Medicare Preventative Services
Yearly “Wellness” visit
NOT an Annual Physical Exam!
Medicare does not cover an annual physical exam – see 15 pages from Medicare to explain the difference. “It’s very important that someone, when they call to make an appointment, uses those magic words, ‘annual wellness visit,’”
An annual physical typically involves an exam by a doctor along with bloodwork or other tests. The annual wellness visit generally doesn’t include a physical exam, except to check routine measurements such as height, weight and blood pressure. CA Healthline.org *
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How often are Eye exams covered?
Medicare doesn’t cover routine eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses. Medicare Part B (Medical Insurance) covers some preventive and diagnostic eye exams:
Medicare Part B (Medical Insurance) covers a yearly eye exam for diabetic retinopathy
by an eye doctor who’s legally allowed to do the test in your state.
Who’s eligible?
All people with Part B who have diabetes are covered.
Your costs in Original Medicare
You pay 20% of the Medicare-approved amount for the doctor’s services, and the Part B deductible applies. In a hospital outpatient setting, you pay a copayment.
Note
To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service. medicare.gov yearly-eye-exam
cms.gov/VisionServices_FactSheet
92012 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
92083 — extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees, or quantitative, automated threshold perimetry, Octopus programs G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2).
92083 — extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees, or quantitative, automated threshold perimetry, Octopus programs G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2).
Preventative Care
Bone Density Osteoporosis
Mammogram coverage under Medicare
Breast cancer screening (mammograms)
Breast cancer is the most common non-skin cancer in women and the second leading cause of cancer death in women in the U. S. Every woman is at risk, and this risk increases with age. Breast cancer usually can be treated successfully when found early. Medicare covers screening mammograms and digital technologies to check for breast cancer before you or a doctor may be able to find it manually.
Who’s covered?
Women 40 and older are eligible for a screening mammogram every 12 months. Medicare also covers one baseline mammogram for women between 35–39.
How often is it covered?
Once every 12 months.
Your costs if you have Original Medicare
You pay nothing for the test if the doctor accepts assignment.
Am I at high risk for breast cancer?
Your risk of developing breast cancer increases if any of these are true:
• You had breast cancer in the past.
• You have a family history of breast cancer (like a mother, sister, daughter, or 2 or more close relatives who’ve had breast cancer).
• You had your first baby after age 30.
• You’ve never had a baby.
Other pages on our website dealing with cancer and how Insurance and Rx Prescription coverage might pay for it
https://medi-cal.healthreformquotes.com/eligibility/cancer-program/
Child & Related Pages – Site Map
If you are low income you might check out LIS – Low Income Subsidy – Extra Help to pay the Rx costs that are not covered. LIS may also pay your Part D and Part B premiums and you might also qualify for Medi-Cal.
Medicare #Preventative Services Publication # 10110
Video's
- Preventative Benefits
- Vaccines
- Stroke Awareness Month Heart Disease - Screenings under Part B
- Glaucoma explained on Medicare.Gov
- Silver Sneakers
- Medicare & You: Flu Prevention
#Medicare10050 and You 2021
Everything you want to know - Read Along
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Is a flu shot covered under the yearly wellness visit?
Medicare Part B (Medical Insurance) covers one flu shot per flu season.
Your costs in Original Medicare
You pay nothing for a flu shot if your doctor or other qualified health care provider accepts assignment for giving the shot.
Things to know
•Don’t wait to get the flu shot. You can get the flu shot many places, including your doctor’s office and your local pharmacy — contact them for details. If you have a Medicare Advantage Plan, contact your plan — most places accept Medicare Advantage Plans.
•Stay safe. Your doctors and pharmacies are working hard to keep you safe and socially distanced. Remember to wear your mask when you get your shot.
VIDEO’s
Medicare & You: Flu Prevention
https://youtu.be/QCQf-J2RLFY
Medicare & You: Vaccines
https://youtu.be/ArBQ0G7mYw4
I have a retiree health plan through Boeing. The flu shot provider couldn’t figure out where to send a bill, so I had to pay it.
We googled and found this page for Boeing retiree’s
https://www.bcbsil.com/boeing/coverage-and-plans/medical/2020/medicare_supplement.html
What plan do you have?
This page for Boeing requires a password. If you send it to us privately, we can check it out for you.
https://leplb0590.upoint.alight.com/web/boeing/login?forkPage=false#/routing
Here’s the Federal Government Guide to Medi Gap Plans and MY video introduction
https://youtu.be/HxqcVChQRZg
https://www.medicare.gov/Pubs/pdf/02110-medicare-medigap-guide.pdf
Federal Guide to Medicare and Other Coverage
https://www.medicare.gov/Pubs/pdf/02179-Medicare-Coordination-Benefits-Payer.pdf
Video on Co-ordination of Coverage
https://youtu.be/WEfXkIpzxpA
How is Vitamin D – 3 level 82306 GA paid?
What is Local Coverage Determination LCK http://www.CMS.gov/medicare-coverage-database
Vitamin D Assay Testing: Medical Necessity and Documentation Requirements
82306-Vitamin D, 25 HYDROXY, includes fraction(s), if performed
Vitamin D lab assay is only reimbursable under Medicare when it meets the indications under the applicable LCD and not as a routine screening according to 42 CFR 410.32(a) source
§ 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.
(a) Ordering diagnostic tests. Except as otherwise provided in this section, all diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests must be ordered by the physician who is treating the beneficiary, that is, the physician who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem. Tests not ordered by the physician who is treating the beneficiary are not reasonable and necessary (see § 411.15(k)(1) of this chapter).
Our webpage on Medicare Appeals
How is the PSA Prostate Specific Antigen Measurement 84153 GA paid under Medicare A or B?
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1801A3.pdf
https://www.questdiagnostics.com/dms/Documents/mlcp/National-Guides/National-MLCP-190-31-Prostate_Specific_Antigen/National%20-%20MLCP%20-%20190.31%20-%20Prostate%20Specific%20Antigen.pdf
Our webpage on Preventative Services for under 65 – ACA / Obamacare
https://individuals.healthreformquotes.com/10-essential-benefits/preventative-care/