Now that I have plan G, what does it NOT cover.

[Time2]

Actually, in one month I will be on Medicare A, B, and D with a Plan G.
Does it fully cover my yearly physical?
Does it fully cover Blood tests, I think I read PSA is every two years.
I expect to go to a dermatologist in the near future and have a few things snipped. Is that covered? Do I need a referral?
Just want to get some ideas, what to do, how to do it and how to save my money.


I'm going from a $10,000 deductible plan to Medicare. So I paid all my costs
previously, luckily with my family of 4, I only paid $1,500 TO $4,000 of my deductible in each of the last 10 years.


Thanks

 

[Sarah S]

Medicare does not cover physicals. There is something called a wellness exam but it is not at all like what you have thought of as a physical.

It may be that if you have a few issues say hypertension, diabetes and prostate problems the doctor would combine a wellness exam and an office visit for all those and it would seem like a physical. Discuss up front with your physician how they will code

Labs and medically necessary dermatology procedures should be covered too after your deductible which will kick in before anything gets paid for. PSAs would need a code that shows a good reason I think

No referrals ! ( unless the specialist asks your pcp for one which would be an old style referral dr X please see my patient not an insurance mandated one.)

 

[travelover]

There is an initial "welcome to Medicare" exam then yearly a "wellness exam" which seems to concentrate on seeing if you are senile yet. To get more of an covered exam you need to present an issue.

 

[REWahoo]

Now that I have plan G, what does it NOT cover.

Plan G covers only what Medicare covers, minus the deducible. You can find that here: What Medicare Covers

 

[aja8888]

Plan G's deductible for this year is $195.00 (I think). Medicare and G cover everything else that is within Medicare's scope.

 

[Sarah S]

There is an initial "welcome to Medicare" exam then yearly a "wellness exam" which seems to concentrate on seeing if you are senile yet. To get more of an covered exam you need to present an issue.

Even the welcome to medicare exam isn’t what most have come to expect as a physical see the description https://www.medicare.gov/coverage/welcome-to-medicare-preventive-visit

 

[Katsmeow]

The lack of a physical may sound like a negative for Medicare but in practice it hasn't been one for DH (he has been on Medicare for several years) or me (new to Medicare in 2019). Basically I have found that normal routine blood work has been covered. I'm sure there needs to be a reason for it if done frequently especially but usually there is one if the doctor is wanting to do it often. Most preventative care tests have clear guidelines as to how often a test can be done. These has seemed very consistent with how my pre-Medicare doctor does it. No, I don't make an appointment for a physical. On the other hand, DH or I can make a routine appointment for some reason (prescription refill, follow up on something that is a problem, etc.) then at that appointment we ask whatever questions we have overall....

 

[Time2]

So, every year I have a general round of Blood tests done, PSA, Lipids, liver enzyme, etc. with my previous BCBS. Now that I'm on Medicare, is this just something my doctor will order, ah, because I'm on meds and these need to be checked? But not as part of a physical.

 

[REWahoo]

So, every year I have a general round of Blood tests done, PSA, Lipids, liver enzyme, etc. with my previous BCBS. Now that I'm on Medicare, is this just something my doctor will order, ah, because I'm on meds and these need to be checked? But not as part of a physical.

If you have medical conditions or take medications that require these tests, then Medicare will pay for them.

 

[Bamaman]

If you really get down to it, a blood chem analysis tells the doctors the state of your physical condition. Some of the physical exam may be "for show." If you're a smoker, getting a chest x ray yearly should be done--even if you have to pay for it out of pocket.

If coded right, you get a "mini exam."

My wife is a 13 year cancer victim, and she goes for a colonoscopy tomorrow. It's going to be the last one she ever gets--per the doctor's office.

What gets me is Medicare is tightening the screws on certain tests, etc., but they pay fortunes to nephrologists for dialysis and to cardiologists for their services. My internal medicine doctor just gets paid a pittance for his services.

I've been warned about $1 test strips to check for blood sugars. My doctor said if contacted by Medicare, tell them you're a type I diabetic and your insulin's being less effective. And that I check my sugars 4x per day. None is true.

 

[Katsmeow]

My wife is a 13 year cancer victim, and she goes for a colonoscopy tomorrow. It's going to be the last one she ever gets--per the doctor's office.

Is that because of her age or what? The general Medicare rule for a screening colonscopy is once every 120 months ( more frequently for some people at higher risk). I have read that the recommendation from the U.S. Preventative Services Task Force is screening from age 50 to 75. But I also read that Medicare will pay for one every 120 months regardless of age. So - is it the doctor recommending against it due to her age or is the doctor saying Medicare won't pay for it?

 

[Time2]

Today I just go a welcome call from my Plan G company, AARP/Humana.
Asking if I had any questions. The subject of a gym membership came up. The plan covers the cost of a gym membership. I have to wait a few weeks, and then I can request a confirmation letter from the company. They only cover certain gyms, but I wanted Planet Fitness and that is on the list.
I have been putting off signing up for about 10 days and then learn I can get it paid. I don't know why this excites me, I can afford to pay it. But I'm excited!

 

[Katsmeow]

Today I just go a welcome call from my Plan G company, AARP/Humana.
Asking if I had any questions. The subject of a gym membership came up. The plan covers the cost of a gym membership. I have to wait a few weeks, and then I can request a confirmation letter from the company. They only cover certain gyms, but I wanted Planet Fitness and that is on the list.
I have been putting off signing up for about 10 days and then learn I can get it paid. I don't know why this excites me, I can afford to pay it. But I'm excited!

I am only aware of AARP/UHC (not Humana). But on my Plan G, you do get free gym memberships. One thing that many people miss is that it isn't limited to one gym. You can use multiple participating locations. That might be useful if one gym has one activity or type of equipment you like while another has something else you might want to use on another occasion.

 

[Time2]

Your right it is United Healthcare.
I'll look into the other gym idea.

Thanks