There is a certain group of tests covered. My doctor orders everything that is free with the wellness exam. It’s a complete metabolic panel, just no tests like for vitamin D levels or that sort of thing. Medicare does cover a urine test, which my pre-Medicare insurance had stopped covering under preventive. I also get my bloodwork for a maintenance medicine at that time.
I have to go every six months for a med check, so she always asks if there are any tests I’d like run - she can get them covered if she orders them at a visit other than the wellness exam.
I’ll add that it can be confusing to know what is & isn’t covered. If you look on the Medicare website, there is no list of bloodwork that would be covered by Medicare with no copays. You just have to talk with the doctor to make sure things are going to be covered.
I saw something that said that annual skin checks aren’t covered by Medicare. I asked … they’re covered, but they’re not covered as preventative care … so the Medicare annual deductible & the 20% coinsurance are charged but it’s definitely covered (just not free to me). So you wouldn’t get a skin check during a wellness check (you’d need a separate appointment). I have not had to pay because I get that done in the fall. My deductible has already been met & my Medigap supplement picks up the rest.
Our PCP does an annual ‘Medicare physical’ on us - it is with lab work that will be approved (with our various medical conditions or what is considered appropriate for an annual visit by Medicare). Urinalysis is annual. DH has PSA every 6 months due to high incidence of family history prostate cancer, and also a prior biopsy with calcium deposit – so watching for changes/problems there.
DH and I also have 6-month visits with lab work by our PCP.
PCP is well aware of what Medicare allows for visits, exam, and testing.
DH had been having 6-month visits with Cardiologist due to Paroxysmal A Fib and prior cardiac ablation, and now it will be one year due to his level of being stable. He had some annual echocardiograms and will have a stress test which last time was done 3 years ago.
We see various specialists, typically annually. Dermatologist - various small things removed, pre-cancerous. DH sees retina specialist annually due to having ‘floaters’ and other conditions to be monitored.
Can ask PCP or the MD office to make sure they will follow what can be covered.
I have had no problems for lab work done by my oncologist. I saw an endocrinologist (due to suspected problem flagged by lab) and had a lot of specific lab work done and then had parathyroid surgery. No problems with Medicare.
We have the annual Medicare deductible and pretty much no other billing. Our drug plans have some copays.
Both DH and I have had dermatologist needing to remove pre-cancerous skin areas pre-Medicare. No problem with dermatology checks on Medicare annually. Sometimes she has frozen something off and sometimes a small separate surgical procedure with local lidocaine/pain medication. We have back-to-back appointments and go in separate rooms. I have to have DH clarify ‘no problem’ to specifically ask him “did the Dermatologist freeze off anything during your appointment”. I document things for each of us on a ‘medical timeline’ - he has a folder with lined notebook sheets, and each line is a visit, test, lab, etc. Then I will highlight with MD visits to be able to visually see quickly. He is on page 5 and I am on P 11. I had aggressive cancer fall 2009, and had to keep a time line because of MD offices asking me various questions and I had the time line with specifics. We don’t have fully integrated medical records across everything.
Mostly I am paranoid, I’m happy if a test is covered even if it’s part of my deductible
This year we ran into a problem (not on Medicare yet) that a PSA test was not covered. Every other test was covered, tests were billed between 10 and 14 dollars. PSA was $139. I don’t understand why, I appealed, I called the office. Denial, it’s ridiculous.
64 year old man, family history. Personal history.
I just don’t want a whole battery of test denied that I need to pay a $1000 for
I was very surprised. It was covered without any charge to me. My PA specifically said that Medicare was “now” covering it. If you have an Advantage plan, it’s possible that they may have different policies?
I need to correct something I stated earlier. The Annual Wellness Visit does not include any bloodwork (per the Medicare website). I looked at my Medicare info & I see that there are two separate visit codes for me on that day. My doctor billed a separate office visit code other than the AWV, which is probably what allowed the bloodwork to be 100% covered. I did some peeking online & I would encourage everyone to talk to their doctor before their annual appointment to find out what is covered & what isn’t. It seems that some tests are covered 100% as preventive, but they can’t be ordered as part of the Annual Wellness Visit.
None of this is straightforward!
PSA tests are covered once a year, no charge (traditional Medicare): Prostate cancer screenings. (But I would make sure that it’s ordered as part of a visit that will allow it to be covered!)
Just be clear to your doc’s office that you want to make an appt for the Medicare Wellness check and the preventive lab work that is covered by Medicare.
But note, if your Hubby goes into the appt and starts asking about other aches and pains, the free Wellness check can become a billable medical appt real fast.
btw: never had a basic Medicare Wellness lab test not covered, including PSA.
We basically now have no copay for whatever checkups & physicals with whatever lab work the docs order. We once had to pay for an A1C lab for H (it was in normal range).
Same for my husband on his Advantage plan. Every once in awhile we have to pay $5 on a lab work bill that’s hundreds of dollars. I’m so jealous! And he had a nurse come to the house to give him a pretty thorough physical. She said he’s doing great.
We still have to figure out how to spend the $600 he’s allowed to spend on anything related to fitness. He has a debit card he can use at ski resorts, for example.
I have not been able to determine what is covered or not. I think so much depends on the MD’s office, and when, how, and what code they use. We had to switch PCP’s, 3x over the last 4 years. Same traditional Medicare Plan with “G” supplement.
PCP-1 always performed a full hands-on physical, including labs during the annual wellness visits. Somehow all labs were covered. This was my long-time PCP, but sadly left the practice.
PCP-2 would not do anything more than the limited questions during a wellness visit, with no hands-on physical exam. Any labs were paid by us, outside of Medicare. They also charged a monthly amount for “chronic care management”. We would need to pay the first few months until deductible was met. Those charges were always suspicious to us, as DH did not have any critical conditions, and did not have any monthly contact with the office. Who on Medicare doesn’t have some type of “chronic” condition?
PCP-3 orders all the usual tests, and sometimes more. If I have a question about a specific issue I’m having, he usually orders a test to better answer my question. So far, all have been covered by Medicare.
I once read that on the whole it’s a decent chunk (about half?) who could pass underwriting test. But… I’m thinking in cases where people want to change plans there is likely to be some new medical challenge that lowers likelihood of passing
I’m not sure I’d pass any underwriting test as I have a progressive chronic health condition that often requires repeated hospitalizations (though so far I’ve never been hospitalized). Oh well, so far, I have never needed any underwriting as we’ve had the same BCBS insurer since H & I married in 1986. H now has a bunch of conditions that would probably make insurers reluctant to underwrite him as well.
I have a couple of quotes on G plans and got my letter letting me know what the IRMAA amount will be.
The quotes are for Blue Cross and Blue Shield. Blue shield has a GPlus that includes vision, chiropractic, hearing aid services and telemedicine. It’s $12 more a month, I need to find out what it exactly covers. I wear glasses so could be worthwhile.
IDK how PCP codes UA as part of annual. He is very careful to follow the Medicare stuff. DH and I both have had abnormalities in UA, and have had follow up with Urologist.
I am dealing with a Medicare issue with my Senate office. Eyeglasses with having had Cataract surgery.
DH has not had a problem with PSAs being covered - but he has a very strong family history (dad and all 4 of his brothers having had prostate cancer; the two bachelors died from the cancer spreading). He had PSAs done prior to Medicare, and has also had a prostate biopsy (calcification removed).
I am having my last “non-medicare” physical tomorrow. He ordered the labwork last week so it would all be in, and for the second time now (last time was sometime pre-covid) there is a “trace” of blood in the UA. He said the protocol now is to have a cystoscope and ultrasound, so I am guessing it will happen again, but IDK if it will all et in under current insurance or will be scheduled when insurance changes to Medicare Sept 1. I am also supposed to be getting my supplemental selected tomorrow (virtual meeting with a friend’s agent- who I met face to face today at a funeral). Hate to have to schedule procedures when insurance will be in transition.
