Medicare Annual Wellness Visit is Worthless

[homestead]

My Medicare Advantage BCBS pays for yearly wellness & physical exam with blood tests.
I skip the wellness and just go for the yearly physical.

 

[aja8888]

Seems like some of us are getting the blood work paid and I have no idea why.

I have been getting these Wellness Exams for 11 years now and blood work was always included. I have no known conditions that would warrant periodic blood work.

I have also had a bone density test and a few EKG's under the exam. Never paid a dime. I suspect part of the billing is going to my supplemental insurance though (Plan F full).

 

[harllee]

OP here--Medicare does pay for alot of things--bone density test, mammogram, colonoscopy, flu shot, dermatology--it just has this strange rule regarding annual physicals. Medicare has always paid when I had to go to the doctor sick--went 3 times last year when I had the flu and between medicare and supplement it paid 100%. DH was in the hospital--Medicare and supplement paid 100%.

If I decide I need physical I will just pay for one. I am not sure how valuable a physical is for me and how often to have one.

 

[harley]

This is interesting. Haven't aged into Medicare yet, am still on BCBS Basic (now Florida Blue). They pay for one well-person physical per year, which always seemed to cover anything my Dr. had any concerns about, including lipid panels and an EKG, since I have elevated Cholesterol and a family history of cardiac disease. Oh, and a bone density test every 2 years, since I have osteopenia. If Medicare doesn't pay for lipid panels and other rather standard screenings, which I currently receive, then why should I even go on Medicare?

I don't think you have a choice, do you?

 

[grasshopper]

I get my "Annual wellness check" my doc does a through exam even checks my toes. We do bunches of blood tests paid by Medicare. Last week I had blood work done and the lab called the my doc to change the code on a couple of tests even. The difference is I have seen my doc for 10 years so she is able to connect a lab test to every ache and pain I have ever had.

 

[Amethyst]

Sure I do. I can stay on Federal insurance, although once I turn 65, it will only pay up to Medicare limits. I am not sure it pays much more than Medicare even now.

I will probably keep the insurance and also join Medicare. That way, one insurance will act as a supplement to the other, or something. I think W2R and others have done this.

I don't think you have a choice, do you?

 

[TromboneAl]

I agree. My doc spent the most time asking me questions to assess my mental capacity. Trouble is, my short term memory has always sucked.

Once a doctor asked me what I had for breakfast and I couldn't remember. I was in my twenties at the time. If that happened today I'd be worried.

 

[Bamaman]

Since I go to a diabetic doctor, I have to be careful when visiting my internist and not let them do bloodwork. I can always get the info from the diabetic doctor for him to reference. Once they ran testing, and it cost me about $85 out of pocket.


It's amusing that I've got to fight Medicare about paying for $1 test strips to check my blood sugars. You ought to see what Medicare pays Nephrologists for hemodialysis treatments plus ambulances 6 times per week to transport some patients. They also pay fortunes to Cardiologists for maintaining those with heart conditions.

 

[Midpack]

I've never had less than a full exam, including blood work.
A couple of glitches when I first went on Medicare, but in general I think it boils down to the idea that some doctors know how to best code things for payment and others don't. No evidence to support that, just my impression.

+1. Same here. Every physical I’ve had included a lipid panel if not other tests, and the last one was my first under Medicare. Last one also included PSA and a one time aorta aneurysm MRI. Maybe my Plan G supplement paid for some of it?

With the ridiculously low cost of original Medicare A & B I wouldn’t expect it to cover as much as it does...and I’m OK with that. A complete physical isn’t that expensive, why not spring for it? Maybe some day US healthcare will evolve like every other developed nation and reward doctors and patients for preventive - unlike the current US non-system.

 

[Fermion]

The last two friends we had that smoked have not been getting annual physicals or chest x-rays. Both were stage IV lung cancer before they knew there was any problem. One lasted 4 months and the other 6 months.

Yearly physicals are important--including chest x-rays even if you have to pay out of pocket.

I'm type II diabetic and closely watched quarterly by a doctor. My doctor always does a blood chemistry analysis which tells the tale. Thankfully I'm very stable.

Do you really want to know ahead of time if you have lung cancer? That one is very hard to treat.

 

[6miths]

The last two friends we had that smoked have not been getting annual physicals or chest x-rays. Both were stage IV lung cancer before they knew there was any problem. One lasted 4 months and the other 6 months.

Yearly physicals are important--including chest x-rays even if you have to pay out of pocket.

I'm type II diabetic and closely watched quarterly by a doctor. My doctor always does a blood chemistry analysis which tells the tale. Thankfully I'm very stable.

Having an annual physical or chest x-rays does not change mortality due to lung cancer. What does is low-dose CT scan in those at very high risk of lung cancer (i.e. individuals who have been heavy smokers and continue to smoke or have been quit for less than 15 years). This screening is recommended by the US Preventative Health Task Force and as such is likely covered by Medicare (Medicare Part B Lung Cancer Screening). Lung cancer is still a very aggressive cancer but this screening has been shown to prolong survival as have newer immunotherapies. Lung cancer screening.

 

[athena53]

It's amusing that I've got to fight Medicare about paying for $1 test strips to check my blood sugars. You ought to see what Medicare pays Nephrologists for hemodialysis treatments plus ambulances 6 times per week to transport some patients. They also pay fortunes to Cardiologists for maintaining those with heart conditions.

I know. I live in an area with mixed demographics and I see free-standing dialysis facilities in the shopping centers. They're big business. It's one of the reasons I'm paranoid about monitoring my a1C regardless of whether or not Medicare pays for it. If I never develop diabetes and I'm "wasting" the $60/test it costs me, so be it.

 

[Gotadimple]

With the ridiculously low cost of original Medicare A & B I wouldn’t expect it to cover as much as it does...and I’m OK with that. A complete physical isn’t that expensive, why not spring for it? Maybe some day US healthcare will evolve like every other developed nation and reward doctors and patients for preventive - unlike the current US non-system.

I asked this same question when I went on Medicare of my doctor. His response was that a complete physical every year for a healthy person isn't necessary. A limited physical (i.e., Wellness exam) is effective at noting issues not seen before - yes they can see those issues on a full exam - but many people don't need a full exam. It's a better use of the clinic's resources and does highlight health issues needing further investigation.

My wellness exam includes weight, bp, a brief physical to check heart, lungs, internal organs using a stethoscope, and discussion of prescriptions, and other lab tests needed.

 

[aja8888]

I know. I live in an area with mixed demographics and I see free-standing dialysis facilities in the shopping centers. They're big business. It's one of the reasons I'm paranoid about monitoring my a1C regardless of whether or not Medicare pays for it. If I never develop diabetes and I'm "wasting" the $60/test it costs me, so be it.

There are several free-standing dialysis facilities around here also. The last thing I want to do is having to visit one of them three times per week for the rest of my days. Kind of puts a crimp in any travel or fun plans you may have!

 

[inkitnow]

The value is in the blood test

If you have a full panel blood test and then the physical exam with your doctor and review the bloodwork, it’s a pretty good indicator of your overall health.
I agree that the physical is worthless. But both together can predict possible problems and confirm abnormalities.

 

[retiredtillwepart]

This thread enforces our need for a Single payer American Healthcare system!

I said it all in the title.

 

[Teacher Terry]

I was all for single payer until I read what Italy is doing. Their hospitals are at 200% capacity so they are dealing with it by not treating people over 65. No ventilators and if you code they are not resuscitating. Pretty scary.

 

[MichaelB]

Coronavirus not only infects people, it also infects threads.

How about we follow the same WHO guidelines and isolate the discussions to avoid having them infect the entire forum.

 

[LimaPop]

Your health is your responsibility, The Medicare AWV is just a light screening and if you have deeper concerns, you should have them addressed and be willing to pay the upcharges.

 

[harllee]

OP here. I am a healthy 68 year old, on no prescriptions, no health problems other than some knee and foot arthritis and allergies. Last year I had a physical and blood work, showed no issues. So this year I just did the Medicare Annual Wellness Exam which in my option was a complete waste of my time. A physical will cost me around $350 (Medicare will not pay any of it) and blood work probably another $300 (Medicare will probably not pay any of it either). So should I get a physical and blood work this year and pay $650 out of pocket or wait a year or two for a physical? (of course I will go to the doctor if I have some health issue). I recently had an eye exam and a dermatology skin check and both of those doctors told me I could wait 2 years to come back. I get a mammogram every year, I am due for a 5 year bone scan soon and a colonoscopy this year (every 10 years). To my knowledge I have never had an EKG or heart stress test--do I need them?

 

[Telly]

Ride ride ride, let it ride.

(I am not a doctor, and it has been many decades since I stayed in a Holiday Inn. I am just a wee bit younger than you, no prescriptions, no arthritis, no allergies, I can do many things most people our age can't, and I do'em!). It's my life, and I can do what I want...

 

[NoMoreJob]

I have an appointment every year which includes but is not limited to my annual wellness visit. We always go over what immunizations I may need which I believe are part of the annual wellness visit. I also have a couple very minor issues and those are addressed at the same time. Medicare covers the entire appointment with the exception of what I may still owe toward my deductible.

My guess is that how things are charged and how much is due by the patient are in large part dependent upon the doctor's/clinic's expertise in navigating the system.

 

[John Galt III]

OP here. I am a healthy 68 year old, on no prescriptions, no health problems other than some knee and foot arthritis and allergies. Last year I had a physical and blood work, showed no issues. So this year I just did the Medicare Annual Wellness Exam which in my option was a complete waste of my time. A physical will cost me around $350 (Medicare will not pay any of it) and blood work probably another $300 (Medicare will probably not pay any of it either). So should I get a physical and blood work this year and pay $650 out of pocket or wait a year or two for a physical? (of course I will go to the doctor if I have some health issue). I recently had an eye exam and a dermatology skin check and both of those doctors told me I could wait 2 years to come back. I get a mammogram every year, I am due for a 5 year bone scan soon and a colonoscopy this year (every 10 years). To my knowledge I have never had an EKG or heart stress test--do I need them?

First of all, how on earth can they charge $350 for a physical? I paid cash for a physical about 15 years ago, and it was only $45. Second, why do you think medicare won't pay for the blood tests? I am on a Medicare Advantage plan with Cap Blue Cross and they told me they would pay for my annual blood tests (lipids, and the big panel of tests for everything. CBC?) I just have a $10 copay. Are you on regular Medicare with a supplement or a Medicare Advantage plan?

 

[harllee]

OP here I am on regular Medicare with a supplement. The rules are totally different for Medicare Advantage plans (I don't want a Medicare Advantage plan--it would be cheaper and might cover a physical but the Advantage plans where I live have limited networks). Regular Medicare only pays for a lipid panel every 5 years unless you have a medical problem that justifies it more often. I have checked around and $350 is about the going rate for a physical. I have never heard of a physical for only $45 even 15 years ago--John you got a real deal there.

 

[Time2]

So, it sounds like you have no secondary coverage for Part B, is that correct?
I have a plan G through United Healthcare, my first visit was (I think charged as AWV and I wasn't billed, I also had blood tests 10 days ago, and have no bill and the website lists no bill.
btw, the reception kept telling me, it's free, and I kept telling her, no, I'm paying for it every month. I don't know if she ever got the point that I pay $415 a month to get what she called free.

Might argue it's less, $415 includes my Medicare premium, Part G premium and my Part D premium.