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Sound Advice: November 24, 2021

Medicare: A few more issues 

Many people look forward to Medicare as the primary source of funding for health problems they will be facing as they get older.  No doubt, Medicare can be a big help, but there are several caveats.

For one thing, physicians who accept Medicare patients may be doing so at costs that exceed the reimbursements they get from Medicare.  Those who do accept Medicare have to assume that the shortfall will be made up by other patients. 

You may still be able to see a physician of your choice, but you will be responsible for payment.  Of the various medical specialties, psychiatry has the largest share of practitioners who have opted out of Medicare: 42%.  If you are enrolled in original Medicare and your doctor opts out of the Medicare program, you can find and compare health care providers near you at http://www.medicare.gov

Medicare reimbursement rates have spiraled downward over the years and are typically even lower than those paid by private health insurance companies.  They are often less than 50% of the usual fees charged. 

Then there’s the matter of filing, which is complex.  Not surprisingly, the codes used by Medicare may not be the same as those for other filings, such as private health insurance.

Coverage for annual checkups is also different.  Medicare covers preventive wellness exams, which are substantially abbreviated versions of physical exams. 

There are two types of Medicare wellness exams.  The first is the Welcome to Medicare exam in which the doctor aims to establish the state of your health when you enter the program and provide a plan of future care.  The doctor will record your vital information (height, weight, blood pressure, body mass).  He will also review your personal and family health history and check risk factors that could indicate future serious illnesses.  Plus, he will recommend tests and screenings that could catch medical issues early and provide a checklist of preventive services to help you stay healthy.

Annual visits thereafter include measures of height, weight, body mass, and blood pressure.  The rest is a discussion of your own and your family’s medical history, any physical or mental impairments, and risk factors for diseases.

The visit provides a snapshot of your current health as a baseline for future yearly visits and is intended as a preventive service, a way of catching potentially serious health issues early.  Your doctor can develop a personalized health plan for you, check that you are up to date with preventive tests such as cancer screenings and flu shots, and may refer you for some tests, many of which Medicare provides for free.

During a physical, the doctor carries out a considerably more comprehensive exam of your major systems, notes significant changes, and reviews concerns.

“I believe keeping our promises should be our highest priority and that means saving Social Security and Medicare while preserving the American dream for our children and grandchildren.”

                                                                                            Former Senator Tom Coburn


N. Russell Wayne, CFP

Sound Asset Management Inc.

203.222.9370

nrwayne@soundasset.com

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