Question for those on Medicare

Sheanie

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Joined
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Location
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Today I had to smile and nod my way thru a mandated virtual appt with the NP in order to refill my meds for asthma, allergies and depression. All told, my care providers office manager requires me to keep 4 yearly appts. 1) well woman, 2) annual physical, 3) chronic health issues, and 4) prescription review and refill.

My question is this: When I am on Medicare, do you, my smart Peeps, think they will require all these (useless) extra visits? Or will they suddenly NOT require so many separate visits to administer what should be done in one annual visit?
 
Actually, the well woman is highly constrained to not include chronic issues or medications. If you use your PCP for the well woman, it can be combined with and under the annual physical.

Annual physical: https://www.medicare.gov/coverage/yearly-wellness-visits

Chronic issues and prescriptions/refills can be combined but not with the annual physical.

I had an annual physical and later got my well woman. They denied my annual physical cause my well woman had been coded as annual physical. Took me forever to get them resubmitted.

Are you on just Medicare A/B or do you have a MedSup plan or did you roll it all into a Medicare Advantage plan?
 
Actually, the well woman is highly constrained to not include chronic issues or medications. If you use your PCP for the well woman, it can be combined with and under the annual physical.

Annual physical: https://www.medicare.gov/coverage/yearly-wellness-visits

Chronic issues and prescriptions/refills can be combined but not with the annual physical.

I had an annual physical and later got my well woman. They denied my annual physical cause my well woman had been coded as annual physical. Took me forever to get them resubmitted.

Are you on just Medicare A/B or do you have a MedSup plan or did you roll it all into a Medicare Advantage plan?
Currently still on commercial insurance. I dont know anything about medicare. Just looking for others experiences.
 
Currently still on commercial insurance. I dont know anything about medicare. Just looking for others experiences.
You’ll need to get with a Medicare Insurance advisor to find the best plan for you. Unlike commercial insurance, there is no family plan. It’s your plan and your hubby has his own plan.
 
Liz knows WAY more than I do, but I suspect it might depend on what kind of policy you get.

In my opinion...you are currently required to have these appointments because they are important to the health of ...the fiscal health...of the practice. With Medicare, it’s more of “what services WILL THEY pay for” than “what services will they make you endure.”


I don't think I’m required to have an annual wellness visit...but the doctor’s office “offers” it and I go along with the program. Once I do, I wonder why I bothered. And now, shamefaced, I announce I had never heard of a Well Woman Visit. Duh.

So I looked and found a discussion of the billing for the two types:
https://capturebilling.com/wp-content/uploads/2015/08/Medicare-Billing-for-a-Well-Woman.pdf
 
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I’m still figuring it out. My annual has ended up in October because I started my Medicare in September. But I do my labs in June/July, so my annual checkup could be around my surgiversary in August.

I haven’t had a separate well woman visit yet - my PCP doesn’t think I need annual cervical exams, and I just do an annual squishogram.

I’m hoping the switch to TeleHealth appointments during C19 will stick around for med checks, therapy and non-hands-on appointments afterwards. I like not having to waste my time driving and sitting near dick people for no good reason. (Or putting on pants, for that matter.)
 
Liz knows WAY more than I do, but I suspect it might depend on what kind of policy you get.

In my opinion...you are currently required to have these appointments because they are important to the health of ...the fiscal health...of the practice. With Medicare, it’s more of “what services WILL THEY pay for” than “what services will they make you endure.”


I don't think I’m required to have an annual wellness visit...but the doctor’s office “offers” it and I go along with the program. Once I do, I wonder why I bothered. And now, shamefaced, I announce I had never heard of a Well Woman Visit. Duh.

So I looked and found a discussion of the billing for the two types:
https://capturebilling.com/wp-content/uploads/2015/08/Medicare-Billing-for-a-Well-Woman.pdf
I think you nailed it. My care plan is prioritized by what they can bill ins for. Case in point, they have cancelled 2 of their "required" appts 10 min before due to ins non coverage.
 
I’m still figuring it out. My annual has ended up in October because I started my Medicare in September. But I do my labs in June/July, so my annual checkup could be around my surgiversary in August.

I haven’t had a separate well woman visit yet - my PCP doesn’t think I need annual cervical exams, and I just do an annual squishogram.

I’m hoping the switch to TeleHealth appointments during C19 will stick around for med checks, therapy and non-hands-on appointments afterwards. I like not having to waste my time driving and sitting near dick people for no good reason. (Or putting on pants, for that matter.)
I dont get any pelvic exam or pap. Nothing to see there.

I, too, am liking this telehealth stuff. Although I havent been billed yet. I did confirm my coverage.

I am looking forward to SS and retirement, now that I have had a taste of what it might be like. Minus the traveling and grandbaby, that is.
 
I just was discussing the costs of Medicare with my daughter:

Our Medicare costs are about $135 each for Part B, about $130 each for Part G, and $20 each for Part D (meds). $185 per year deductible each, and some med copays. Mine are somewhat high for Adderall and Pristq.

$3240 + 3120 + 480 + 370 = 7210 plus copays for meds is another 800 or so, so about $8000 for the two of us.

Charles’ copay for the Xifaxan was $1000/mo - I applied to the manufacturer for patient assistance and he’s getting it for free!
~~~~
So hardly free, and post-tax dollars, but no copays for doctors’ appointments and very limited preauthorization required (so far, just for high end drugs).
 
You can find all you need online at Medicare but if you have never dealt with it, it can be confusing.
You start by going online and creating a profile on Medicare, including your zip code. Then add all maintenance medications.
Then read up on whether you want a Medicare Advantage plan (called Part C) which includes A&B and can include part D, prescriptions or go the original Medicare A&B, add a Medicare Supplement and a Prescription plan.

From what I’ve heard, plan G is the best Med Sup now.

The biggest difference between the “all in one” plan and going the Med Sup and Prescription route is access to medical professionals. Most Advantage plans are an HMO or a regional PPO.

It’s because of the regional, that I ended up with Boyce instead of Pomp for my DS. They had no issue with which surgery. They had major headaches with my wanting to go outside of TN. I spent about a month calling every bariatric clinic in TN with three questions: 1) Did they perform the DS ( I knew the answer but had to call and document the answer), 2) Did they perform the DS on lightweights, and 3) Did they accept Medicare. And I had to call all of them to get an exception to their policy. Boyce was my last call cause I was already with his partner at the time, Williams who is an asshat.

Personally I would avoid any policy thru BCBS as they are real asshats about going out of state. When we moved to NC in 2013, our house was less than a 5 mile walk to the SC state line. But my PCP has to be in NC, closest one was 40 mins away. As soon as we could, (during enrollment), we changed to Humana Medicare which based it on zip code not state. A 50 mile radius from our house included several major hospitals and my PCP of choice, all in S.C.
 
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Today I had to smile and nod my way thru a mandated virtual appt with the NP in order to refill my meds for asthma, allergies and depression. All told, my care providers office manager requires me to keep 4 yearly appts. 1) well woman, 2) annual physical, 3) chronic health issues, and 4) prescription review and refill.

My question is this: When I am on Medicare, do you, my smart Peeps, think they will require all these (useless) extra visits? Or will they suddenly NOT require so many separate visits to administer what should be done in one annual visit?
I have Medicare but it is secondary. I also see an Obgyn for well woman and an allergy specialist for my allergies but that was before Covid. Medicare requires me to go to my pcp 2x a year and my next appointment is in June. We shall see how that goes. I don’t actually want to see anyone right now unless I am really sick.
 

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