Absolutely, but in the healthcare sphere, you definitely need to be your own best advocate. If they can bill for more, all too often, they will. Thanks for your comment!
Does a Plan G cover a yearly physical that traditional Medicare A and B does not? While I'm not on any medications, I have a couple borderline issues that my PCP checks yearly through bloodwork. It would be odd to suddenly not have those checked and covered.
Plan G will cover all of your copays and coinsurance. So, if you need to see your doctor, there should be no charge. If you have borderline issues as you stated and your PCP is keeping an eye on them through bloodwork, he/she should be billing as diagnostic, so you should good! If for whatever reason, they ask you to sign the form I mentioned, then you should question how they are billing the visit. Thanks for your question!
All these "complexities" could've been solved by the government by requiring heath care providers to absorb the cost of ALL surprise bills. It's that easy.
Unraveling the Medicare Maze: Key Insights to Keep Your Costs Down From physicals to screenings and Medigap coverage, here’s how to navigate Medicare’s complexities and avoid unexpected bills. Introduction: If you’ve ever walked into a doctor's office expecting a routine check-up and walked out with a bill in hand, you’re not alone. Understanding the ins and outs of Medicare coverage can be tricky, but it’s essential for preventing surprises. This article breaks down critical aspects of Medicare wellness exams, physicals, and additional coverage options to help you manage your healthcare with confidence. With these tips, you’ll be ready to maximize your benefits while minimizing out-of-pocket expenses. 1. Medicare Part B (1:02) Covers medical insurance for doctor visits. Divided into hospital insurance (Part A) and medical insurance (Part B). Medicare Part B is your go-to coverage for doctor’s visits. Anytime you see your primary care physician (PCP), Part B is likely being billed. It’s crucial to understand what is and isn’t covered under Part B to avoid unexpected charges. This includes understanding preventive services, routine care, and the limits of what Medicare will pay for each service. 2. Medicare Physical vs. Medicare Wellness (1:31) Different types of visits: Welcome to Medicare, Wellness Visit, Routine Physical. Timing matters for coverage. Medicare distinguishes between three types of check-ups: the Welcome to Medicare visit, the Medicare Wellness visit, and routine physical exams. While the first two are fully covered, routine physicals are not. Understanding the purpose and timing of each visit ensures that you won’t be stuck with a large bill for services you thought were covered. 3. Write This Down! (4:00) Physical exams not related to a specific condition may not be covered. Important to know the rules to avoid liability. Here’s a key takeaway: physical examinations that aren’t for diagnosing or treating a specific medical condition aren’t covered by Medicare. If you’re going in for a routine check-up without a specific complaint, you could be footing the bill. Be sure to ask your provider if the visit qualifies under Medicare’s coverage guidelines before scheduling that appointment. 4. Screenings (4:53) Medicare offers comprehensive coverage for preventive screenings. Operate within Medicare’s guidelines to avoid extra costs. Medicare provides excellent coverage for preventive screenings, but only if you stay within their guidelines. Regular screenings, such as mammograms and colonoscopies, can be fully covered-but stepping outside those parameters can lead to hefty bills. To maximize your benefits, ensure that all screenings are performed within Medicare’s approved schedule. 5. Screening vs. Diagnostic (5:44) Transitioning from screening to diagnostic can increase costs. Example: A routine colonoscopy could turn into a diagnostic test if tissue is removed. Sometimes, a screening can unexpectedly turn into a diagnostic procedure, and that’s when costs can add up. Take colonoscopies, for example: if you go in for a preventive screening and your doctor finds and removes a polyp, that changes the visit from fully covered to partially out-of-pocket. It’s important to be prepared for these scenarios. 6. Medigap (7:09) Medigap fills financial gaps left by Original Medicare. Offers 10 different plans with varying levels of coverage. One of the best ways to protect yourself from unexpected Medicare costs is by enrolling in a Medigap plan. These supplemental insurance plans help cover deductibles, co-insurance, and out-of-pocket expenses that Medicare doesn’t fully cover. With 10 different plans available, it’s important to choose the one that best fits your needs and budget. These plans can be a financial lifesaver, especially for those needing frequent medical care. Summary: Navigating Medicare’s complex coverage rules can feel overwhelming, but understanding the key differences between covered services and out-of-pocket costs can save you from unpleasant surprises. From distinguishing between physicals and wellness exams to maximizing your Medigap benefits, proactive planning is your best defense against unexpected bills. With the right knowledge, you can ensure that your healthcare is both affordable and comprehensive.
Supplement plans like G or N only cover services that are covered by original Medicare. So no, they won't cover a routine Physical and blood labs. Advantage plans usually will cover those services, though.
Original Medicare doesn't cover what would be considered a "routine annual physical". But if you went in with a specific complaint (i.e. sinus infection, stomach pain, etc...) it would be considered diagnostic. For these types of visits and diagnostic tests, there are copays or coinsurance. Medicare Supplement plans (i.e. Plan G or Plan N) would step in to cover these copays or coinsurance. Thank you for your question!
There is a fourth type of scam office visit that you will pay for. It’s called the “meet the doctor” visit. This is when you change your primary care physician. It’s possible now to buy your blood test online and usually for way less than what you will pay through the doctor. Do this and take the results with you to your wellness visit. If he or she refuses to go over the results with you, say goodbye and find another doctor.
You never did go back and explain how you can get most things covered which you said you would. I don't understand the part where you say a physical isn't covered. I have heard this before but I've talked to people on Medicare who say they get all their labs and physicals covered.
Please check the time stamp for Medicare Supplement plans! Medicare Supplement plans cover many if not most of your out of pocket costs. Physical examination and labs can be covered as diagnostic but it is important to understand the semantics because if your doctor does not bill them as diagnostic you can be responsible for the full bill. Than you for your question!
@@tegayle7961 Should they? Absolutely. Do they have to if you ask just ask for a general physical? Absolutely not. If the visit is not diagnostic in nature nor is it the medicare wellness or welcome visit, you can be billed. Unfortunately, it is these assumptions that often lead to unexpected bills. It sounds like you have a doctor who is looking our for your best interests though! Thank you for your comment.
Well, most people 65 or older already have known, ongoing medical conditions that are already under treatment, so I don't see why you need a "routine physical". All you really need are routine follow-up visits.
What a click bait title. The ACA gave folks on Medicare a FREE annual "wellness" checkup. If you are on Medicare and got a bill, it's up to you to correct them. Not watch a stupid video
Except you absolutely cannot correct it if you have signed the paperwork we mentioned. It is much easier to prevent a simple mistake rather than going back and forth with billing departments and Medicare once you have made the mistake.
You can often get those benefits with a Medicare Advantage plan but that's definitely not always the best solution. There may be changes coming though. Thanks for your insight!
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As usual, helpful and comprehensive information. Thank you! I am 62 and preparing for Medicare enrollment now with your help. 😊
Thank you for your kind words!
You have to ask for a series of SCREENINGS, not a physical exam.
Thanks for the feedback. Yes, asking for a physical can unfortunately be problematic!
If you have a decent doctor, they know what to do properly to give you a physical , I just don't call it a physical.
Absolutely, but in the healthcare sphere, you definitely need to be your own best advocate. If they can bill for more, all too often, they will. Thanks for your comment!
Does a Plan G cover a yearly physical that traditional Medicare A and B does not? While I'm not on any medications, I have a couple borderline issues that my PCP checks yearly through bloodwork. It would be odd to suddenly not have those checked and covered.
Plan G will cover all of your copays and coinsurance. So, if you need to see your doctor, there should be no charge. If you have borderline issues as you stated and your PCP is keeping an eye on them through bloodwork, he/she should be billing as diagnostic, so you should good! If for whatever reason, they ask you to sign the form I mentioned, then you should question how they are billing the visit. Thanks for your question!
All these "complexities" could've been solved by the government by requiring heath care providers to absorb the cost of ALL surprise bills. It's that easy.
It does seem needlessly complicated sometimes!
I was told by my new doctor’s office that I can’t get a Welcome to Medicare visit until he sees me first. Is this true?
No. Your initial visit can be the "Welcome to Medicare" visit. Sounds like it may just be that particular doctor's policy to do it that way.
I can't imagine why that would be. So, do they expect you to pay out of pocket to then have a Welcome to Medicare visit?
Agreed (and it seems like an unusual policy to me...)
Unraveling the Medicare Maze: Key Insights to Keep Your Costs Down
From physicals to screenings and Medigap coverage, here’s how to navigate Medicare’s complexities and avoid unexpected bills.
Introduction:
If you’ve ever walked into a doctor's office expecting a routine check-up and walked out with a bill in hand, you’re not alone. Understanding the ins and outs of Medicare coverage can be tricky, but it’s essential for preventing surprises. This article breaks down critical aspects of Medicare wellness exams, physicals, and additional coverage options to help you manage your healthcare with confidence. With these tips, you’ll be ready to maximize your benefits while minimizing out-of-pocket expenses.
1. Medicare Part B (1:02)
Covers medical insurance for doctor visits.
Divided into hospital insurance (Part A) and medical insurance (Part B).
Medicare Part B is your go-to coverage for doctor’s visits. Anytime you see your primary care physician (PCP), Part B is likely being billed. It’s crucial to understand what is and isn’t covered under Part B to avoid unexpected charges. This includes understanding preventive services, routine care, and the limits of what Medicare will pay for each service.
2. Medicare Physical vs. Medicare Wellness (1:31)
Different types of visits: Welcome to Medicare, Wellness Visit, Routine Physical.
Timing matters for coverage.
Medicare distinguishes between three types of check-ups: the Welcome to Medicare visit, the Medicare Wellness visit, and routine physical exams. While the first two are fully covered, routine physicals are not. Understanding the purpose and timing of each visit ensures that you won’t be stuck with a large bill for services you thought were covered.
3. Write This Down! (4:00)
Physical exams not related to a specific condition may not be covered.
Important to know the rules to avoid liability.
Here’s a key takeaway: physical examinations that aren’t for diagnosing or treating a specific medical condition aren’t covered by Medicare. If you’re going in for a routine check-up without a specific complaint, you could be footing the bill. Be sure to ask your provider if the visit qualifies under Medicare’s coverage guidelines before scheduling that appointment.
4. Screenings (4:53)
Medicare offers comprehensive coverage for preventive screenings.
Operate within Medicare’s guidelines to avoid extra costs.
Medicare provides excellent coverage for preventive screenings, but only if you stay within their guidelines. Regular screenings, such as mammograms and colonoscopies, can be fully covered-but stepping outside those parameters can lead to hefty bills. To maximize your benefits, ensure that all screenings are performed within Medicare’s approved schedule.
5. Screening vs. Diagnostic (5:44)
Transitioning from screening to diagnostic can increase costs.
Example: A routine colonoscopy could turn into a diagnostic test if tissue is removed.
Sometimes, a screening can unexpectedly turn into a diagnostic procedure, and that’s when costs can add up. Take colonoscopies, for example: if you go in for a preventive screening and your doctor finds and removes a polyp, that changes the visit from fully covered to partially out-of-pocket. It’s important to be prepared for these scenarios.
6. Medigap (7:09)
Medigap fills financial gaps left by Original Medicare.
Offers 10 different plans with varying levels of coverage.
One of the best ways to protect yourself from unexpected Medicare costs is by enrolling in a Medigap plan. These supplemental insurance plans help cover deductibles, co-insurance, and out-of-pocket expenses that Medicare doesn’t fully cover. With 10 different plans available, it’s important to choose the one that best fits your needs and budget. These plans can be a financial lifesaver, especially for those needing frequent medical care.
Summary:
Navigating Medicare’s complex coverage rules can feel overwhelming, but understanding the key differences between covered services and out-of-pocket costs can save you from unpleasant surprises. From distinguishing between physicals and wellness exams to maximizing your Medigap benefits, proactive planning is your best defense against unexpected bills. With the right knowledge, you can ensure that your healthcare is both affordable and comprehensive.
Interesting summary 🙂 Thanks for your comment!
So.... Original Medicare doesn't cover physicals and blood lab panels.... Would a Plan G or Plan N supplement cover those costs?
Supplement plans like G or N only cover services that are covered by original Medicare. So no, they won't cover a routine Physical and blood labs. Advantage plans usually will cover those services, though.
Original Medicare doesn't cover what would be considered a "routine annual physical". But if you went in with a specific complaint (i.e. sinus infection, stomach pain, etc...) it would be considered diagnostic. For these types of visits and diagnostic tests, there are copays or coinsurance. Medicare Supplement plans (i.e. Plan G or Plan N) would step in to cover these copays or coinsurance. Thank you for your question!
They can! But It definitely depends on the terms of your plan (which can be tricky!). Thank you for your response.
Thank you.
Glad to be of help!
There is a fourth type of scam office visit that you will pay for.
It’s called the “meet the doctor” visit. This is when you change your primary care physician.
It’s possible now to buy your blood test online and usually for way less than what you will pay through the doctor.
Do this and take the results with you to your wellness visit. If he or she refuses to go over the results with you, say goodbye and find another doctor.
Really? A "meet the doctor" visit? I hadn't heard of that one- how annoying! Thanks for the warning!
@@iHealthBrokers It’s nothing more than a money grab. They billed Medicare $300.
You never did go back and explain how you can get most things covered which you said you would. I don't understand the part where you say a physical isn't covered. I have heard this before but I've talked to people on Medicare who say they get all their labs and physicals covered.
Please check the time stamp for Medicare Supplement plans! Medicare Supplement plans cover many if not most of your out of pocket costs. Physical examination and labs can be covered as diagnostic but it is important to understand the semantics because if your doctor does not bill them as diagnostic you can be responsible for the full bill. Than you for your question!
I have been on Medicare for years and my annual physical, tests and labs r fully covered. Ur doctor should know how to bill this to get reimbursed.
@@tegayle7961 Should they? Absolutely. Do they have to if you ask just ask for a general physical? Absolutely not. If the visit is not diagnostic in nature nor is it the medicare wellness or welcome visit, you can be billed. Unfortunately, it is these assumptions that often lead to unexpected bills. It sounds like you have a doctor who is looking our for your best interests though! Thank you for your comment.
I believe i saw that you can initially choose an advantage plan for one year then switch to a Supplement plan without underwriting... correct?
Yes, if you are within that trial right period. Great question!
Im not sure I beleive this. I just had a full physical and paid $35. That with just Medicare part A & B.
Your doctor likely billed it as a diagnostic visit as opposed to a "physical". Thanks for your comment!
I get a “wellness” check every 6 months that is covered by Medicare.
They are probably billing it as a diagnostic visit, but as long as you are not getting unexpected bills, that's great! Thanks for your comment!
I really never knew this!
@@lifemadeeasier697 it’s pretty surprising, isn’t it?
Well, most people 65 or older already have known, ongoing medical conditions that are already under treatment, so I don't see why you need a "routine physical". All you really need are routine follow-up visits.
One every several years might be prudent.
Good point (as long as your doctor is filing it as diagnostic!)
Unfortunately, if they bill it as a physical then you'd likely have to pay!
You are a broker.
Correct. It's even in our name! Thanks for your comment!
Definitely not a joke lol
@@TheJesp01 haha! Too true!
It’s a complete joke, she doesn’t have her facts right.
@@herculesrockefeller8969that’s just patently untrue. This information is literally pulled from Medicare.gov.
What a click bait title. The ACA gave folks on Medicare a FREE annual "wellness" checkup. If you are on Medicare and got a bill, it's up to you to correct them. Not watch a stupid video
Except you absolutely cannot correct it if you have signed the paperwork we mentioned. It is much easier to prevent a simple mistake rather than going back and forth with billing departments and Medicare once you have made the mistake.
Medicare should at the very least cover everything covered by Medicaid.
Never understood that. Medicaid will pay dental, eyeglasses, hearing aids, nursing home cost and more. But Medicare that we pay for wont.
@damham5689 We're paying for their care AND ours. It's ludicrous!
It's a big problem because so many people don't qualify for Medicaid BUT still don't have enough extra income to afford the benefits you mentioned.
You can often get those benefits with a Medicare Advantage plan but that's definitely not always the best solution. There may be changes coming though. Thanks for your insight!
This is how welfare works. So do you want to deny them healthcare, or do you want to get healthcare free also?
Do any other viewers find the bangs on her right side flicking when she blinks her eyes distracting?
So sorry that the blinking and existence of hair was distracting to you! We will try to rectify that in the future. Have a good day!
@@iHealthBrokers thanks. First time to your channel, good content.
@@JimzAuto Glad to be of help!
@@iHealthBrokers I have rectified the hair issue in my case by losing it! : -)
@@MikeD_ 😂😂😂 I guess that's one solution!