Does Medicare cover annual physical exam?

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills

Does Medicare cover annual physical exam?

Postby Browser » Sat Mar 01, 2014 11:29 pm

A friend recently had her annual physical exam, just as she has always done for years. But this was the first physical she's had since going on Medicare. She was surprised when she received the Medicare statement showing that none of the exam costs were approved. Which brings up the question whether Medicare does, or ever did, cover an annual physical exam. Perhaps Medicare only covers "diagnostic" treatment and a physical is not considered to be diagnostic? If not covered, how do Medicare patients proceed in order to continue to have an annual physical exam? For some people, this is an important part of their routine healthcare.
If we have data, let’s look at data. If all we have are opinions, let’s go with mine. – Jim Barksdale
Browser
 
Posts: 3336
Joined: Wed Sep 05, 2012 4:54 pm

Re: Does Medicare cover annual physical exam?

Postby island » Sat Mar 01, 2014 11:38 pm

Covers an annual "wellness"exam. I believe it has to be coded as that in order to be covered
island
 
Posts: 726
Joined: Tue Jul 23, 2013 1:45 pm

Re: Does Medicare cover annual physical exam?

Postby sscritic » Sat Mar 01, 2014 11:47 pm

They cover a Wellness visit after 12 months. They also cover a Welcome to Medicare visit. Of course, if you don't ask your doctor for these specific exams, then they won't be covered. See Medicare and You if you want to learn. You should encourage your friend to read it as well.

Yearly “Wellness” visit

If you’ve had Part B for longer than 12 months, you can get a yearly “Wellness” visit to develop or update a personalized plan to prevent disease or disability based on your current health and risk factors. This visit is covered once every 12 months.
...
Your first yearly “Wellness” visit can’t take place within 12 months of your enrollment in Part B or your “Welcome to Medicare” preventive visit. However, you don’t need to have a “Welcome to Medicare” preventive visit before your yearly “Wellness” visit.
...
During the first 12 months that you have Part B, you can get a “Welcome to Medicare” preventive visit. This visit includes a review of your medical and social history related to your health, and education and counseling about preventive services, including certain screenings, shots, and referrals for other care if needed. When you make your appointment, let your doctor’s office know that you would like to schedule your “Welcome to Medicare” preventive visit.

You pay nothing for the “Welcome to Medicare” preventive visit if the doctor or other qualified health care provider accepts assignment.

If your doctor or other health care provider performs additional tests or services during the same visit that aren’t covered under this preventive benefit, you may have to pay coinsurance, and the Part B deductible may apply.
sscritic
 
Posts: 21858
Joined: Thu Sep 06, 2007 8:36 am

Re: Does Medicare cover annual physical exam?

Postby cheese_breath » Sat Mar 01, 2014 11:50 pm

Here's what you get.

http://www.medicare.gov/coverage/preven ... exams.html

It's not much. As I recall the Welcome to Medicare visit covered more when I started Medicare in 2006 than it does now.
The surest way to know the future is when it's the past.
User avatar
cheese_breath
 
Posts: 3561
Joined: Wed Sep 14, 2011 7:08 pm

Re: Does Medicare cover annual physical exam?

Postby mur44 » Sun Mar 02, 2014 1:20 pm

Physical Exam consists of the following:
History: Allergies,
Medications

Vitals: T, HR, BP, RR

Head, Eye, ENT

Respiratory

CV

Abdominal: Digestive,
Urinary

Extremities/Joint

Lab/imaging

Physical Exam is NOT covered by Medicare.


Disclosure: I am a Certified Volunteer Medicare Counselor from NJ
mur44
 
Posts: 493
Joined: Tue Feb 27, 2007 9:30 am

Re: Does Medicare cover annual physical exam?

Postby chaz » Sun Mar 02, 2014 1:29 pm

Medicare mails an annual booklet showing what is covered.
Chaz | | “Money is better than poverty, if only for financial reasons." Woody Allen | | http://www.bogleheads.org/wiki/index.php/Main_Page
chaz
 
Posts: 13361
Joined: Tue Feb 27, 2007 2:44 pm

Re: Does Medicare cover annual physical exam?

Postby Browser » Sun Mar 02, 2014 1:37 pm

mur44 wrote:Physical Exam consists of the following:
History: Allergies,
Medications

Vitals: T, HR, BP, RR

Head, Eye, ENT

Respiratory

CV

Abdominal: Digestive,
Urinary

Extremities/Joint

Lab/imaging

Physical Exam is NOT covered by Medicare.


Disclosure: I am a Certified Volunteer Medicare Counselor from NJ

Thanks. Is there anything a Medicare patient can do to be able to still get a comprehensive annual exam covered somehow? This is something many people feel is a healthcare necessity. You are accustomed to doing this under your employer health insurance and unexpectedly you get cut off by Medicare -- I suspect most people don't realize this and get caught off guard like my friend when they find they have to pay out-of-pocket. And it's costly because you have to pay the retail costs, not the discounted costs that insurers pay.
If we have data, let’s look at data. If all we have are opinions, let’s go with mine. – Jim Barksdale
Browser
 
Posts: 3336
Joined: Wed Sep 05, 2012 4:54 pm

Re: Does Medicare cover annual physical exam?

Postby cheese_breath » Sun Mar 02, 2014 2:27 pm

Browser wrote:
mur44 wrote:Physical Exam consists of the following:
History: Allergies,
Medications

Vitals: T, HR, BP, RR

Head, Eye, ENT

Respiratory

CV

Abdominal: Digestive,
Urinary

Extremities/Joint

Lab/imaging

Physical Exam is NOT covered by Medicare.


Disclosure: I am a Certified Volunteer Medicare Counselor from NJ

Thanks. Is there anything a Medicare patient can do to be able to still get a comprehensive annual exam covered somehow? This is something many people feel is a healthcare necessity. You are accustomed to doing this under your employer health insurance and unexpectedly you get cut off by Medicare -- I suspect most people don't realize this and get caught off guard like my friend when they find they have to pay out-of-pocket. And it's costly because you have to pay the retail costs, not the discounted costs that insurers pay.

Some Medicare Advantage plans might cover physicals (you would have to investigate them), but once you go to a MA plan you might not be able to return to original Medicare. There are only a few conditions which allow one to go back.
The surest way to know the future is when it's the past.
User avatar
cheese_breath
 
Posts: 3561
Joined: Wed Sep 14, 2011 7:08 pm

Re: Does Medicare cover annual physical exam?

Postby richard » Sun Mar 02, 2014 2:29 pm

Am I reading correctly that Medicare doesn't cover standard blood tests, check urine for diabetes, prostate and the like?

Wouldn't a Medigap plan, such as F or N, cover an annual exam?
richard
 
Posts: 7609
Joined: Tue Feb 20, 2007 3:38 pm

Re: Does Medicare cover annual physical exam?

Postby sscritic » Sun Mar 02, 2014 2:35 pm

richard wrote:Am I reading correctly that Medicare doesn't cover standard blood tests, check urine for diabetes, prostate and the like?

It covers specific items, not a grocery cart full of whatever your doctor wants to throw in.
Prostate cancer screenings

How often is it covered?

Medicare Part B (Medical Insurance) covers:

    Digital rectal exam: Once every 12 months

    Prostate Specific Antigen (PSA) test: Once every 12 months
Who's eligible?

All men over 50 (beginning the day after your 50th birthday) with Medicare are covered.

Your costs in Original Medicare

    Digital rectal exam: You pay 20% of the Medicare-approved amount for the digital rectal exam and for the doctor's services related to the exam. The Part B deductible applies. In a hospital outpatient setting, you pay a copayment.

    Prostate Specific Antigen (PSA) Test: You pay nothing for PSA the blood test. If you get the test from a doctor that doesn’t accept assignment, you may have to pay an additional fee for the doctor’s services, but not for the test itself.
http://www.medicare.gov/coverage/prosta ... nings.html

That same page has a search box:
Is my test, item, or service covered?

You can search for the other tests you are interested in.
sscritic
 
Posts: 21858
Joined: Thu Sep 06, 2007 8:36 am

Re: Does Medicare cover annual physical exam?

Postby cheese_breath » Sun Mar 02, 2014 2:35 pm

richard wrote:Am I reading correctly that Medicare doesn't cover standard blood tests, check urine for diabetes, prostate and the like?

Wouldn't a Medigap plan, such as F or N, cover an annual exam?

No you don't and and no it doesn't.

Medicare does cover blood and urine tests when your doctor thinks they're necessary. In fact it covers them 100% so your Medicap plan doesn't even get involved. I have my blood tested every 3-4 months for cholesterol and annually for prostate.

http://www.medicare.gov/coverage/clinic ... vices.html
The surest way to know the future is when it's the past.
User avatar
cheese_breath
 
Posts: 3561
Joined: Wed Sep 14, 2011 7:08 pm

Re: Does Medicare cover annual physical exam?

Postby richard » Sun Mar 02, 2014 2:56 pm

cheese_breath wrote:
richard wrote:Am I reading correctly that Medicare doesn't cover standard blood tests, check urine for diabetes, prostate and the like?

Wouldn't a Medigap plan, such as F or N, cover an annual exam?

No you don't and and no it doesn't.

Medicare does cover blood and urine tests when your doctor thinks they're necessary. In fact it covers them 100% so your Medicap plan doesn't even get involved. I have my blood tested every 3-4 months for cholesterol and annually for prostate.

http://www.medicare.gov/coverage/clinic ... vices.html

First thing I checked is cholesterol, which leads to "Medicare Part B (Medical Insurance) covers screening blood tests for cholesterol, lipid, and triglyceride levels every 5 years. These screening tests help detect conditions that may lead to a heart attack or stroke." Also "Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them."

From this I would have thought it only covers once every 5 years, but your post says it will cover more frequently if your doctor thinks the tests are necessary. Is this disclosed on another part of the Medicare site?

An annual physical isn't covered, but a wellness check plus tests the doctor thinks are necessary is covered? What else is there to an annual physical beyond the wellness list, blood work and a few other lab tests that are listed?
richard
 
Posts: 7609
Joined: Tue Feb 20, 2007 3:38 pm

Re: Does Medicare cover annual physical exam?

Postby Browser » Sun Mar 02, 2014 3:03 pm

richard wrote:
cheese_breath wrote:
richard wrote:Am I reading correctly that Medicare doesn't cover standard blood tests, check urine for diabetes, prostate and the like?

Wouldn't a Medigap plan, such as F or N, cover an annual exam?

No you don't and and no it doesn't.

Medicare does cover blood and urine tests when your doctor thinks they're necessary. In fact it covers them 100% so your Medicap plan doesn't even get involved. I have my blood tested every 3-4 months for cholesterol and annually for prostate.

http://www.medicare.gov/coverage/clinic ... vices.html

First thing I checked is cholesterol, which leads to "Medicare Part B (Medical Insurance) covers screening blood tests for cholesterol, lipid, and triglyceride levels every 5 years. These screening tests help detect conditions that may lead to a heart attack or stroke."

From this I would have thought it only covers once every 5 years, but your post says it will cover more frequently if your doctor thinks the tests are necessary. Is this disclosed on another part of the Medicare site?

An annual physical isn't covered, but a wellness check plus tests the doctor thinks are necessary is covered? What else is there to an annual physical beyond the wellness list, blood work and a few other lab tests that are listed?

Kind of a grey area here. I believe Medicare now covers a colonoscopy once every 10 years, but it apparently covers more frequently based on Drs. orders. I've had three within less than 10 years. After the first routine one, the Dr. wanted me to have another just 3 years later - no specific reason that I was told. They found a polyp on that one, so had another one just done after 5 years. All were covered fully by Medicare. Believe me, I knew a couple people who died of colon cancer and they can roto-root me as often as they want.
If we have data, let’s look at data. If all we have are opinions, let’s go with mine. – Jim Barksdale
Browser
 
Posts: 3336
Joined: Wed Sep 05, 2012 4:54 pm

Re: Does Medicare cover annual physical exam?

Postby manwithnoname » Sun Mar 02, 2014 6:34 pm

I call up every year to schedule my annual Medicare physical and get all the tests which are free. I have MA which provides for one physical every 12 months.
I thought that the ACA requires a free annual physical for everyone on Medicare.
manwithnoname
 
Posts: 1584
Joined: Mon Jul 22, 2013 7:52 pm

Re: Does Medicare cover annual physical exam?

Postby wilpat » Sun Mar 02, 2014 6:58 pm

Kind of a grey area here. I believe Medicare now covers a colonoscopy once every 10 years, but it apparently covers more frequently based on Drs. orders. I've had three within less than 10 years. After the first routine one, the Dr. wanted me to have another just 3 years later - no specific reason that I was told. They found a polyp on that one, so had another one just done after 5 years. All were covered fully by Medicare. Believe me, I knew a couple people who died of colon cancer and they can roto-root me as often as they want.


I had 1/3 of my colon removed 4 years ago and Medicare covers colonoscopy's twice a year for me now.
Contrary to the belief of many, profit is not a four letter word!
User avatar
wilpat
 
Posts: 486
Joined: Sun Jan 20, 2008 7:30 pm

Re: Does Medicare cover annual physical exam?

Postby Browser » Sun Mar 02, 2014 8:55 pm

wilpat wrote:
Kind of a grey area here. I believe Medicare now covers a colonoscopy once every 10 years, but it apparently covers more frequently based on Drs. orders. I've had three within less than 10 years. After the first routine one, the Dr. wanted me to have another just 3 years later - no specific reason that I was told. They found a polyp on that one, so had another one just done after 5 years. All were covered fully by Medicare. Believe me, I knew a couple people who died of colon cancer and they can roto-root me as often as they want.


I had 1/3 of my colon removed 4 years ago and Medicare covers colonoscopy's twice a year for me now.

Good wishes to you and hope that you remain well. :thumbsup
If we have data, let’s look at data. If all we have are opinions, let’s go with mine. – Jim Barksdale
Browser
 
Posts: 3336
Joined: Wed Sep 05, 2012 4:54 pm

Re: Does Medicare cover annual physical exam?

Postby cheese_breath » Sun Mar 02, 2014 9:45 pm

manwithnoname wrote:I call up every year to schedule my annual Medicare physical and get all the tests which are free. I have MA which provides for one physical every 12 months.
I thought that the ACA requires a free annual physical for everyone on Medicare.

I think you're confusing the annual wellness exam with a physical. The ACA added the wellness exam to Medicare, but it isn't the same as a physical. See this link again for what is includes...

http://www.medicare.gov/coverage/preven ... exams.html
The surest way to know the future is when it's the past.
User avatar
cheese_breath
 
Posts: 3561
Joined: Wed Sep 14, 2011 7:08 pm

Re: Does Medicare cover annual physical exam?

Postby manwithnoname » Mon Mar 03, 2014 1:38 am

cheese_breath wrote:
manwithnoname wrote:I call up every year to schedule my annual Medicare physical and get all the tests which are free. I have MA which provides for one physical every 12 months.
I thought that the ACA requires a free annual physical for everyone on Medicare.

I think you're confusing the annual wellness exam with a physical. The ACA added the wellness exam to Medicare, but it isn't the same as a physical. See this link again for what is includes...

http://www.medicare.gov/coverage/preven ... exams.html


No, I my MA insurance specifically provides for a complete physical exam each year with all of the tests and my doctor calls me back with the results in a day or so. Co pay is 0.

I am also eligible for the annual wellness exam that you describe but that is not part of the physical.

I also get a wellness test from the VA when I renew my meds.

What kind of Medicare insurance are you thinking of?
Last edited by manwithnoname on Mon Mar 03, 2014 1:58 am, edited 1 time in total.
manwithnoname
 
Posts: 1584
Joined: Mon Jul 22, 2013 7:52 pm

Re: Does Medicare cover annual physical exam?

Postby sscritic » Mon Mar 03, 2014 1:54 am

manwithnoname wrote:
cheese_breath wrote:
manwithnoname wrote:I call up every year to schedule my annual Medicare physical and get all the tests which are free. I have MA which provides for one physical every 12 months.
I thought that the ACA requires a free annual physical for everyone on Medicare.

I think you're confusing the annual wellness exam with a physical. The ACA added the wellness exam to Medicare, but it isn't the same as a physical. See this link again for what is includes...
http://www.medicare.gov/coverage/preven ... exams.html

No, I have a complete physical exam each year with all of the tests and my doctor calls me back with the results in a day or so.

I get the wellness test from the VA when I renew my meds. Two completely different exams.

But you said you had MA, which I took to mean Medical Advantage (Part C). The question, as I read it, was about traditional Medicare Part B. C isn't B. You are comparing Carrots and Bananas.
sscritic
 
Posts: 21858
Joined: Thu Sep 06, 2007 8:36 am

Re: Does Medicare cover annual physical exam?

Postby manwithnoname » Mon Mar 03, 2014 2:04 am

sscritic wrote:
manwithnoname wrote:
cheese_breath wrote:
manwithnoname wrote:I call up every year to schedule my annual Medicare physical and get all the tests which are free. I have MA which provides for one physical every 12 months.
I thought that the ACA requires a free annual physical for everyone on Medicare.

I think you're confusing the annual wellness exam with a physical. The ACA added the wellness exam to Medicare, but it isn't the same as a physical. See this link again for what is includes...
http://www.medicare.gov/coverage/preven ... exams.html

No, I have a complete physical exam each year with all of the tests and my doctor calls me back with the results in a day or so.

I get the wellness test from the VA when I renew my meds. Two completely different exams.

But you said you had MA, which I took to mean Medical Advantage (Part C). The question, as I read it, was about traditional Medicare Part B. C isn't B. You are comparing Carrots and Bananas.


To me MA is Medicare because that is the coverage I have. Best part is that I don't pay a monthly premium for the basic MA or a co pay for routine visits which saves me a $1000 a year. I only pay $25 a month for dental and vision coverage.
manwithnoname
 
Posts: 1584
Joined: Mon Jul 22, 2013 7:52 pm

Re: Does Medicare cover annual physical exam?

Postby sscritic » Mon Mar 03, 2014 2:10 am

So you abbreviate MedicAre MA? If MA is your abbreviation for MedicAre, what abbreviation do you use for MedicAre AdvAntAge? MAAAA?

Whatever you call it, Part B is not Part C and Bananas aren't Carrots.
sscritic
 
Posts: 21858
Joined: Thu Sep 06, 2007 8:36 am


Return to Personal Finance (Not Investing)

Who is online

Users browsing this forum: BahamaMan, BolderBoy, cyclone792, dgdevil, dhodson, Gill, itstoomuch, jay22, MatsuGrabik, Meg77, placeholder and 77 guests