Is Medicare Free?

[imoldernu]

Most everyone here will already know the answer, but for those who aren't there yet, this short Forbes article is a quick overview of what to expect at age 65, with regards Medicare costs.

https://www.forbes.com/sites/forbesfinancecouncil/2017/06/19/is-medicare-free/#762f39ae57ef

 

[kcowan]

And your company might pay when you retire. Another thing to check out.

 

[Silver]

I just started on regular Medicare last August and am learning some facts about the cost myself, so this is a timely thread.

I saw my PCP for a routine visit in May. Checking the Medicare site, I saw that the visit was denied payment from Medicare because it was coded as a "periodic preventive exam" 99397. When I checked out at the front desk I was told it would be billed as a "physical".

Doing some research I found out that this code 99397 is never covered by Medicare. There is one annual "Wellness" visit that is covered which is code G0438 or G0439, but this would not have applied to me because I had Medicare less than 12 months, and had already had the "Welcome to Medicare" visit coded G0402 within those 12 months.

I have already met my Medicare Part B deductible for the year. I have a high deductible plan F which didn't pay for two reasons: It was denied by Medicare and I have not reached the deductible. So.....I am surprised to realize I will be paying the full $225.00 billed by my provider. I assume providers use this code so they will be paid the full billing amount and not have to accept a discounted amount from Medicare.

I'm being treated by this PCP for hypertension and high cholesterol, so it's not as if there is nothing to claim treatment for. I will have some discussion with my PCP at the next visit regarding her plans for coding future visits, but this is a good learning for me related to Medicare costs.

 

[audreyh1]

I just started on regular Medicare last August and am learning some facts about the cost myself, so this is a timely thread.

I saw my PCP for a routine visit in May. Checking the Medicare site, I saw that the visit was denied payment from Medicare because it was coded as a "periodic preventive exam" 99397. When I checked out at the front desk I was told it would be billed as a "physical".

Doing some research I found out that this code 99397 is never covered by Medicare. There is one annual "Wellness" visit that is covered which is code G0438 or G0439, but this would not have applied to me because I had Medicare less than 12 months, and had already had the "Welcome to Medicare" visit coded G0402 within those 12 months.

I have a high deductible plan F which didn't pay for two reasons: It was denied by Medicare and I have not reached the deductible. So.....I am surprised to realize I will be paying the full $225.00 billed by my provider. I assume providers use this code so they will be paid the full billing amount and not have to accept a discounted amount from Medicare.

I'm being treated by this PCP for hypertension and high cholesterol, so it's not as if there is nothing to claim treatment for. I will have some discussion with my PCP at the next visit regarding her plans for coding future visits, but this is a good learning for me related to Medicare costs.

You haven't been billed yet, right? It may go through more processing.

 

[Blue Collar Guy]

Great more confusing stuff to look forward to! Wait, what am i worried about? I will probably be dead before im 65, or it will go broke the day before im eligible. If i live to get it, im sure ill be denied i.I am sure a means test will be instituted by then.

 

[braumeister]

Great more confusing stuff to look forward to! Wait, what am i worried about? I will probably be dead before im 65, or it will go broke the day before im eligible. If i live to get it, im sure ill be denied i.I am sure a means test will be instituted by then.

I don't think you have anything to worry about. I think saw this recently on the Medicare website:

Q: Is there any chance of Medicare going broke or shutting down?

A: No, none at all. The Medicare program was designed from the start to be self perpetuating. Of course, that doesn’t mean there won’t be some adjustments in the best interest of all.

For example, it was recently determined that retirees in New York City tend to be much more affluent than those in the rest of the nation. So in the interest of fairness, next year (2017) an appropriate surcharge will be applied to Medicare payments for enrolled NYC participants. Instead of the usual 20% deductible for most treatments covered under Part B, the surcharge will increase their deductible to 750% (sometimes higher). In this way, those who are unfortunate enough to live outside the Big Apple can be somewhat compensated for not having access to the finer things of life.

 

[jonat]

DW just went on Medicare and it is confusing - even more so because, for the next year or so, she is covered under my employer-based plan, so there needs to be coordination of benefits. Medicare is always primary, but if you're in this situation you have to ask your insurance company to arrange for automatic coordination with Medicare.

Regarding physicals - those new to Medicare get a "wellness" visit that includes the office visit but NOT any of the tests. It took me THREE MONTHS to get my insurance company to pay for DW's blood work for her physical.

 

[Sunset]

....
I'm being treated by this PCP for hypertension and high cholesterol, so it's not as if there is nothing to claim treatment for. I will have some discussion with my PCP at the next visit regarding her plans for coding future visits, but this is a good learning for me related to Medicare costs.

Your PCP will probably charge you extra for that visit since you want to discuss billing.

Seems it is something you can phone the office about without an appointment and discuss it with the billing staff (medical knowledge not required to bill properly).

 

[Silver]

You haven't been billed yet, right? It may go through more processing.

Good point. Perhaps the PCP's office will adjust the amount billed. I doubt it, but I can always hope.

I wanted to mention this incident only because we are told by Medicare that "TYPICALLY" we are billed about 20% of what is charged once the deductible is met, and then our Medigap plan comes into play. This is one example of when Medicare is bypassed completely by a provider, and we may be billed 100% of the charge as if there was no insurance at all.

Most of us here try hard to anticipate our future costs. I thought I had these costs pretty well nailed down once I got onto Medicare. I'm suddenly realizing that may not be true.

 

[athena53]

For example, it was recently determined that retirees in New York City tend to be much more affluent than those in the rest of the nation. So in the interest of fairness, next year (2017) an appropriate surcharge will be applied to Medicare payments for enrolled NYC participants. Instead of the usual 20% deductible for most treatments covered under Part B, the surcharge will increase their deductible to 750% (sometimes higher). In this way, those who are unfortunate enough to live outside the Big Apple can be somewhat compensated for not having access to the finer things of life.

Are they serious? People living in NYC aren't all rich and the cost of living there is crazy high. And why doesn't this apply to Seattle San Francisco, LA and other affluent areas? Also not sure how a "750% deductible" works. And, if you are "rich" you pay the IRMAA surcharge for Medicare B anyway, regardless of where you live.


Silver, thanks for the cautionary tale. I'm due for an annual exam in December and figured I'd postpone it to early next year when I'm on Medicare; current plan has lousy out-of-network coverage and my doc, whom I like very much, is out-of-network. Looks like I could get stuck with 100% of that visit.

 

[braumeister]

Most of us here try hard to anticipate our future costs. I thought I had these costs pretty well nailed down once I got onto Medicare.

Thanks, I needed a good laugh today.

Seriously, it has always been a mystery to me why most other developed countries have figured out how to control healthcare costs, but we haven't. Maybe someday.

 

[REWahoo]

Are they serious?

Zing!

Maybe someday.

Please stop, you're killing me!

 

[aja8888]

After being on Medicare for 8 years now, there are two things that you MUST do before meeting with a doctor or going for a test:

1. ASK (verify) the provider if they accept Medicare. If not, move on.

2. Once they say they accept it, CALL Medicare and ASK them if the visit/procedure/test will be covered by them.

Other than that, pray for no coding mistakes, of which, YOU will have to get resolved. (ask me how I know)

 

[Silver]

Your PCP will probably charge you extra for that visit since you want to discuss billing.

Seems it is something you can phone the office about without an appointment and discuss it with the billing staff (medical knowledge not required to bill properly).

I did speak with both the office staff and then billing office. They said that this is a common Medicare code used by all providers, and that it is correctly coded and billed.

When I asked if they knew that Medicare never covers charges when that code is used, they said they believed that the provider did know this, but that since this was the service I was provided it would be fraud to charge anything else.

I'll wait to see what I am actually billed by their office, and also discuss this with my PCP when I see her next. I like her, have trusted her input in the past, but my decision to continue with her may depend on her response.

 

[Just_Steve]

I don't think you have anything to worry about. I think saw this recently on the Medicare website:

BCG is going to have a stroke and you sir will be to blame.

 

[braumeister]

BCG is going to have a stroke and you sir will be to blame.

Hey, I'm to blame for so many things I've lost count.

Anyway, I guess I should apologize for not including a few smileys in that post. Honestly, it was totally tongue in cheek.

 

[CRLLS]

DW just went on Medicare and it is confusing - even more so because, for the next year or so, she is covered under my employer-based plan, so there needs to be coordination of benefits. Medicare is always primary, but if you're in this situation you have to ask your insurance company to arrange for automatic coordination with Medicare.

Regarding physicals - those new to Medicare get a "wellness" visit that includes the office visit but NOT any of the tests. It took me THREE MONTHS to get my insurance company to pay for DW's blood work for her physical.

.

I can't speak to your experience but I can speak for DW. There is a one time "Welcome to Medicare" visit that is covered within a certain time limit for all those that are new to Medicare .

DW had the following tests covered 100%, all done my her GP

EKG
Blood work
Pneumonia shot
Pap Test
Mammogram


The "Wellness" is a free annual office visit for all Medicare members. It is more like a follow-up office visit to see how you are doing in general. If they treat you for anything, it is not coded as a Wellness Visit and there may be deductibles or other charges involved. Check the Medicare site for details about certain vaccinations. Some are covered by Part B, Others are covered under the Part D plans.

 

[LARS]

Pardon my ignorance as Medicare is still more than a few years away still.

My question: on Part A and Part B is there a maximum out of pocket or are you on the hook for 20% with no cap?

 

[braumeister]

It's 20%. That's why Medicare supplemental plans are popular.

 

[imoldernu]

I posted this on another thread, but for those who receive billings from your healthcare provider, suggest you use the "3 month rule"... in other words, "wait", as it takes time for billings and payments to be finalized, and receiving a followup bill from the doctor, is often premature.
We haven't had a problem with billing in many years... just don't panic when a follow up bill comes in.

On the other hand, paying that 2nd bill can "get lost" depending on your doctor's morality.

In any case, if a problem persists, you'll always receive a warning about how failure to pay will affect your credit standing.... That's the time to call to straighten things out...

Been in Medicare for 16+ years, and very happy with how it works.

 

[Blue Collar Guy]

I don't think you have anything to worry about. I think saw this recently on the Medicare website:

That is priceless. Thank you hahahahahahah

 

[Blue Collar Guy]

BCG is going to have a stroke and you sir will be to blame.

I had to google it hahahahah. I was dying hahahah

 

[Bestwifeever]

DH and I see our docs for annual physicals with blood tests etc., and we see a nurse practitioner for the wellness visit (which imo basically is screening you for risk of falling and I hear many many conspiracy theories about that ). We sometimes get charged the plan G deductible long after the visit, and that's it. Maybe we're coded as follow up for established issues?

 

[athena53]

I had to google it hahahahah. I was dying hahahah

Well, at least you checked it out- I fell for it. Guess I believed they were capable of penalizing the rich with a 750% deductible.

 

[Car-Guy]

I am sure a means test will be instituted by then.

Medicare is already means tested. Earn enough income after 65 and you will find out how much more it can cost you.

Of course that is subject to change. And go up even more.