Medicare Coverage Questions Lately!

Lately, I have had several calls from Medicare Supplement Plan Clients with coverage concerns/questions. The important thing to understand with Original Medicare with Medicare Supplements is that if Medicare does not cover a procedure, your Medicare Supplement will not cover it. Your Medicare Supplement covers your 20% responsibility after Medicare covers its approved 80%. You need to be your own advocate with your doctors - most understand how Medicare works and are ethical but some are not or don't understand Medicare!

Example - A sweet client went in for her Medicare Wellness Visit (eyes, ears, throat, check your heart & do blood work - that is it!) If you ask any questions about a specific issue, it will change the nature of the visit and the cost. However, Medicare will only pay for the Wellness Visit Portion. Her doctor, whom she has been going to for years, asked if she wanted an EKG (which she had never had for any reason before). She asked the doctor if Medicare would cover its cost, and the doctor said Yes. Months later, she received a bill from the doctor's office stating Medicare had denied coverage for the EKG and she now owed $400 for that procedure. She now has two choices - pay the bill or get on the phone with the doctor and scream that she was misled and will not pay the bill. Maybe they will cancel the charges and maybe they won't. Medicare pays for an EKG for an issue but not a part of a physical.

You have to be proactive before your visits and make sure the procedure is covered by Medicare and if not, what the cost to you will be. Here is a Medicare Link to Find Out What Medicare Covers

Another Example - Dermatologist Annual Check-Up is not covered by Medicare unless there is an issue or history to follow up.

When a doctor prescribes one of the New Medications you see on TV - just know it will be expensive and ask if there is another option or a Generic available. Most doctors will prescribe the generic but some may get a dividend from the pharmaceutical company for prescribing.

So be your own advocate to protect yourself - ask questions, check the procedure ahead of time, and question your bills. If you have a Medicare Supplement Plan G, your doctor bills should be covered completely - no bills to you in most cases. Most of the time, if you call the billing office, they will say - Oh that was a mistake! If you have a Plan N know you will have a $20 doctor co-pay and may have some access charges - doctors can charge up to 15% over the Medicare-approved charges called Part B Excess Charge, which would be your responsibility. Plan G or Plan F (not available since 2020) are the only Med Sups that pay those access charges.

I am here to help anytime. Please stay cool & hydrated in this summer heat, but have fun! I will be away on vacation 8/1-8/11, but will respond to urgent calls.

Teri Basch 704-270-6766 W 704-293-1827 C