Welcome to Medicare. What’s covered, what isn’t? In the exam room I notice a sign. “Lab work is not covered by Medicare“. You owe $289. Do not pass go. Do not collect $200.
Welcome to Medicare physical exam? Covered. Lab work? Not covered. Really? You turned 65 and signed up for Medicare. What happens next?
Here is a short introduction to Medicare. What’s covered, what isn’t, and what to expect
- Medicare’s definition of preventive care has surprises
- Lab work may not be covered
- Medical necessity is the rule
- Free exams aren’t always free
Whether you have original Medicare and a supplement or you enrolled in an Advantage plan, the underlying rules of what is covered and what isn’t are the same. The difference is in how you pay for it.
You might want to view our Medicare Exam video on YouTube
Table of Contents
Turning 65 – Welcome to Medicare 2019 – What’s Covered?
By the time you reach 65 and enroll in Medicare, most people have a doctor (or doctors) they like and trust. They want to continue that relationship and are not interested in picking a doctor from a list provided by an insurance company.
Georgia Medicare Plans specialize in helping you keep your doctor(s) and finding a Medicare supplement plan that fits your needs and budget. We have rates and information on more than 230 different Medigap plans and will provide a FREE REPORT on all plans based on your age, gender and zip.
You can start your research by comparing rates and benefits for roughly 30 plans by getting an INSTANT GA Medigap quote.
I understand your confusion. Most people want information so they can understand what lies ahead. They want the time to read, make notes and ask questions.
Most of the insurance agents you will talk to are not old enough to enroll in Medicare and have not experienced it first hand. Bob Vineyard turned 65 in September, 2015 and enrolled in Medicare. In spite of 40 years in the health insurance business and over 400 Medicare clients, I am still learning things every day about how Medicare works.
Ask me anything. Others talk, we listen.
Welcome to Medicare Surprises
When I turned 65 and signed up for Medicare, one of the first things I did was schedule my Welcome to Medicare physical.
Because I chose original Medicare and a supplement plan, I was able to keep my doctor. My group insurance plan required me to have an annual exam and wellness interview so there should not have been any surprises with my Welcome to Medicare exam.
That was the wrong assumption.
While waiting in the exam room I saw a notice on the bulletin board.
Lab work is not covered by Medicare
Seriously? What’s that all about?
Preventive screenings are covered by Medicare in the following situations
- Abdominal aortic aneurysm scan – Men only, if you smoked 100 cigarettes in your lifetime
- Bone density – Mostly women, if you are estrogen deficient or have osteoporosis
- Lab tests – Only if considered medically necessary by Medicare
What is considered medically necessary?
Medicare defines medically necessary as tests or treatment needed to diagnose or treat an illness, injury, condition, disease or symptoms that meet accepted standards of care.
Preventive lab work may not be covered by Medicare.
Congratulations! You are healthy. Your test is not covered!
I take no medications. For the last few years my doctor has run routine lab work to make sure my body is doing what it is supposed to. As much as it galls me to say, my Obamacare plan covered routine tests like CBC, Lipid Panel, CMP, etc. at no charge to me.
These tests were not free. The labs and technicians do not volunteer their time. The costs associated with the lab tests were absorbed by the health insurance carrier and baked into the premiums.
Not so with Medicare.
Those under age 65 pay nothing.
If you are 65 and older, there is no more free lunch.
When I asked about the sign on the wall. The one that said “Lab work is not covered by Medicare” her response took me aback.
Medicare generally doesn’t cover those tests if you are healthy. But if you were sick, they would pay for them.
Sign this ABN form. If Medicare denies the claim you will have to pay the cost of your lab work. You will owe $289.
So much for my “free” Welcome to Medicare exam.
Medicare physical exam.
Is it covered? Is it free? How much will I have to pay?
Original Medicare is quite good in most respects. No more doctor networks. Forget about balance billing (when you use Medicare providers that accept assignment). Huge bills for health care are a thing of the past.
So exactly what is covered, and what isn’t? Check out this free Guide to Medicare Preventive Services. And yes, it really is free. Click to download.
More ways to save money.
Most of the retirees we talk to are paying too much for their Medicare supplement plan. Many are facing rate increases. One large Mutual company has increased rates 10 times since 2012!
Medigap plan F will be retired in 2020. Switch now if you can. Plan G is popular with over 90% of our clients. Some have not had a rate increase in two years.
Get a free GA Medigap quote. FREE report listing rates for all plans based on your age, gender and zip code sent by email once we confirm your information.
You need to be informed. The more you know and understand the better it will be for your bank account.
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