Medicare

What's the Difference Between a Medicare Annual Wellness Visit vs. an Annual Physical?

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There are Two Main Differences:

Medicare will Pay for an Annual Wellness Visit, but not an Annual Physical.

The purpose of an Annual Wellness Visit is to establish your baseline health condition and prevent medical problems before they occur. It is fully covered by Medicare as a cost-saving way to keep you healthy.

When making an appointment, be sure to specify that you want to schedule an Annual Wellness Visit in order to prevent getting a costly bill afterward.

Typical things covered in a Wellness Visit:

  • Check height, weight, BMI, blood pressure, etc.

  • Complete and review a Health Risk Questionnaire that may identify personal risk factors that may affect your physical and mental health

  • Look for signs of cognitive impairment

  • Discuss risks based on your personal and family health history

  • Assessment and update prescriptions taken

  • If recommended by your doctor, Medicare also covers preventive services such as preventive cancer and cardiovascular screenings, cholesterol testing, bone density measurement, flu shots, alcohol abuse counseling, etc.

Once your current baseline health condition has been established, you and your doctor can then develop a person wellness program based on your unique health factors.  

If your Wellness Visit exceeds the services covered because your doctor recommends additional testing or treatment, Medicare beneficiaries will typically owe a copay or other charges.

An Annual Physical is Much More Comprehensive than a Wellness Visit

A typical annual physical includes all the services of an Annual Wellness Visit, plus additional services based on your health condition.

Additional services potentially covered in an Annual Physical:

  • Lung exam

  • Head and neck exam

  • Abdominal exam

  • Neurological exam

  • Reflex exam

  • Blood and Urine lab tests 

As a general rule, an Annual Physical includes more in-depth services where the doctor has to “physically” touch you, test you, or take samples from you.

Both are Important

Even if you are in good health, an Annual Wellness visit is important for maintaining your health because it helps diagnose and address health concerns early. Annual physicals are important as a more in-depth health exam addressing specific needs.

I hope this post helps. Please contact me with any questions.

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Medicare & The IRMAA Cliff

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What is IRMAA?

IRMAA stands for Income-Related Monthly Adjustment Amount and is often described as a tax on Medicare. If you’re an individual with income over $85,000/year, or part of a couple with income over $170,000/year, IRMAA will increase your Medicare premiums for Parts B and D.

The good news is that 95% of Medicare recipients will not face this higher cost. Some might say having to pay IRMAA is a good problem, but those who pay the higher fee rarely see it that way.

The amount you pay is based on your MAGI, or modified adjusted gross income from two years ago. The income brackets top out at $500,000+ for individuals and $750,000+ for couples.

With IRMAA, going just $1 into a higher income bracket could result in paying thousands more in Medicare premiums. This is known as the “cliff” and just a few dollars more in income can result in a significantly higher premium. Also, since IRMAA uses joint income for determining premiums, one high-earning spouse can force both spouses into a higher premium bracket.

What to Do

Plan with foresight and know the ramifications of your financial actions. Make sure that you and your financial advisor are aware that large stock trades, the sale of a house or business and other transactions may result in a jolt in your Medicare premium.

If your income drops significantly to due a one-time, life-changing event, you have the right to appeal for a lower premium by filing form SSA-44. Social Security considers any of the following situations to be life-changing events: the death of a spouse; marriage, divorce or annulment; retirement or reduced work hours for one or both spouses; loss of income-producing property due to natural disaster; or loss of a pension. Filing the form is particularly important during your first year of retirement.

One-time cash windfalls such as the sale of a vacation home, a large portfolio distribution or a Roth IRA conversion, do not qualify as a life-changing event and will result in a higher premium two years later.

I’m a licensed Medicare insurance broker in Tennessee and appointed with Aetna, Blue Cross, Cigna, Humana, United Health Care, and many more carriers. If you have questions on IRMAA or any other Medicare issue, please feel free to call me. Thanks.

Photo by Witches Falls Cotages is licensed under CC BY 2.0

Turning 65 and Medicare - What You Need to Know

Turning 65 brings some welcome relief for insurance coverage with the help of Medicare. Medicare is a massive healthcare programs that brings insurance relief for millions of older Americans, but qualifying and enrolling in Medicare brings confusion for many people.

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Here are answers to some of the most common questions:

When can I enroll in Medicare?

You are able to apply 3 months before you turn 65, even if you’re not yet ready to retire. However, if you have health insurance through your employer, you may wish to wait to enroll in Part B. You may be able to enroll sooner if you are disabled and can qualify.

Many people think that if they start claiming their Social Security benefits at age 62, they can enroll in Medicare at the same time, but that’s not the case. You have to wait until age 65.

How do I enroll in Medicare?

Basically, you enroll for Medicare through the Social Security website.

If you are already claiming Social Security benefits at age 65, you will be enrolled in Medicare automatically, so you don’t have to do anything. Your Medicare card will be mailed to you about three months before your 65th birthday.

If you are not claiming Social Security benefits when you turn 65, then you will need to apply for coverage through the Social Security website here. The process only takes about ten minutes, then you just wait for your card to arrive in the mail. If you don’t already have a Social Security account, you will need to create that first.

What Exactly Does Medicare Cover?

There are 4 parts to Medicare:

  • Part A (Hospital Insurance) - covers hospital stays and some stays in skilled nursing facilities. Most Americans pay no premium for Part A. It has a deductible of $1,364 per benefit period. For hospital stays of over 60 days or skilled nursing stays longer than 20 days, coinsurance is required.

  • Part B (Medical Insurance) - covers doctors' visits, lab tests, outpatient procedures, etc. You must pay a small premium for Part B, and you can opt out if you wish. Standard premium is $135.50/month and goes up to $460.50/month depending on income.

  • Part C (Medicare Advantage) - provides additional Medicare coverage through private insurance companies who are approved by CMS.

  • Part D (Prescription Drug Coverage) - provides coverage for prescription drugs. Part D plans are also offered by private insurance companies. Premiums are low - generally about $50/month or less.

I hope this information helps. I will be happy to guide you through the process of answering any of your questions. I have many options available for Part C and Part D coverage, as well as many Medicare supplement choices.

medicare photo by Aaron Fulkerson is licensed under CC BY-SA 2.0