Making the Transition to Medicare

[nwsteve]

Was in getting an annual physical and asked the Doc about the transition to Medicare which is 13 months away for me.
His advise was that as long as I had private pay insurance that covered preventive care at no cost, I should get as much done under it as possible. He indicated that Medicare was now much more restrictive in its coverage and would be much more limited that what I could get under my insurance.
Anyone have any experiences to validate or put more qualifiers on what I was able to get?
Thanks
Nwsteve

 

[JakeBrake]

The first thing I would do is check the Medicare website and see if "the Doc" is listed as one who takes Medicare assignment. This might influence his attitude.

The walk-in clinic where I go for minor ailments does not take Medicare assignment, but they charge the Medicare rate which is much lower than the list price. They file my claim with Medicare and Medicare sends me a reimbursement check.

I handled my mother's care under Medicare for several years and in my first year on Medicare I have had major medical expenses. So far I am satisfied with the way Medicare handled my mother's medical claims and has handled my medical claims.

As a disclaimer I must say that my retiree medical insurance through Megacorp was nothing special, so Medicare is an improvement for me.

 

[kaneohe]

https://www.cms.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

You might check here to compare w/ your current policy. Prior to this year, Medicare only covered your first physical and it had to be within x months of turning 65 (forget what x was, something like 6 or 12mos). Subsequent physicals were not covered. Looks like starting this year, the subsequent physicals are covered although you would have to compare w/ your own private policy to determine whether coverage is more or less.

One thing to keep in mind is how often procedures are allowed. In a previous year, I thought as long as I went once a year, certain things were allowed.........turns out certain things were allowed every 12 mos (not once a year) and when I went in Nov when the previous year was in Dec, certain procedures (lab tests, in this case) were ruled ineligible for reimbursement.
I see in the referenced chart that the preventive physicals are allowed annually......I'd double check to be sure that meant once a year and not once every 12 mos.

 

[nwsteve]

https://www.cms.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

You might check here to compare w/ your current policy. Prior to this year, Medicare only covered your first physical and it had to be within x months of turning 65 (forget what x was, something like 6 or 12mos). Subsequent physicals were not covered. Looks like starting this year, the subsequent physicals are covered although you would have to compare w/ your own private policy to determine whether coverage is more or less.

One thing to keep in mind is how often procedures are allowed. In a previous year, I thought as long as I went once a year, certain things were allowed.........turns out certain things were allowed every 12 mos (not once a year) and when I went in Nov when the previous year was in Dec, certain procedures (lab tests, in this case) were ruled ineligible for reimbursement.
I see in the referenced chart that the preventive physicals are allowed annually......I'd double check to be sure that meant once a year and not once every 12 mos.

Thanks for a great reference. I was surprised that cardio-vascular screening was only paid for once every five years. Wonder if the logic is that once you get to 65 and have low risk, you are not expected to become high risk? Not sure that makes sense but hey, it IS a government program.
Nwsteve

 

[Hobo]

Thanks for a great reference. I was surprised that cardio-vascular screening was only paid for once every five years. Wonder if the logic is that once you get to 65 and have low risk, you are not expected to become high risk? Not sure that makes sense but hey, it IS a government program.
Nwsteve

Yea, and no reason for the taxpayer to pay for your broken heart more than once every 5 years.

You may know this, but if you refuse to sign up for Medicare at age 65, then it is very hard and expensive to get on the program. You should also look at Part A, which pays for hospitals, and Part B which pays for going to the doctor. Part A is free, Part B cost well over $100 per month. I am a veteran and get health care for free - so I never really looked into seriously into alternative insurance programs. Still, they insist on giving me hospital coverage (Part) for free. But I would think for $1500 plus a little extra from your own money you could get something that more closely fits your personal preferences in health insurance for just going to the doctor.