Annual Physical Exams on Medicare

[travelover]

Pre Medicare I used to get an annual physical exam free from my insurance company - in fact it was mandated to get a reduced rate. Now with Medicare, I get a "wellness visit" which seems to consist of weight, height and blood pressure measurements as well as a bunch of questions on depression and a series of quizzes to see if I'm losing my marbles.

For those of you on Medicare, how do you handle physical exams - do you pay for a real exam or are you getting something more comprehensive as part of your wellness visit? I'm talking about post the initial "Welcome to Medicare" examinations.

 

[Katsmeow]

I would not do anything on a wellness visit unless I wanted to pay for it and have to pay for the wellness visit itself. I wouldn't mix the two.

It is only my first year on Medicare but DH has been on it several years. Basically not having an annual physical exam is not that important. First, there are some things that are covered as preventative care. In some cases, you can do it annually (mammogram) while others have a longer period. For example a lipid panel is once every 5 years without any signs or symptoms of cardiovascular disease.

https://www.medicare.gov/Pubs/pdf/10110-Medicare-Preventive-Services.pdf

But, bear in mind that most people over 65 will have at least some sign or symptom of cardiovascular disease. For example, last year (when I was 64) I had a lipid panel and I have somewhat elevated total cholesterol and LDLs so I am sure it would be fine for me to have a lipid panel this year. That kind of thing. I am taking a medication where it is recommended to do certain lab tests periodically so that will be done. I have osteoporosis so I will have a bone density test to basically test how my medication is doing.

For DH, over the last 6 years I think he has overall had as many tests as he would with an annual physical. It is just that each time needs to be justified by some symptom or sign or it has to fit within the preventative services schedule. I haven't found that anything more is really needed.

 

[nwsteve]

I would not do anything on a wellness visit unless I wanted to pay for it and have to pay for the wellness visit itself. I wouldn't mix the two.

It is only my first year on Medicare but DH has been on it several years. Basically not having an annual physical exam is not that important. First, there are some things that are covered as preventative care. In some cases, you can do it annually (mammogram) while others have a longer period. For example a lipid panel is once every 5 years without any signs or symptoms of cardiovascular disease.

https://www.medicare.gov/Pubs/pdf/10110-Medicare-Preventive-Services.pdf

But, bear in mind that most people over 65 will have at least some sign or symptom of cardiovascular disease. For example, last year (when I was 64) I had a lipid panel and I have somewhat elevated total cholesterol and LDLs so I am sure it would be fine for me to have a lipid panel this year. That kind of thing. I am taking a medication where it is recommended to do certain lab tests periodically so that will be done. I have osteoporosis so I will have a bone density test to basically test how my medication is doing.

For DH, over the last 6 years I think he has overall had as many tests as he would with an annual physical. It is just that each time needs to be justified by some symptom or sign or it has to fit within the preventative services schedule. I haven't found that anything more is really needed.

+1 Wellness visit not really all that value added. It is worthwhile to frame a health related need or two when scheduling. For my next appointment, I have asked for approval for HIIT exercise. needs for shingles shot (I know the answer), risks for doing a colonoscopy since I am 72, etc etc. When at the doc you can ask about other risks related concerns. YMMV

 

[Alan]

I think Medicare also provides free of charge a pneumonia vaccine shot which may be worth having. Our normally very healthy daughter has recently recovered from a nasty bout of pneumonia so when I went in for my flu shot today and was offered the pneumonia vaccine I gladly accepted it.

 

[Bamaman]

I would not do anything on a wellness visit unless I wanted to pay for it and have to pay for the wellness visit itself. I wouldn't mix the two.

It is only my first year on Medicare but DH has been on it several years. Basically not having an annual physical exam is not that important. First, there are some things that are covered as preventative care. In some cases, you can do it annually (mammogram) while others have a longer period. For example a lipid panel is once every 5 years without any signs or symptoms of cardiovascular disease.

My wife would beg to differ with you. She is a Medical Technologist managing major hospital and reference laboratories. And she's a 12 year cancer survivor of a very aggressive uterine cancer. Had her doctor not caught her condition on a routine physical, she would have been terminal in another 6 months.

We had a friend who hadn't been getting routine physicals including chest x-rays. When he found out he had lung cancer, it was already at Stage IV. We buried him last year. Lung cancer is the big killer and he was typical of the disease.

My wife is obviously an expert at reading laboratory test results. And from here on, she has yearly physicals, and is closely monitored. She also watches her blood chemistry numbers closely.

And remember that not all physicals are created equal. We know a doctor that got a treadmill and trained for doing stress tests. He also took additional training at reading EKG's. A number of his patients had quiet but serious heart problems and were referred to cardiologists to head off before they became heart attacks.

 

[kaneohe]

I consider the free wellness visits better than nothing but not really worth that much. Must be tough for the docs too if they know you will be charged for something extra that's not in the guidelines.

That's to me the beauty of my Medicare supplement. Other than the initial deductible, everything is covered by Medicare or the supplement company and I am charged nothing so I suppose everything is based on the coding the docs office uses to make sure it is justified medically.

 

[wmc1000]

I think Medicare also provides free of charge a pneumonia vaccine shot which may be worth having. Our normally very healthy daughter has recently recovered from a nasty bout of pneumonia so when I went in for my flu shot today and was offered the pneumonia vaccine I gladly accepted it.

Yes medicare pays for both of the pneumonia vaccine shots administered 1 year apart. I just got the second one this month.

 

[kaneohe]

I would not do anything on a wellness visit unless I wanted to pay for it and have to pay for the wellness visit itself. I wouldn't mix the two.

............................................................................

wouldn't the doctor be able code the visit as a wellness visit plus other stuff
so you would not be billed for the wellness visit?

 

[Alan]

Yes medicare pays for both of the pneumonia vaccine shots administered 1 year apart. I just got the second one this month.

Thanks for the confirmation.

 

[kaneohe]

Question about flu shots..........my understanding is that Medicare covers 1 shot per season (begins in Sept?) so if last yr I got one in November, this yr I can get 1 in Oct. this yr and it will be covered? Anyone have any actual experience w/ this?

Most Medicare things have a more rigid time schedule limit......like every 12 mos. which means if you do it in November last yr, you can only do it in Nov or later this yr.

 

[Chuckanut]

Medicare paid for my first EKG in 30+ years. They found a few interesting anomalies, but it appears I am an outlier since my heart functions very well.

Medicare does not pay for the urine sample test, so my doctor does not do it. I wonder if I should offer to pay for it myself and what the cost is?

Overall the Wellness Exam is pretty basic. I am surprised the doctor did not thump on my back to hear how it sounds.

We actually spent most of the time talking about an small problem that was discovered as a result of my recent surgery. We are dealing with that.

One more thing, this year the doctors in my area are testing all the Boomers for Hep-C. Apparently, the insurance companies will cover the cost. It's a lot cheaper to cure it than treat it.

 

[Gotadimple]

You don't pay for the Wellness visit. You do pay for a discussion about issues not included in a wellness visit. Most providers prefer if you have issues you identify the issue at the Wellness and if it requires an additional examination schedule a separate office visit.


For me, personally, I have some prescriptions that need labwork done before the annual refill authorization. I do the Wellness for the basic health check-up, ask questions and get simple answers or get coached 'that needs further examination', then walk down to the lab for the blood draw. No charge except for labs. Make a second appointment if necessary.


- Rita

 

[H2ODude]

I noticed when went on M (now 68) that the annual visits became a bit less intensive. I got all bent when I figured out I got billed ~$100 on the last one and after a bunch of digging found out he'd coded it as something beyond the wellness visit because I guess we talked about something. I have supplement N so it applied to the deductible. Anyway.

I guess what triggered it is I asked about the slight heart murmur I have, and that I'd had an echocardiogram about a decade ago based on then GP's rec. I've thought about it and next visit I think I'll ask about a referral to a cardiologist for consult. I suppose he'll code my visit for that, $100, and then I can fill out the deductible at the cardiologist.

 

[MichaelB]

I noticed when went on M (now 68) that the annual visits became a bit less intensive. I got all bent when I figured out I got billed ~$100 on the last one and after a bunch of digging found out he'd coded it as something beyond the wellness visit because I guess we talked about something. I have supplement N so it applied to the deductible. Anyway.

I guess what triggered it is I asked about the slight heart murmur I have, and that I'd had an echocardiogram about a decade ago based on then GP's rec. I've thought about it and next visit I think I'll ask about a referral to a cardiologist for consult. I suppose he'll code my visit for that, $100, and then I can fill out the deductible at the cardiologist.

If you have traditional Medicare you don't need a referral. Just make the appointment and go to the cardiologist.

 

[H2ODude]

If you have traditional Medicare you don't need a referral. Just make the appointment and go to the cardiologist.

I actually called a cardiologist's office to do that (insurance didn't come up) and they said I needed a referral. It did surprise me.

 

[Teacher Terry]

On city data forum people were saying that the wellness exam is not a regular physical. Not much happens except for asking you about depression, how often you fall and a bunch of memory questions. No thanks.

 

[harllee]

Every year I have trouble with the billing on the Medicare Wellness Exam. Last year I made an appointment for a Wellness Exam and when I got to the appt I spoke to both the doctor and the nurse and told them I wanted the Medicare Wellness Exam and not a physical and they said they understood. Of course I later get a bill for $300 for a full physical. I called the billing dept and complained loudly. It got fixed after 4 months and several calls and emails on my part. This year when I go for my Medicare Wellness exam I am going to tell the doctor that if I get another bill for a full physical I am switching doctors.

 

[Katiek]

I was at the doctor recently and when I was checking in I heard a receptionist telling a woman that if she wanted a physical it would be $200, or she could schedule a wellness visit for free.

 

[Red Badger]

Medicare does not pay for the urine sample test, so my doctor does not do it. I wonder if I should offer to pay for it myself and what the cost is?

Or here. https://requestatest.com/

 

[Bamaman]

I am Type II diabetic and am on an insulin pump at my option. Medicare requires me to see the endocrinologist every 3rd month, and I always get a full blood workup. Otherwise they will not pay for my insulin and the supplies for the pump--including blood test strips--80%. My doctor takes very good care of me.

Insulin pumps run $6800 with supplies running $40 a week. Insulin is $315 a vial, and it lasts about 3 weeks--$100 a week. Just my deductibles are quite expensive per year.

 

[Gotadimple]

Every year I have trouble with the billing on the Medicare Wellness Exam. Last year I made an appointment for a Wellness Exam and when I got to the appt I spoke to both the doctor and the nurse and told them I wanted the Medicare Wellness Exam and not a physical and they said they understood. Of course I later get a bill for $300 for a full physical. I called the billing dept and complained loudly. It got fixed after 4 months and several calls and emails on my part. This year when I go for my Medicare Wellness exam I am going to tell the doctor that if I get another bill for a full physical I am switching doctors.

And call your insurance company, if you carry a supplemental or Advantage plan. The insurance company holds a contract with each physician in their network, and this is probably a violation. If you just do Traditional Medicare, then call Medicare and register a complaint. They aren't allowed to 'upcode.'

 

[harllee]

And call your insurance company, if you carry a supplemental or Advantage plan. The insurance company holds a contract with each physician in their network, and this is probably a violation. If you just do Traditional Medicare, then call Medicare and register a complaint. They aren't allowed to 'upcode.'

I called both my supplement and traditional medicare and they said it was my problem to handle since the doctor billed with a code for full physical. After many complaints I finally got the billing dept to change the code. This year I am going to tell my doctor if it happens again I will find another doctor.

 

[homestead]

My BCBS Advantage plan covers yearly wellness and physical exams. I skip the wellness and just do the physical exam.

 

[H2ODude]

I'm confused. If you opt for a full physical, Medicare and a supplement (once past the deductible) won't cover the cost? So a procedure first has to be Medicare approved for consideration by the supplemental coverage? I'm blissfully ignorant of much of this thanks to not using much healthcare. I'm more familiar with experience of MIL who lived with us 8 years, had MC and supplement, seemed she was always off to a Dr. for something or spending time at the hospital or rehab, never any cost to speak of. That ended 4 years ago.

 

[REWahoo]

So a procedure first has to be Medicare approved for consideration by the supplemental coverage?

Correct. Medigap/supplement insurance only pays when Medicare pays their portion.