New to Medicare: question about Welcome to Medicare Visit

[fh2000]

I just joined Medicare in January, 2021. I have seen my primary doctor for the last 20 years, and they are accepting Medicare.

I understand that I can schedule a one-time 'Welcome to Medicare Visit' this year, and 'Medicare Annual Wellness Visit' beginning next year. Since 'Welcome to Medicare Visit' is pretty basic, during this visit, if I have questions about my health, or would like to schedule blood test as I have done every year in the past, I guess I will be billed separately for those services.

I have Medigap Plan G. Will it cover the cost of those extra services during Welcome to Medicare Visit? I may at least pay the deductible $203 first?

 

[Bamaman]

Your Medicare Plan G supplement is one of the two most expensive and comprehensive options. A big plus to that plan is that you have the option to use doctors of your choice and control your healthcare better than those in Advantage. Many markets don't have the best physicians accepting Advantage.

But all you can get yearly is a mini-physical they call a Wellness Visit. I'd have to refer you to Medicare.gov to see what that means.

Many people really need a full blood chemistry analysis and a chest x-ray yearly as a defensive measure. And that may cost you a little out of pocket.

Out of all my family friends, we only knew two gentlemen that continue to smoke. And both were not getting yearly chest x-rays. Both came down with stage IV lung cancer and passed within 6 months.

I'm a type II diabetic and on an insulin pump (at my option.) I'm required to see my endocrinologist every three months, and I get two complete blood chemistries yearly and two specific blood tests yearly. And he takes care of me very well. I seldom see my primary care physician--especially since he's now doing tele-medicine.

Even if Medicare doesn't cover full yearly physicals, it's a smart thing to pay out of pocket for specific tests from time to time. After all, most of what the doctor is looking for in a physical is found in that blood analysis and x-ray.

 

[harllee]

I have been very disappointed with the Welcome to Medicare physicals and the Medicare Annual Wellness visit, very little is included. I have sprung for a full physical and blood work and it cost $350 but I guess it is worth it every couple of years or so.

 

[friar1610]

I have had good luck with getting tests covered. I think it’s because I have HPB and high cholesterol, both well controlled with meds. So I think my PCP codes them as tests related to documented, chronic conditions (as opposed to “fishing” for potential new problems). Whatever he does, he seems to have broken the code on how to assign codes for billing and I don’t get billed for the tests by MEDICARE.

 

[W2R]

I never scheduled a specific "welcome to Medicare" visit or "annual Wellness visit". I see my internist/endocrinologist 2-4 times a year (depending on how my diabetes is doing), and I have blood work done for those visits. After getting to Medicare age I just continued those regular checkups and blood work.

I have Medicare Part B, and my federal BCBS insurance is secondary and supplements Medicare. I have not paid a cent for any of the above care.

 

[RobbieB]

Never did either. Don't know what they are. Have advantage, they tell me what I need to do.

 

[VanWinkle]

Your Medicare Plan G supplement is one of the two most expensive and comprehensive options. A big plus to that plan is that you have the option to use doctors of your choice and control your healthcare better than those in Advantage. Many markets don't have the best physicians accepting Advantage.

But all you can get yearly is a mini-physical they call a Wellness Visit. I'd have to refer you to Medicare.gov to see what that means.

Many people really need a full blood chemistry analysis and a chest x-ray yearly as a defensive measure. And that may cost you a little out of pocket.

Out of all my family friends, we only knew two gentlemen that continue to smoke. And both were not getting yearly chest x-rays. Both came down with stage IV lung cancer and passed within 6 months.

I'm a type II diabetic and on an insulin pump (at my option.) I'm required to see my endocrinologist every three months, and I get two complete blood chemistries yearly and two specific blood tests yearly. And he takes care of me very well. I seldom see my primary care physician--especially since he's now doing tele-medicine.

Even if Medicare doesn't cover full yearly physicals, it's a smart thing to pay out of pocket for specific tests from time to time. After all, most of what the doctor is looking for in a physical is found in that blood analysis and x-ray.

My yearly Ct scans of chest are paid 100% by my Medicare Advantage with UHC as preventitive. I have found that my UHC Medicare Advantage has access to all of the same DRs I had before medicare including specialists at the most recognized hospital is this area. Your experience(or lack thereof) with medicare advantage may be different, but mine has been excellent. Mine is a PPO so I can go to any specialist in network without a referral.

Best to you,

VW

 

[bmcgonig]

Having just joined Medicare also I have similar questions.

So far I discovered that they won’t pay for your yearly cholesterol tests just because you want them, but will pay for them every 5 years. I also gather that if you have high cholesterol they will pay for those tests as often as your doctor wants them?

I’m assuming that if we go to the doctor with some weird complaint like “night sweats” which could be any problem under the sun, then any tests that the doctor orders to troubleshoot it will be paid for? Is that true?

By the way I like to get cholesterol tests, hba1c tests etc., done every year so I use a website called Jason Health which orders any one you want at local labs like Quest. Very reasonable/cheap. Lots of other ones out there as well but prices vary considerably among them.

https://www.jasonhealth.com/wizard

 

[14thMed]

If you are a veteran, then go to the V.A .Schedule your appt. before your Dr's appt . V.A does cholesterol tests every year. Take that report with you.

 

[JARON46]

If you are a veteran, then go to the V.A .Schedule your appt. before your Dr's appt . V.A does cholesterol tests every year. Take that report with you.

Just because you are a veteran does not mean you get free medical care at the VA. It is means tested. I know because I applied but did not qualify because I had too much income.

 

[jdmorton]

fh2000 - I am in a very similar situation as you as I started Medicare on January 1st this year and have a supplemental policy similar to Plan G. Also I have been seeing the same primary care physician for the past 25 years. I had to schedule a 'Welcome to Medicare' visit in late February in order to have Medicare pay for my CPAP supplies that periodically need to be replaced.

My doctor told me not to worry about the 'Welcome to Medicare' versus a physical as he was going to perform all of the usual physical exam procedures and write any prescriptions or referrals needed anyway - which he did. The practice my doctor belongs to has been in business for 60 years and he has been there pretty much his entire career (although not since it first opened ).

All of the doctors I have accept Medicare, which is not unusual since I live in Pennsylvania which has the 5th highest number of individuals over the age of 65 and the 7th highest percentage of individuals over the age of 65 versus total state population in the U.S.

I did not get a script for the usual blood work because I had it done in July 2020 and my doctor reviewed the results with me during my visit and did not see a reason to do them again so soon.

As for what I will be billed, I don't know yet since it has been only a month since my visit.

Anyway, that was my experience with my Welcome to Medicare wellness visit after starting Medicare.