In my previous blog, I explained the difference between a “Welcome to Medicare” preventive visit and Medicare’s yearly “Wellness Visit”. Both of these exams are typically 100 percent covered by Medicare as long as your provider is a Medicare participating provider – but there are instances when these exams can lead to out-of-pocket expenses on your part. Here are a few examples:
Frequent testing or evaluation. Your doctor may order specific lab tests or procedures for you. Many lab tests and some procedures are only covered if performed during specific intervals — say every 90 days, for example. If, however, your medical condition requires a test or procedure be performed more frequently, you could be responsible for any deductible, coinsurance, and/or copayments that apply.
Routine exam turns into a not-so-routine exam. Let’s say you’re scheduled for a “preventive care” colonoscopy, an exam that is typically covered 100 percent by Medicare. If during the “preventive exam” your doctor finds a polyp or other lesion that requires removal, this “preventive care” exam is no longer “routine” and you’ll be responsible for any deductible, coinsurance, and/or copayments that apply.
Routine exam versus diagnostic exam. If your doctor schedules you for a mammogram every year as “preventive care,” this is covered 100 percent by Medicare. If, however, you see your doctor because of a lump in your breast, which requires a mammogram for evaluation, this is considered “diagnostic” and is then subject to your deductible and coinsurance.
Follow-up care and/or testing. It’s possible during your preventive care exam that your doctor may receive results that require further studies or follow-up care. Follow-up appointments, further diagnostic testing, and referrals are not considered “preventive care,” and you will be responsible for any deductible, coinsurance or copays that apply.
An Ounce of Prevention is Worth a Pound of Cure
It’s a proven fact that prevention is the best medicine. Many illnesses can be prevented or caught early by following through with your preventive care appointments and testing — this can also help reduce your out-of-pocket costs by avoiding costly invasive procedures.
Be sure to discuss with your physician which preventive care procedures are covered and at what intervals they are covered – and always be sure you receive your results — even if you believe they are negative!
Have you been surprised by out-of-pocket charges after a preventive care visit? Share your stories —
Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.