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Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

Dear Tom and Alan:

I started Medicare just last year. One of the first things I did was to get a physical.

I called to schedule a physical for this year and was told I would have to pay for it, plus whatever the lab tests cost.

This is going to be a few hundred dollars that I can’t afford. I thought preventive stuff was a big part of Obamacare and that it didn’t cost anything.

What am I missing?

Meg

Tom: Here’s a little background from the March 20 californiahealthline.org:

“When the Medicare program was established more than 50 years ago, its purpose was to cover the diagnosis and treatment of illness and injury in older people. Preventive services were generally not covered, and routine physical checkups were explicitly excluded, along with routine foot and dental care, eyeglasses and hearing aids.”

Al: For quite a while now, we’ve had a “welcome to Medicare” preventive visit.

Once you have Medicare Part A (hospital) and Medicare Part B (doctors), you get what is essentially a free physical checkup, as long as you get it done within the first 12 months of having Part B.

Our reader, Meg, should be receiving Medicare & You, a brochure put out annually by the Centers for Medicare & Medicaid Services (CMS).

In the 2019 issue on page 49, they point out that after the initial welcome visit, a beneficiary is entitled to a yearly wellness visit.

This involves a Health Risk Assessment questionnaire intended to develop a personalized plan to help her stay healthy.

The kicker for all these “free” visits is that there may very well be charges for lab tests or other services not covered under preventive services.

Tom: Back to Meg’s original question, the Affordable Care Act (ACA, Obamacare) established coverage of the annual wellness visit.

It specifies you pay nothing as long as the doctor accepts Medicare (i.e., takes what they give).

There are many things not covered by Medicare A & B:

  • Dental care that is not medically necessary
  • Most vision benefits
  • Dentures
  • Cosmetic surgery
  • Massage therapy
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Long-term care
  • Concierge care

Al: Long-term care is a benefit that many people are unclear about. Given that Medicare will cover up to 100 days in a Skilled Nursing Facility some assume that would take care of them.

In reality, a Skilled Nursing Facility will usually kick you out ASAP. In particular when one’s condition is such that there is no rational expectation for improvement, the Skilled Nursing Facility will determine that “custodial care” is needed, not the acute care treatment of a Skilled Nursing Facility.

For the Activities of Daily Living, such as, dressing, bathing, feeding oneself, walking, etc., a hospital is not necessary.

Once the care is not medical, neither Medicare nor a supplement will cover it.

Tom: And, yes, we know LTC is expensive and gets more so as we age.

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Submit questions to schrette@gmail.com or alancash@gmail.com.

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