Caution: Genetic Testing and Medicare

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There have been reports of educational sessions and Facebook ads stating that Medicare would pay for genetic testing for cancer screening or pharmacogenomic testing.  All the senior needs to do is supply their Medicare number and have a swab taken.

In most cases, this is Medicare fraud.  Genetic testing is only covered by Medicare when you have signs or symptoms of a disease or condition and your physician says that the test is medically necessary. Genetic tests used to screen for disease risk or to see how medicines may affect you are not covered by Medicare.

Please do not give your Medicare number to anyone outside of your healthcare networks like your physician’s office, hospital or pharmacy.

This includes outside screenings that you pay for yourself.  These outfits who set up screenings at churches, etc., will use your Medicare number to bill Medicare for a “Wellness” visit, so when your doctor tries to bill for this annual benefit, it has already been used.

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Medicare will not pay for a routine medical physical

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Medicare will not pay for a routine medical physical. However, they do pay for you to see your doctor once per year. During the first 12 months that you have Medicare Part B, you can get a “Welcome to Medicare” preventative visit. The doctor will review your health via an interview. They can also do some preventative covered services like your flu and pneumonia shots. You pay nothing for this visit if your provider accepts Medicare assignment.

If you have had Part B Medicare longer than 12 months, you can get a yearly “Wellness” visit. Make sure that when you are scheduling the appointment, that you specify that you want a wellness visit.

If your doctor or other healthcare provider performs any additional tests or services during either of your Welcome to Medicare or Wellness visits, during the same visit and they are not preventative, you may have to pay coinsurance and the Part B deductible may apply.

My personal doctor actually does the physical and writes off what Medicare does not cover. However, doctors are not obligated to do that by law. So be careful what you ask for. If you schedule an appointment with your healthcare provider and you have a “diagnosis” (something not normal), then the visit and corresponding tests should be approved to be paid. Medicare is starting to deny some routine screening tests such as a vitamin D blood test. If your provider knows that it is not routinely covered by Medicare, then they are obligated to tell you up front. Generally, you will have to sign paperwork stating you are aware that you may be responsible for the bill.

Remember, if Medicare does not approve the charges, then your Medicare supplement will not pay either.

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I am turning age 65. Do I have to get Medicare?

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The short answer is “not necessarily.”  Of course, the general perception is that if you don’t have Medicare at age 65, you will be subject to a late enrollment penalty. That is true for some people who are currently without health insurance or have health coverage through an employer with less than 100 employees.  However, many people are still covered by employer health coverage at age 65 and older. If you or your spouse are actively working and are covered by a work plan, you may delay getting Medicare Part A and/ or Part B until you want it, or the employment coverage ends.

Around the time you turn 65, you are eligible for an Initial Enrollment Period (IEP) where you can sign up for Part A and/or Part B.  After IEP is over, you have a chance to sign up later using a Special Enrollment Period (SEP).  Usually, you don’t have to pay a late enrollment penalty if you sign up for Medicare during an SEP.

There are multiple reasons why you may want to delay getting Medicare at age 65, and there are a few reasons you may want to even if employer coverage is available to you.  Every individual’s situation is slightly different.  I would be happy to consult with you with no obligation.  You may also contact Medicare at  www.Medicare.gov or call 1-800-MEDICARE.

 

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Important things to know about Annual Enrollment

Annual Enrollment Period, (AEP) also know as Open Enrollment Period (OEP) is from October 15th through December 7th each year.

All Medicare Advantage Plans and all Prescription Drug plans will change annually.  Medicare supplements (Medigap) benefits will stay the same and automatically renew.

  • It is important to “shop” for a plan every year..  This can be done at www.Medicare.gov or by contacting a reputable insurance agent that represents numerous plans.
  • Your existing insurance plan is required to let you know by letter what changes will be made for the upcoming calendar year.
  • If you are satisfied with your existing coverage, it will automatically renew for the next year.
  • If you want to change plans, this OEP is the time to make the change.
  • Be an educated consumer.  Changing plans could save you thousands of dollars per year.

Medicare Costs to Beneficiaries for 2018

Every year the Centers for Medicare and Medicaid (CMS) may change the out of pocket costs to Medicare recipients (known as beneficiaries).  In 2018, the Part A premium will continue to be $0 for most beneficiaries.  The Part B Premium will be $134 per month depending on your household income.  Those with higher incomes will pay more.  This is called IRMAA  and it based on a sliding scale. Feel free to contact me for more detailed information.

The Part A Hospital Deductible is $1340 per benefit period.

The Part B Medical Deductible remains stable at $183 per calendar year.

A Rehab/Nursing home stay will cost an additional $167.50 per day for days 21-100.

Please know that a supplemental Medicare policy (Medigap) may help pay for these increased costs.  Those who have Medicare Advantage Plans need to read their Summary of Benefits document since each plan has different premiums, deductibles and copays.