered. Thank you!
Routine preventative bloodwork that is a part of an annual physical exam that is not related to an illness or diagnosis is not covered.
Ie. A routine physical exam where you have blood tests done to check thyroid, etc … is not covered by traditional Medicare. Bloodwork that is diagnostic and related to an illness or specific condition is covered.
@@AbtInsuranceAgency so If I don't have heart disease or diabetes but just want my cholesterol and blood sugar levels checked every year, they would NOT be covered under the annual wellness check.
Thanks
Thank you Stephanie, All of your videos that I have watched are very informative and you explain the details in a way that is easy to understand. I live in the state of Washington. Do you service the state of Washington?
This was so helpful! Your videos are the best…presentation as well as information!
Thank you so very much!! ☺️
We are brand new to Medicare, we are SHOCKED that the annual physical with our physician is not covered. Will our supplemental insurance cover it? Should we appeal to the doctor to see if he will bill it as a “Medicare wellness visit” even though we want a physical? We are healthy, on no prescription meds and want to continue getting annual physicals to stay that way. Medicare only paying when something is wrong is CRAZY!
Medigap plans only cover services covered by Parts A and or B of Medicare. You should talk to your doctor about having them request “diagnostic testing “ separately from your annual wellcheck so that there is a better chance Medicare will cover this testing.
@@AbtInsuranceAgency Thank you.
My annual "physical exam" last year cost $662, including a blood test, which was paid for by my Medicare Advantage plan. If Medigap insurance covers only what Medicare approves, then this is a good reason for me not to change to a Medigap policy. My typical medical care for a year is for a physical exam, eye exam, & dental exams & cleanings, none of which apparently are covered by Medicare or Medigap.
Definitely something to consider!
Wow, didn’t know this. Thank you. Turn 65 next yr. So, if I have blood work done during a annual wellness exam, part B and a supplement will pay for none of the blood lab bill ? Do Advantage plans generally cover a complete annual physical ?
If we are billed by Medicare, can the bill be resubmitted by the doctor"s office with different codes?
I find your videos super helpful .So fills with great information ..I am turning 64 next month and want to use your company to set me up with all the tools I need ..I know I am early ..but I want to gather as much info as possible ..I am in Los Angeles .Ca ...What’s your email ?...and what is that billing code for the Wellness Examination..Thanks Kent
Kent, please email us any time at stephanie@abtinsuranceagency.com !
I have no idea what the billing code is, but my doctor got more of a payout on my Wellness Exam than my usual monthly visit under Medicare Advantage & did far less.
EXCELLENT
Thanks Stephanie for the video that gives us a lot info. I like it. One agent told me that if I have supplement plan G with Medicare coverage, then the annual physical exam is covered (I don't need to pay anything). But in your video, you said the annual physical exam is not covered. I'm not sure who is right? Please advise. Thanks in advance.
The “Medicare Wellness Exam” is covered , but a full routine physical examination is not covered by Medicare or Plan G. I hope this helps!
@@AbtInsuranceAgency Got it. Thanks Stephanie for your advice. The agent also told me that I can enroll part G now 6 months before I turn 65 in Oct. even I haven't enroll Medicare yet (I'm eligible to roll Medicare next month). Is it true? Thanks,
Stephanie, thank you for this video. We had no idea that annual physicals wouldn't be covered by Medicare. We will use the wellness initial enrollment evaluation. One question: am I right that a Medigap policy will not cover any part of an annual physical?
Rustay Rnova that’s right. Medicare Supplement insurance covers what Parts A and B cover.
This seems to be a subtle but important point. What I understand from this is that medigap does not provide any additional coverage of medical issues over A and B but instead helps to only mitigate the expenses for medical issues that A and B cover but pass some expense onto the patient for that coverage. Is this correct?
@@tommason8104 hey Tom!! It appears Stephanie may have overlooked your post!! You have a very important question that I am on as well: I would answer if I knew for sure!! Best wishes!!
Does this usually happen with Advantage plans?
The "wellness" plan as you describe seems totally useless for me.
Does medicare cover A1C blood test? I usually get an A1C test every 3 months.
I am still working past 65 and have full benefits with my employer. Where do I find the details regarding what I should do to keep my employer benefits and also notify Medicare?
Medicare actually doesn't need to be notified you are delaying, as long as you are not collecting social security benefits yet. You will let them know that you had creditable employer coverage when you do go to apply later on. You can keep your employer plan by renewing regularly!
However, if you employer has less than 20 employees, then you should apply for Medicare when first eligible.
Great info.
If a procedure isnt covered by Medicare, does my medigap insurance cover it after the deductible?
Does it make a difference if your plan is a medicare advantage plan versus medicare?
Yep, she didn't mention the differences in how it works between a Medicare Advantage plan vs. Original Medicare A&B with a Medigap/supplement plan.
I cancelled my annual physical in Oct, because I thought it would be covered. Found out my doctor does not Dr a welcome to Medicare visit. I even asked a few people, even my broker. I think she misunderstood me when I asked if I should cancel my annual appt and wait for my Medicare to kick in to have my physical.
I have issues and was waiting to get them checked when I went in Dec. High cholesterol being one, along with some other issues. Now I am wondering in I should just cancel and never go see my doctor until I get really sick.
I should have blood tests as well as other wellness checks as I have not had some tests for over 3 years. But I guess Medicare would rather fix you after you get cancer or some other disease rather then prevent it. Not feeling good about Medicare right now and mine just started in Nov. I go to my wellness check in Dec or maybe just cancel it as they can't test for anything anyway.
Yes Medicare does not want you to get annual blood work which may discover and prevent a medical issue. I think their goal is for the Medicare recipient to have the heart attack, get the cancer etc to reduce your life span which means less payout of Medicare and social security benefits in the long run.
So I joined July 2022, have not had a wellness exam yet, but did schedule my colonoscopy which I last had 5 yrs ago And was told then to have another in 5 yrs. Reason I sched it plus dad passed from colon cancer. I also would like to schedule a pap and mammogram which again hadn't had one in about 5 yrs also. Do I need to have a wellness exam before I can schedule these last 2, and do I have to schedule a wellness exam if all they are going to do is bp height and weight? Is there a penalty if you don't have a wellness exam?
There is no penalty for not getting a wellness exam.
If you are on prescription drugs and have CPT codes for hypertension, colesterol etc. your labs are covered. I have labs done every year fully covered by Part B and my supplement.
Where can I get a digital copy of the CMS brochure you referenced in this video?
The link below will take you to that brochure:
www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf
Thanks for watching!
@@AbtInsuranceAgency Thank you, Steph
So what’s an average cost for a physical that we’d pay out of pocket. ? Even with my plan G supplemental insurance?
PMIC Medicare Supplement covers 100% of all preventive can including annual physical
Yes.
Would blood work labs be covered if doctor needs those to make sure blood level are correct for drugs currently taking? Example thyroid levels.
It would depend on how the doctor is coding this.
So get a good doctor
In the last four years, I have received four annual exams each with comprehensive blood work, two cataract surgeries, and a colonoscopy. The first cataract surgery was 6 months after the exam, so I had to get a more recent blood test along with an EKG. The second cataract surgery and the colonoscopy both required EKG's but were performed soon after the medical exams so the lab work results were current and considered acceptable. With that said, I have never paid for anything except for the yearly Part B deductible. Original Medicare and my Plan G carrier paid for the rest.
My doctor won’t do a “wellness” exam. She considers it a suit waiting to happen and I totally agree with her. Useless.
Wish I could find a doctor like that.
The "wellness" visit is a waste of time if you can walk in there. No blood work, don't check your heart, lungs, or blood pressure. Its a waste of your time and their money. A regular visit for an ailment will get you more answers. Just cough a couple of times and they will check you out.
Isn't a doctor obligated to tell you the price or cost of anything he is giving you? He can give you anything he wants. I thing I'll be asking for a price list when I walk into his office. Maybe the law should recommed
I have a Medigap Plan N. I had a full annual physical in January and have not received a single bill, other than the annual Part B deductible. It all comes down to how your doctor's office codes the insurance form with the various billing codes. ;) I was very careful in explaining
that I was on a supplement plan, which did not include a physical. (My doctor does not offer wellness checks ... only full physicals).
Good job Mark!! was the difference in price of Parts N to Part G a big difference? has it made any difference. I am leaning to G but value your advice! TY
So, what did you ask for (an annual physical or a annual wellness visit when you called in to make an appointment?
@@enufots4621 My appts (labs and physical) are already made a year ahead (after each physical), so I don't have to ask for anything. (However, I would just ask for an annual physical). Doctor's insurance/billing departments know how to work "with the system" when submitting paperwork.
So, if you have a supplement and need a physical, just call your doctor's office and ask ... and see what they say.
You are extremely fortunate to have this doctor.
So if we buy Supplemental plan, does that cover ?
Typically Medicare Supplement/Medigap plans only cover claims approved by Medicare Parts A and/or B.
I’ve watched many of your videos but probably not in the right sequence. I am 64 1/2 so I want to be prepared. Currently self employed but on my wife’s employer health plan. Wondering if her health plan can act as my supplemental plan?
I have an HMO plan through my employer. Am I required to apply for medi care when I turn 65? I would prefer to defer medi care until I retire at age 67. Thank you.
In many cases you can delay Medicare until you retire, without penalty - this video explains more: th-cam.com/video/UlgLlvfmD6c/w-d-xo.html
What pray tell is exactly included in ain initial preventive physical examination or annual wellness visit and do I have to visit a low income clinic that is FQHC to get one?
Dora, it's basically the same as a marriage physical today. Depending on your health needs, you already may be going to your primary care doctor every 1 to 6 months, I go every three or 4 times yearly. So my doctor doesn't perform these physicals on me anymore, although did get my initial "Welcome to Medicare" physical. Which was exactly what I described above, like that needed for marriage, to basically ensure you're alive & to get a list of current conditions, if any.
The AMA lobbyist had a good day when physicals where excluded.
Can you explain which states you do not work in and why?
Currently MA, CT, WI and MN. Medigap rules and regulations are a bit different there and I am not licensed in those states right now, but have a great referral partner who does work in these areas!
****** Time to update with the new "no surprise medical bills" law? I noticed this is 3yrs ago, or have u done update video on this with new law?
Good tip!
Howdo we find that document?
I have osteopenia & have been for 15+ years (am disabled). It says here that Medicare covers this test. However sometimes, my MA plan will charge a small fee for this test. It's my understanding that the MA plan is supposed to cover (at a minimum) everything that Medicare does, by law. Is this correct?
So initial year and yearly wellness is the same
Does Medicare cover semi annual bloodwork?
It would depend on how it is coded.
This is why when the Dr.s office calls to set up my Medicare wellness check I say no.
Good for you. Its worthless
What Logic is there to not have an annual physical with Blood Work done when you are 65+? Doesn’t make sense at all. Wtf?
Agreed!
Certainly makes ZERO sense, as only lab results can determine or rule out many conditions in it's early stages. This also is more cost effective to the patient & the insurer (Medicare in this instance). Welcome to what? Without a Medigap (or MA) plan, that physical is basically no more than that required for marriage. To ensure you are who you say & are alive.
I suggest to Abt Insurance Agency about your Medigap options. Especially if just eligible & are guaranteed issue. These are my plans at age 65 & will work a sedentary weekend job (allowed by SSDI rules) to pay for these extras.
Because when you turn 65 you are not worth the time or effort. Everything is centered around
the young.
@@mizmarie6511 Is this your personal opinion or are you employed in the insurance industry? Yes I agree that it's best to take care of oneself while young to prevent future health issues, but to say "when you turn 65 you are not worth the time or effort" is exactly what many feared about Obamacare ("death panels", which didn't happen). I've had not only Medicare since 2006 from being disabled, but also Medicare Advantage plans (similar to employer insurance) & have been treated kind by both my doctors & insurers.
My doc wants to see me twice/ year for medication review
Annual physical exam with no physical symptoms is a waste of time and money. Maybe tell you have high blood pressure, which you can test at home.
I think this whole wellness exam is a joke. Please tell me how having a supplemental plan helps you when if Medicare doesn't cover a complete physical then your supp plan won't either. To my way of thinking routine yearly bloodwork is a must. I might as well go to a local health screening yearly and pay for it myself and watch doctors who are you tubers and self treat my symptoms. Many people suddenly find out they have cancer and it is already at stage 4 but they had very minor if any symptoms at all.
Complete blood panel should define a physical exam. Nutrition, vitamin and mineral deficiencies, heavy metal testing and this would shorten the time for diagnosing many health problems.
Why doesn’t the doctor or staff let Medicare patients know ahead of time that a “annual physical “ isn’t going to be covered?
When you sign up for Medicare you get a list of preventative services that are covered. If you request a service, such as a routine physical, your doctor office should tell you that it isn't covered, but otherwise you should read the information.
My Dr informed me, she basically said what Medicare covers is a hands off physical. All questions, so if you want bloodwork done and want it covered, you need to have a complaint or symptom. It's crazy, all the years I worked, it was mandatory(or you paid more for your health coverage) to have a physical. Then when you most likely will benefit from it, it's not covered.
does the supplement N plan then cover routine bloodwork or are they exempt also?
Medicare Supplement Plans cover what Medicare A and B covers. So if Medicare denies the claim (ie. doesn't cover routine preventative labs) then the Medigap Plan won't pay on it either.
This info is very useful because Medicare does NOT clarify such issues.
im new to medicare i need help !
That's what we're here for! Call us anytime, (888) 465-9728 😊
Bloodwork alone could easily cost $500-700...
Yes depending on what your doctor ordered. And if Medicare doesn’t cover it, you pay the full billed amount, not the reduced insurance amount. Prior to being on Medicare, if my employer health insurance did not cover something, they reduced the charge to what the allowed amount was under the plan and that is what I would be billed for. Not Medicare, you will be billed for whatever the doctor billed Medicare for which is usually an inflated charge.
Im about to be 65 and I'm not sure about part D .
Question : can I withdraw from part D at any time or a year after I got part D ? I will appreciate your answer. Thanks
Noel, yes you can cancel your Part D drug Plan, or simply not pay your Part D premiums and the plan will cancel. However, if you go more than 63 days without creditable drug coverage you will be assessed a penalty if you choose to enroll in Part D again in the future.
When you turn 65 you are no longer worthy of a physical.😡
Plan F
Do Advantage Plans cover an "annual routine physical exam"?
Medicare Advantage plans typically covers MORE than the "Welcome to Medicare" physical & is often free of cost. I go so often that they don't do the usual annual on me, because labs are required to monitor Prediabetes & high (or bad) LDL cholesterol levels.
Most MA plans also has lots of included educational materials, plus free virtual nurse visits. While these won't be able to issue a prescription, will help a member decide to go to a doctor, or if an over the counter medicine may be helpful. However, please don't call this number for sudden chest pain, headaches or anything one would consider calling 911 over.
Disgusting and discriminatory! Many seniors don’t know this ...they just wonder why their doctor suddenly stopped providing a standard annual preventive checkup! An annual checkup allows your doctor to go through a checklist of exams to catch problems before they happen. Now a senior needs to create their own list and ask for each and every exam and if they forget something or are embarrassed to ask, they pay the price with $ and their health.
I'm inviting others to ontact your legislators and alert them! This is not acceptable! Why should there be a game as referred to in this video? Health insurance is not supposed to contain a “gotcha” and people need to stop accepting subpar services. Senior citizens paid for this in payroll deductions AND continued premiums. Insurance always paid for an annual physical. Medicare needs to do the same. Seniors should not be expected to “play the game” to get decent healthcare. Without a standard annual physical to catch problems BEFORE one experiences symptoms, Medicare switches seniors from HEALTHCARE to SICKCARE overnight.
You left a message on my 📱recently, right?! I plan on listening to your full message soon! You might need to call me back if I can’t easily locate your complete message. Will let you know!👍🏻
please help me
My God get to the point Jesus
EXCELLENT