Does Medicare with Medigap plan G cover a physical

[MaryM373887]

I recently went for my annual physical. The one I get every year to check my blood pressure, weight and other vitals, along with basic bloodwork for cholesterol, glucose, etc. I got a flu shot too. Insurance covered the bloodwork and flu shot, but not the doctor visit. I’m being billed $723 for a wellness visit. The United Healthcare Medigap side doesn’t know why Medicare won’t approve the charge and I should call Medicare to dispute it. Medicare says they don’t cover any physicals your first year (I’ve only been on Medicare since August). I’m being sent paperwork to dispute this decision. What does a Medicare plus AARP Medigap plan cover? Not an annual checkup? I’m thankful that they did cover the bloodwork and flu shot, but if they can’t cover a basic physical what will they cover if I go to see an orthopedic doctor about my sore hip/lower back? Medigap costs me $147/month.

[GailL1]

@MaryM373887 

 I believe you are interpreting the “Welcome To Medicare” coverage too literally - it is a very defined benefit and it is NOT a “physical”.  Neither is the Medicare annual wellness visit - 

Medicare.gov - Welcome To Medicare Preventive Visit

Medicare.gov - Annual Wellness Visit 

Now, your doctor can order other stuff that is medically necessary but those things will be covered only as other Part B are covered - as long as your doctor accepts Medicare assignment and you have Traditional Medicare, those things that are medically necessary are covered at 80% of the Medicare approved amount - if you have a Medigap (Plan G), it will cover the other 20% AFTER you have met the Part B deductible for this year.

Preventive testing of those things that are rated either A or B by the US Preventive Service are covered at 100% of the Medicare approved amount - other preventive test if medically necessary are only covered ast 80% of the Medicare approved amount.

Medicare.gov - Preventive Services - details

Now as to what you got billed vs what was paid - that is a matter of how the doc accepts Medicare - accepts assignment or is non participating.  And what was done and the codes they used for billing Medicare.

Used Medicare.gov as your go to if you have original Medicare and a Medigap plan - you should have excellent Part B coverage with those.

[MaryM373887]

Thanks. I’m not happy about the wellness visit issues for sure, and disappointed that the type of physical we’re used to having - with routine bloodwork- is not covered. I did the interview questionnaire online prior to the Welcome visit and the doctor briefly reviewed my answers. Awkward because she’s been my primary care for years. My husband and I are now trying to find out how many more “hidden costs” we’ll face, including dermatology which fair skin people need. Always something 

[GailL1]

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@MaryM373887 wrote:

Thanks. I’m not happy about the wellness visit issues for sure, and disappointed that the type of physical we’re used to having - with routine bloodwork- is not covered. I did the interview questionnaire online prior to the Welcome visit and the doctor briefly reviewed my answers. Awkward because she’s been my primary care for years. My husband and I are now trying to find out how many more “hidden costs” we’ll face, including dermatology which fair skin people need. Always something 

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Again, you seem to be misinterpreting your Medicare benefits - blood work and anything else that is medically necessary is covered - just NOT at 100% - like the Welcome to Medicare or the Annual Wellness check, as defined by Medicare, are.  

Go to your Derm. Dr. if he accepts Medicare Assignment he will bill Medicare (the traditional program) and they will pay him 80% of the Medicare approved rate after the Part B deductible for the service covered.- the last 20% is on you either out of pocket or paid for by a supplemental plan - either a Medigap or Medicaid if one is poor.

If you have a Medigap Plan G, then once you have met the Part B deductible for the year, you are pretty much home free under this coverage.  

[cat0w]

Have you looked at the Medicare website?

What Medicare covers | Medicare

Annual Wellness Visit Coverage (medicare.gov)

I'll be going for my wellness checkup in January. First, I'll go for my lab work and then a week later I will return to see my doctor and have my annual wellness checkup and go over the results of my lab test.

[MaryM373887]

So, is the bloodwork covered as part of a wellness exam? CBC, cholesterol and glucose screening. The website doesn’t specifically say that. Are Pap smears covered? I was getting these every few years as part of a physical. That and physical checks of my neck, breasts and abdomen for any lumps, bumps, etc. I didn’t even need to undress for this exam. Bloodwork was ordered and we had a brief conversation about my life (had this doctor for years, and she sees my adult daughter too).

[cat0w]

@MaryM373887 

Did you check out the link I provided for, Annual Wellness Visit Coverage (medicare.gov) and scroll down to this?

[MaryM373887]

I did just now. Thanks. Once every five years for bloodwork. It’s sad that Medicare even with a supplement plan doesn’t offer the basic preventative services we’re used to. Between buying a separate dental plan, prescription plan and a supplement we’re paying the same as we did for an employer sponsored couples plan.

[cat0w]

@MaryM373887 

What is your location? I am in Central Texas and have Baylor Scott and White Advantage plan. All my care is covered in the plan. Dental cleaning and check up is paid for two times each year. Additional work does have a co-pay. My prescription plan has co-payments. 

As a type two Diabetic I have lab work done two times each year and have never paid anything for that.

While Medicare went up some this year my Baylor Scott and White plan went down the same amount so my withholdings from SS stayed the same. I received my SS statement (COLA) for 2024 over the weekend.

[MaryM373887]

I live in NH and have the Medigap plan G. We’re buying a separate dental plan to cover extra issues like crowns, etc.

[columbopdx]

The first visit when you join medicare is called a "welcome to medicare" visit, not an annual physical.

See if your doctor can change the code on it.

[new577]

It’s very simple…

our UHC medigap plan g (or for that matter, any company or any plan), will cover the gap for only charges Medicare allows (Medicare pays, supplement pays; Medicare does not pay, supplement does not pay)

 I would think your complaint is with Medicare and your doctor.

when Medicare sends the completed claim to the medigap insurer, said insurer must pay the gap on any approved claim.

[MaryM373887]

is there anyway to find out what is covered? I’m concerned because my husband and I are both on this plan. We see a dermatologist for skin cancer screening/treatment yearly, my husband needs a hip replacement and has waited for retirement to move forward with this, etc. I need to know Medigap is a better option than Medicare Advantage. Medigap is expensive and we also had to buy RX and dental insurance separately.

[new577]

With few exceptions, original Medicare will pay for all services that are medically necessary.

i see my internist and/or  other specialists at least my two times per month. Not one claim or lab has been rejected by Medicare. 
And my supplement has paid every gap in coverage it was suppose to.

yes, it’s expensive, but after the part b deductible is satisfied, I do not pay another $.01 the rest of the year!