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Is The Medicare Annual Wellness Visit Mandatory?

When you sign up for Medicare, you will receive several preventive care services at no cost to you. The exams and screenings offered to you are meant to assess your overall health and your risk for developing certain illnesses. One of these free preventive care services is the Medicare Annual Wellness visit. Many wonder if this visit is a mandatory part of maintaining Medicare Part B coverage. While it is not mandatory, it is beneficial.

What’s Included In the Medicare Annual Wellness Visit

older caucasian man with a nurse — *Your doctor will check your family history, check your weight, blood pressure and more, while offering personalized heal advice/plan.*

The purpose of a Medicare Annual Wellness Visit is to check your overall health, assess your risk factors, and create a wellness plan to help prevent any illnesses you may be at risk for. Your doctor will briefly examine you, but this visit is not to be confused with a physical. A physical is a more comprehensive visit, at which your doctor checks you from head to toe and asks for lab work to be completed. Medicare does not cover physicals, but a Medicare Annual Wellness Visit is the next best thing.

At these visits your doctor will:

Review your medical and family history.
Check your height, weight, blood pressure, and other routine measurements.
Develop or update a list of providers and prescriptions.
Offer personalized health advice.
Create a list of risk factors and treatment options for you.
Discuss a plan for care in the event that you are unable to take care of yourself.
Screen you for conditions such as dementia and depression.

Eligibility For the Medicare Annual Wellness Visit

In order to be eligible for a Medicare Annual Wellness Visit, you need to have been enrolled in Medicare Part B for at least 12 months. When you first sign up for Part B, you will have an initial Welcome to Medicare Exam within the first 12 months of your enrollment. Once you have had this exam, then you are eligible to begin having an Annual Wellness Visit every year.

Medicare will cover your Annual Wellness Visits 100% as long as you see a participating Medicare provider. However, if your doctor prescribes any additional treatments or lab work in the course of this visit, then Medicare will cover 80% of the costs of these extras.

illustration of pill bottle with 2 bills beside it — *When going to your doctor, bring your medication with you.*

What To Bring To The Visit

Before you go to your first Medicare Annual Wellness Visit, you will need to fill out a long health risk assessment questionnaire. To avoid sitting at the doctor’s office filling out this form, you can request that it be mailed to you. That way, you can fill it out at home and have it ready when you go to your appointment. In addition to this form, bring any medications you are taking and a list of questions/concerns you may have.

When scheduling your appointment, make sure you let your doctor’s office know that you are scheduling an Annual Wellness Visit and not a regular checkup or wellness visit. If you are not clear about this, you could be charged for a regular wellness visit.

Medicare offers you free preventive care visits so that you can stay on top of your health. So while it is not mandatory to go to these appointments, it is definitely a good idea – you’ll be able to assess your risks and come up with a proactive plan to stay healthy. Your doctor will go over all of your medications, address any concerns, and come up with a new health plan and treatments for you to follow. These visits will keep you feeling your best; they could even end up saving your life.

Get A Plan From One of The Best Rated Medicare Supplement Companies Through EZ

There are a lot of choices when it comes to Medicare Supplement Plans. You not only have the choice between 10 different letter plans, but you also have the choice of multiple companies to buy your plan from. There’s Aetna, Cigna, Humana, Mutual of Omaha, and so many more. But which one in this sea of companies should you go for? First you need to determine which companies service your area. Next, you need to check each company’s ratings. At EZ, we have agents who can find the company that best fits your needs, so you can get the best possible plan and service.

How Companies Are Rated

yellow trophy with a star in the middle of the cup part. — *Organizations like the Better Business Bureau will sometimes evaluate multiple companies and give awards based on certain factors.*

Ratings for insurance companies that offer Medicare Supplement Plans are not based on the coverage that their plans offer. This is because Medicare Supplement Plans are standardized by Medicare, so each insurance company has to offer the same benefits for each letter plan across the board. Insurance companies can, however, set the premiums for their plans, so those vary from one company to another. Ratings aren’t generally determined by price alone, though. Insurance company ratings are based on:

The variety of plans offered. Many companies only offer a limited number of policies out of the 10 different letter plan types.
Their customer service. This is determined by customer reviews.
Awards received. Organizations like the Better Business Bureau will sometimes evaluate multiple companies and give awards based on certain factors.
How many states they offer plans in. Some companies only offer plans in a handful of states, while others serve more areas.

The Top Rated Companies

After evaluating all of the criteria above, we have determined that the top 5 Medicare Supplement insurance companies are:

Humana– Covers all 50 states, offers plans A,B,C,K,L,N, and has the best additional member benefits. This company generally uses attained-age pricing, meaning premiums increase as you age, and premiums depend on your location, age, tobacco use, and gender. They offer small discounts to those who are living with another senior member who has one of their Medicare Supplement Plans.
Aetna- Covers 42 states, offers plans A,B,G,N, and is rated best for customer service. Aetna generally uses attained-age pricing, so premiums increase as customers age. They also offer a 12-month rate lock, which guarantees that your premiums will not go up in the first year. They offer a 12% discount for customers who live with another senior who has one of their Medicare Supplement Plans.
Cigna– Covers 50 states, offers plans A,B,C,D,G,N, and has been rated the best overall value for the plans they offer. They do not require customers to use an in-network doctor, and they offer competitive premiums and some of the most affordable options. They offer a 7% discount for customers living with one other person that is enrolled in one of their Medicare Supplement Plans.
AARP– Covers 50 states, offers plans A,B,C,G,K,L,N, and is rated the most experienced in working with seniors. To qualify for a plan, you must be an AARP member. Their plan prices are community-rated. They offer an enrollment discount in most states of up to 30% for seniors aged 65, and they offer a 5% discount when more than one person in the household is enrolled in one of their plans.
Mutual of Omaha– Covers 50 states, offers plans A,G,N, and is rated the most experienced in working with the Medicare system; they have been offering Medicare Supplement Plans since 1966. Their plans usually use attained-age pricing, so premiums increase as customers age. They offer a 12% discount if you live with one other person (over 60 years old) that is also covered by one of their plans.

If you are interested in getting a plan from a top-rated Medicare Supplement company, EZ can help. We work with all of these companies, and more, and we will provide you with a highly trained licensed agent who works with these companies. Your agent will compare all available Medicare Supplement Plans to find the best one for you. You deserve the best, so we’ll make sure you get the best. To get free Medicare Supplement Plan quotes, enter your zip code in the bar above, or if you prefer to speak to an agent directly, call 888-753-7207. Our agents are ready to help!

A Medicare Supplement Plan Could Be Saving You Money Right Now!

Medicare provides peace of mind. It’s great to know that it’ll be there after you retire and no longer have employer-based health insurance. But Medicare Part B only pays for 80% of your medical costs, which leaves you with 20% of the bill, in addition to any unmet deductibles or copays. That 20% may not seem like a lot, but if you’re living on a fixed income as many seniors are, it can add up.

Luckily, when you sign up for Medicare Parts A and B, you have the opportunity to sign up for a Medicare Supplement Plan as well. These plans provide coverage for the out-of-pocket expenses that Medicare doesn’t cover. Medicare Supplement Plans offer you protection from losing your assets to large medical bills.

blood shaped blood bag with a connecting tube. — *Medicare Supplement Plans cover up to three pints of blood for a blood transfusion.*

What Medicare Supplement Plans Offer

Some of the reasons to choose a Medicare Supplement Plan are:

Helps pay a portion of the approved expenses that you are left to pay out-of-pocket. This includes:
- Copays
- Coinsurance
- Deductibles
- Blood transfusions for up to three pints of blood
- Hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Medicare Part A (hospital insurance) deductible
- Medicare Part B (medical insurance) deductible
- Part B excess charges
- Medical costs incurred while traveling outside of the U.S.
- Out-of-pocket limits
There is no network, so you can go to any doctor or hospital that accepts Medicare assignment.
Coverage will automatically renew each year (unless you want to switch plans)

hand holding a paper that says "medical bill" on it with dollar signs on the bottom circled in red. — *Older people are more vulnerable to accidental falls and broken hips, and when these happen it can mean big medical bills.*

Why You Should Have One

Life is unpredictable, and it doesn’t get any less unpredictable as you get older. Older people are more vulnerable to accidental falls and broken hips, and when these happen it can mean big medical bills. Health care and out-of-pocket costs are on the rise, and you could fall into debt if you had an accident or were diagnosed with a serious illness. Having a Medicare Supplement Plan means not having to worry about that happening to you. It also means not having to set aside money to pay for 20% of any bills you accumulate; you just have to budget for your monthly premiums.

One thing to remember is that you need to sign up for a plan during your Medicare Supplement Plan Open Enrollment Period (the 6-month period that starts the first day you are 65 and enrolled in Part B). Otherwise, you will need to undergo the medical underwriting process, and may end up with higher premiums.

Which Plan Is Right for You?

The cost and coverage of Medicare Supplement Plans vary from one letter plan to another. Some have high deductibles with lower monthly premiums, while some offer more coverage for a little more money per month. There are 10 different types of plans to choose from, so in order to choose the coverage you need for a price that works for you, you need to research and compare all the plans.

Comparing all the plans can take a long time and you might be wondering where to even start. That is why we created our business- to help you compare and sign up for plans at no cost to you. We want to help you make an informed decision, so you can get the best care at the best price. To get your free quotes, enter your zip code in the bar above, or to speak directly to a licensed agent, call 888-753-7207.

Does Medicare Cover Colonoscopies?

Colorectal cancer is the second leading cause of cancer-related deaths in men and women in the U.S. It is estimated that about 1 in 20 people will be diagnosed with colorectal cancer in their lifetimes. This number is high in part because 1 in 3 people are not up-to-date on their colonoscopy screenings. Colonoscopy screenings are the most effective way to detect and prevent colorectal cancer. Getting regularly screened is especially important for older adults, because if you are 65 or older, you are at a greater risk of dying from colon cancer. Fortunately, Medicare covers colonoscopies at specific time intervals, based on a person’s risk for colon cancer.

doctor in blue gown holding a black tube with a light on the end of it. — *During a colonoscopy, a thin, tubed camera is inserted inside the body so that doctors can view the lining of the colon.*

What Is A Colonoscopy?

Colonoscopies are safe, common procedures. According to the CDC, over 25 million colonoscopies took place in 2012. During this procedure, a thin, tubed camera is inserted inside the body so that doctors can view the lining of the colon. There are two types of colonoscopy:

Screening colonoscopy– a routine procedure performed to see how healthy the colon is and to check if there are any polyps that need to be removed.
Diagnostic colonoscopy– performed to check for irregularities because a person is having intestinal issues.

When a colonoscopy is performed, the patient will normally be put under general anesthesia.

How Much Does It Cost?

Many factors go into determining the price of a colonoscopy. This includes the location where it is done, what kind of anesthesia is used, and whether any tissue samples have to be sent to a lab for testing. The average cost of a colonoscopy is almost $4,000. If you have private insurance, the procedure will be covered after you meet your deductible. Medicare also covers colonoscopies, but how they are covered depends on whether they are considered a screening or a diagnostic procedure.

What Medicare Covers

Because a screening colonoscopy is considered a preventive service, Medicare Part B will cover it. Medicare will cover all screening costs as long as the doctor accepts Medicare assignment. This means that your doctor agrees to accept the Medicare-approved amount as full payment for the procedure.

Medicare will cover the cost of screening colonoscopies:

Once every 24 months (2 years) if you are at high risk of colorectal cancer because of family history or history of colon polyps or inflammatory bowel disease.
Once every 120 months (10 years) for patients who are not considered high-risk.

Your screening will be covered in full whether or not you have met your deductible.

Only the screenings themselves are covered, so if your doctor finds a polyp or takes tissue samples during the colonoscopy, then you will have to pay a portion of the bill. You might owe:

20% of the Medicare-approved amount
A copay if you’re in a hospital getting the procedure done

Medicare Supplements can help pay for the additional 20% of out-of-pocket costs if a polyp is found or if you require more than just a screening. Before scheduling your colonoscopy, contact your Medicare Supplement Plan insurer and find out just how much they will cover if a polyp removal is necessary.

A colonoscopy is an important screening test that can help catch colorectal cancer early and possibly save your life. There’s no reason not to get one done if you are over 65, because Medicare covers the cost, and a Medicare Supplement Plan can help pay for any other costs associated with getting tested. If you are looking for a Medicare Supplement Plan, we will help compare the different plan types in your area. We will help you find one that meets your health and financial needs. To get free quotes, enter your zip code in the bar above, or to speak to an agent directly call 888-753-7207. No obligation. No hassle. Just free quotes.

Federal Judge Rules Medicare Patients Can Challenge “Observation Care”

There may come a time in many seniors’ lives when they require emergency hospitalization. The hospital provides the necessary treatment, then they might send the patient to a nursing care facility for further care. If you find yourself in this situation, you might think that Medicare will fully cover both your hospital stay and your aftercare. But this is not always the case. If the hospital changed the status of your stay from “inpatient” to “observation care,” you would end up with a big bill, and you would have no way to appeal the decision – until now. At the end of March, a federal judge ruled that beneficiaries who were charged for aftercare after having their status changed can challenge the bills they received.

black and white pic of an elderly man sitting in a wheelchair — *Medicare has very specific rules about covering care in a skilled nursing facility.*

How Observation Status Affects Billing

Medicare has very specific rules about covering care in a skilled nursing facility. In order for your stay to be covered, you need to have been hospitalized as an inpatient for 3 or more consecutive days before going to the facility. But, if you are classified as “under observation” during your stay in the hospital, then you would be considered an outpatient, rather than an inpatient. This means that if the hospital labels your stay as “observation care,” any care you receive at a nursing facility would not be covered by Medicare.

If your status is changed from “inpatient” to “under observation” during your hospital stay, your aftercare could end up costing you thousands of dollars out-of-pocket – or you could even be denied care.

The Lawsuit & Its Ruling

In 2011, seven Medicare beneficiaries filed a class action lawsuit against the Department of Health and Human Services (HHS). In Alexander v. Azar, these beneficiaries argued that their status had been switched from “inpatient” to “under observation,” and that they should be given the right to appeal this decision.

On Tuesday, March 24, District Judge Michael Shea ruled in favor of all beneficiaries who had their statuses changed and then received large bills for aftercare. According to his ruling, any patient since January 1, 2009 who had been admitted as an inpatient by their doctor but later had their statuses switched are entitled to appeal the denial of their claims. The new ruling only applies to beneficiaries who were admitted as inpatients and then later switched to outpatient status by the hospital. If the doctor admitted them as “under observation,” then they cannot appeal.

Judge Shea estimates that hundreds of thousands of beneficiaries will be able to appeal and get reimbursed.

It can be frustrating to know the rules of Medicare, but not have any control over following them. Hospitals decide how to classify patients, and their decision could cost you thousands of dollars. Luckily, thanks to Judge Shea, Medicare beneficiaries now have a way to appeal these decisions, and possibly get out of medical debt.

Does Medicare Cover Cataract Surgery?

As you age, your likelihood of developing cataracts increases. About 30% of Americans 65 and older have some kind of vision impairment from cataracts, and for those over 80, that number jumps to 50%. While Medicare does not cover routine vision care such as eye exams for glasses, it does cover diagnosis and treatment for chronic eye conditions, including cataracts. Cataract surgery is considered a medically necessary surgical procedure, but Medicare will only cover the basics.

The Surgery

Cataracts occur when the lens of your eye becomes clouded. Having this condition makes your vision blurry and less colorful, or like you are looking through a foggy or dusty window. During cataract removal surgery, the surgeon removes the clouded lens and replaces it with an artificial implant. It takes about an hour to perform and can be done in different 2 ways:

Phacoemulsification– A tiny probe is inserted into the lens and ultrasound waves are used to break up the cataract. The particles are then “vacuumed” out.
Extracapsular– The doctor makes an incision in the cornea and lifts out the lens in one piece before replacing it with the implant. You will most likely need stitches after this procedure.

Surgery is normally very successful for the majority of people who get it done. After surgery, you might need to wear an eye patch and use special eye drops to prevent infection.

What Medicare Covers

Medicare will cover your cataract surgery as long as it is deemed “medically necessary” by your doctor. Both traditional and laser cataract surgeries are covered, but if you opt for premium products such as intraocular lens (IOL) implants, then you will have significant out-of-pocket expenses that Medicare will not cover. Medicare will also cover one pair of glasses after cataract surgery.

glasses with words on each lens from a book in the background — *Medicare covers one pair of glasses after cataract surgery.*

The specific list of what Medicare covers includes:

Preoperative exams
Removal of cataracts
Implantation of lens
Postoperative exams
One pair of prescription glasses

How Much Medicare Covers

Cataract surgery can cost about $2,700 for one eye and $5,200 for two eyes, depending on the type of procedure and whether it is done on an outpatient basis or in a hospital. For outpatient procedures, Medicare Part B covers 80% of the costs of the outpatient facility, the doctor’s fees, and other costs related to the surgery, once you meet your deductible.

Medicare’s Part A will cover the hospital stay if your cataract surgery takes place in the hospital instead of an outpatient facility. You will have to pay a separate Part A deductible if your cataract surgery needs an inpatient stay.

Help with Out-of-Pocket Costs

Because Medicare Part B only covers 80% of the cost of the surgery, you will have to pay the remaining 20% out-of-pocket. Having a Medicare Supplement Plan can help you pay this balance. A Medicare Supplement Plan works like any other private insurance plan: you pay monthly premiums and your plan can cover deductibles, copays, and other out-of-pocket expenses. The cost of each plan, as well as the coverage they provide, varies.

Medicare covers 80% of costs, but if you need surgery or any other type of procedure, you could still end up paying hundred of dollars out-of-pocket. It is wise to have a Medicare Supplement plan to help you pay for those out-of-pocket costs. In order to find the right Medicare Supplement Plan for you, you’ll have to compare all the different types, which can be time consuming and confusing. EZ.Insure will help compare all the plans and their costs, and will help you sign up for the best plan for your budget. To get free quotes, enter your zip code in the bar above, or to speak directly to a trained agent, call 888-753-7207.

Tag: medicare

Is The Medicare Annual Wellness Visit Mandatory?

What’s Included In the Medicare Annual Wellness Visit

Eligibility For the Medicare Annual Wellness Visit

What To Bring To The Visit

Get A Plan From One of The Best Rated Medicare Supplement Companies Through EZ

How Companies Are Rated

The Top Rated Companies

A Medicare Supplement Plan Could Be Saving You Money Right Now!

What Medicare Supplement Plans Offer

Why You Should Have One

Which Plan Is Right for You?

Does Medicare Cover Colonoscopies?

What Is A Colonoscopy?

How Much Does It Cost?

What Medicare Covers

Federal Judge Rules Medicare Patients Can Challenge “Observation Care”

How Observation Status Affects Billing

The Lawsuit & Its Ruling

Does Medicare Cover Cataract Surgery?

The Surgery

What Medicare Covers

How Much Medicare Covers

Help with Out-of-Pocket Costs

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