Jesse Smedley
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
Did you know that Medicare actually doesn’t cover an annual physical. Medicare does cover “regular doctor’s visits”, but using the wrong terminology can result in a big bill.
Part B
Original Medicare is divided into Part A (your hospital insurance) and Part B (your medical insurance). Anytime you see a doctor, Part B will be billed.
Now, if we think of “regular” doctor’s visits, meaning anytime you visit your PCP. However, Medicare divides these types of visits into three basic categories.
Remember, a physical examination performed without a relationship to treatment treating or diagnosing a specific illness symptom or complaint, or injury is not covered by Medicare. And if your visit falls completely outside of Medicare’s parameters, you might have to pay the whole thing. Be especially careful if your doctor asks you to sign anything about your liability and the nature of the visit (especially if it is an Advance Beneficiary Notice of Non Coverage).
If it is a diagnostic visit, you might have to pay for the Part B deductible and then the 20% for any medical services or lab work. You can see how that can add up quickly.
Screening vs. Diagnostic
Medicare also covers many different screenings (the list of quite long!). Again, you need to go by Medicare’s guidelines though. Medicare is great coverage, but if you don’t follow the guidelines you can end up with large and unexpected bills.
In addition to working outside the parameters, there are confusing bills when tests become diagnostic vs. screening i.e. colonoscopies
Medicare covers screening colonoscopies once every 24 months if you’re at high risk for colorectal cancer. If aren’t considered high risk, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy.
There is no charge for a screening colonoscopy. However, if a polyp is found, the test switches to diagnostic and there will a 15% coinsurance.
Medigap
One of the best ways to maximize your benefits is to consider a Medigap or Medicare Supplement Plan. These types of plans fill in the financial gaps of Original Medicare. There is more than just what we’ve covered so far!
There are 10 different types of plans to choose from with varying levels of coverage and price points. Although most of our clients opt for Plan G due to its cohesive coverage, there are other plans available that can help to mitigate some of the potential large out of pocket costs associated with Medicare.
