I’m going to ask my gyno next time I go if he takes Medicare patients. I’ll be three years away from Medicare the next time I see him.
I have never had a gynecological issue either, but I do take HRT. Eventually my Florida PCP (a family practice doc) would no longer write my HRT script. I now have an internist. Guess I should ask if she takes Medicare and if she’d be willing to write an HRT script for me.
Wow, even as an established patient!
I do understand how many physician as Primary Care Physician practices ‘balance’ the patients they accept as new patients to limit Medicare to a certain percent of their overall patient population. Specialists often accept the referrals, and some specialists accept direct patient appointments - in our area they accept Medicare.
Certainly helps to know your state and local situation with care once one is on Medicare and what additional choices are made with the move into Medicare.
I am ‘fortunate’ that I no longer need gyn services, since I had hysterectomy BSO at age 56 due to prolapsing uterus and ‘something’ showing up on right ovary (it was a calcification, but right ovary had not functioned well) and I was relieved with having this surgery (as a breast cancer survivor). Got the cancer monkey off my back. Ovarian and uterine cancers are often hard to detect.
At my last GYN appt when I was still 64, I asked my GYN “what’s next?”. He explained that well-woman care falls under the internist when on Medicare. He said of course I would see him if something signaled a problem, but general well care falls to the internist.
I’m in the DC area and I haven’t yet heard of difficulties getting into a doc with Medicare. Although I may be older than most of my friends!
Before 65, I’d also heard that it can be hard to get a new internist once on Medicare, so I signed up for a concierge practice owned by a hospital system. Yes, I know it is a “fortunate” choice. It was a bit strategic — as I widow I need a doc I can talk to and a more thoughtful system. (We had the concierge practice for my husband for two years before his death).
Hmmm, I still see my Gyn and he’s never told me my internist is supposed to take over my care since I passed 65. Maybe he’ll mention that when he’s going to retire? My internist never mentioned it either.
As long as there’s a medical reason, then GYN services are permitted.
it’s when there’s not a medical reason that Medicare says that you should go to your PCP
For instance, I always went to a Gynecologist for my annual Pap tests. I felt more comfortable having a woman do those tests as my PCP was a man
Now I have a new PCP, a woman, she does the Pap and orders mammograms. I have no gynecological issues. If I did, then seeing a gynecologist is medically necessary
it’s also how things are coded also. If things are coded as necessary, then it’s deemed medically necessary and covered. Routine care is not covered.
I just visited my OBGYN at 64. She told me if my pap was clear (which it was) I had graduated and didn’t need another pap ever. She did say to come every few years to get checked. I don’t think she would have said that if she thought Medicare would not cover future visits after I turned 65.
Well, I’m due to see my internist 12/2025. I will ask her. I’m fine if I don’t have to see my GYN any more, but feel the internist already is so busy and doesn’t have that much time for the physical as it is.
I found a pretty good explanation online: Medicare-specific information for gynecology visits | University of Iowa Health Care. It’s still confusing.
I was referring to why the physicians don’t want to deal with medicare (and these rules) as most gynecologist’s patients are under 65 and not on medicare. I think this is clear that they can only bill medicare and if it is denied, you (patient) have to pay and they are warning you that a lot may not be covered if they do it but would be covered if a PCP did it (stop smoking, diabetes, etc). I also think they are warning that these things may have been covered if you had different insurance in the past that allowed you to choose a gyno as a PCP but medicare doesn’t allow that.
There are reasons I don’t like my PCP office, but one thing that is nice is they ONLY deal with people on medicare so do know the rules for timing of tests, of what needs referrals and what doesn’t.
That was helpful to me to see DES exposure as a reason to continue. I’ll have to follow up on that.
Can someone explain the Medicare billing system? (Yes, I know…). However, I do not understand the large gap between what is billed to Medicare vs. what is actually paid by Medicare. Why are the large amounts billed if a provider knows the agreed amount? Do providers really only get paid what I see on the summary statements? No wonder many providers will no longer accept Medicare.
An example below of a colonoscopy summary statement (dollars rounded). Deductible was already met, so entire procedure was covered.
For the Anesthesia: Amount billed: $2,600. Amount Medicare pays: $85. Amount Supplemental pays: $15. Due: $0
For the Surgery (polyp removal): Amount billed: $1700. Amount Medicare pays: $197. Amount Supplemental pays: $35. Due: $0
Unique situation here. Husband is 67 and last year while he was unemployed he got his medicare with part G set up. When he got a job in March of this year, he was told I could not go on his insurance unless he was on it. Not wanting to risk his part G (he does have pre-existing conditions), I got some awful and expensive insurance. I am 61. Well this insurance is going up . He asked his HR if there was any way to cover me, and they said that if he “paused” his part G, he could use their insurance as his supplement , and then I could get coverage.
So 1. Can employee benefits be a supplement?
Anyone have any experience with this?
I got the same advice. My friend had an issue a long time ago and she said Medicare only covers every two years as I guess it’s not a current issue.
Can you make an appointment to talk with Medicare dot gov?
I know you can talk to the healthcare dot gov people as I’ve done that a couple of times this past year
I am also on an ACA plan and my husband is on Medicare. He’s not working though so no alternatives for an outrageously expensive plan with high deductibles. I’m hoping for no surprises for the next year and a half until I can go on Medicare.
Is anyone answering the phone while the government is on shutdown?
I just went to Medicare dot gov
Yes they are open
There’s also a chat option. I really like a chat option
You can save your conversation for prosperity
Good to hear. Would love to comment further but that would probably be better served in the PF!
At my last year’s Gyn appointment, my doctor told me that Medicare would only cover every other year visits - I don’t remember if she specifically said check-ups - and that year’s pap test would be the last recommended one unless it showed abnormalities or symptoms presented. She did say that for an annual mammogram, I can call the office and they’d be happy to write a prescription. This is in NJ if that matters at all.
Yes, the Medicare-approved amount is what the physician actually gets paid. The billed amount represents the physician’s customary charge, but they rarely receive this full amount since private insurers pay negotiated rates—typically higher than Medicare’s. Medicaid payments, on the other hand, are even lower than Medicare’s.
Medicare reimbursement rates generally decrease every year, which lower the physician fee schedule conversion factor while overhead have increased every year. Because Medicare and Medicaid reimbursements often don’t cover practice overhead, many physicians cannot afford to take on large numbers of these patients.
VA reimbursements are even less. Veterans can see VA doctors for some things but not everything and the reimbursement is such that it is hard to find someone to treat them if it’s outside of the VA