Preventive Care

[mariemerganser]

I am speaking with a guy who is very specific on how prev care is covered if he were to choose Plan B. If he is going for routine exams and getting testing done to make sure his heart, blood pressure etc are in check, how would this be covered? He has had serious heart problems and is very concerned about how this testing is covered. The only Medigap plan, to my knowledge, that he can get in FL is Plan B through United American. He is on Medicare b/c of a disability.

 

[moonlightandmargaritas]

I don't work this market, so be careful, but I believe Blue Cross offers their MA plans to folks on under 65 Medicare, but only in selected counties...

 

[mariemerganser]

So would it be more beneficial for him to do an advantage plan rather than United American Plan B (which is his only option for medigap) knowing that routine health screenings are a big concern for him?
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How are stress tests, echocardiograms and catheritizations covered under Medicare?

 

[Bob_The_Insurance_Guy]

You're best bet is to find both Medicare Advantage Plan designs, as well the top Med Supp companies in your area, get a copy of the Evidence of Coverage, and perhaps place a call into the Member Services department.

Get clarification on it up front, in writing if possible (have them e-mail/fax you the pages with that exact verbiage).

If he is of limited income, and is more comfortable with a "pay-as-you-go" system, with predictable costs, then Medicare Advantage plans may better suit his situation. If he wants to pay a Medicare Supplement plan a monthly premium, and not have to worry about any payment for services, then a Medicare Supplement Plan is the better option. I would go with either a Part D, F or J (my two cents worth).

PROCEED WITH CAUTION

 

[thewold]

he has heart problems and high blood pressure, correct? probably on meds for it, so doctor wants to see him what like every 3 or six months. I'm not going to say this as 100% correct but that sounds to me like diagnostic. Should be covered under part B of medicare which the medigap B will cover. Medicare covers all lab.

Preventative would be like an annual physical. Or if prostate cancer ran in the family and the client wanted to get a prostate exam more often than medicare would allow, it would be preventative.

Very rarely do I have a client not on meds and they regularly see doctors to have a check up and it is always covered. Now I do have a few clients who are in perfect health, no meds and go once a year for a routine physical. That is not covered unless they have the preventative benefit under their supp.

As far as the MA goes, I don't know what to tell as I don't know what the plans are like in FL. But I would go with the supp if possible. That's just me, I hate MA plans and will very very rarely sell one.

 

[retread]

I am speaking with a guy who is very specific on how prev care is covered if he were to choose Plan B. If he is going for routine exams and getting testing done to make sure his heart, blood pressure etc are in check, how would this be covered? He has had serious heart problems and is very concerned about how this testing is covered. The only Medigap plan, to my knowledge, that he can get in FL is Plan B through United American. He is on Medicare b/c of a disability.

Medicare was never designed to cover all medical expenses. It is Basic Medical (catastrophic) coverage. If you want preventive care, you need either a supplement that will provide what Medicare doesn't, or a Medicare Advantage plan which is comprehensive like Major Medical plans. They emphasize preventive care, and that was one of the main reasons they were established by Medicare.

Only Med Sup plans E and J do the job. Other than that, you need an MA plan.

 

[mariemerganser]

Well since he is under 65 on disability, he only has one option for medigap (Plan B United American). I was lucky enough to find his doctors and hospitals with secure horizons so we are going to do that. Thanks so much.

 

[retread]

Well since he is under 65 on disability, he only has one option for medigap (Plan B United American). I was lucky enough to find his doctors and hospitals with secure horizons so we are going to do that. Thanks so much.

What makes you think being under 65 on disability that he only has one option? If he can get a Med Sup, he can surely get a MA plan. As long as he has been on disability for 24 months, he qualifies for Medicare. If he qualifies for Medicare and has Parts A and B, he can get a MA plan.

 

[Frank Stastny]

I have been selling Med Supps for 15 years. Never, not once has a client ever had a Medicare claim denied because of a "routine physical" exam.

The guy is on disability, he has "serious heart problems", there is no such thing for this guy as a "routine physical" examination.

In the experience of my clients doctors do not run tests on seniors for the hell of it. For 15 years I have sold nothing but Plan B in the beginning and of late Plan D. I have never, repeat, never had a client who had a claim denied for going to the doctor.

To sell that guy an MA is doing him a huge disservice. He needs the ability to go to any doctor who can help him. Not be limited by some HMO or PFFS plan.

Plan J is a joke. That is why Medicare is getting rid of it. If your prospects doctors accept assignment then the very best plan you can put that prospect in is Plan D.

I find it very hard to believe that of all the Med Supp companies that exist that only one, UA, will sell a plan that will cover someone on Medicare Disability. However, you may very well be right.
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Medicare was never designed to cover all medical expenses. It is Basic Medical (catastrophic) coverage. If you want preventive care, you need either a supplement that will provide what Medicare doesn't, or a Medicare Advantage plan which is comprehensive like Major Medical plans. They emphasize preventive care, and that was one of the main reasons they were established by Medicare.

Only Med Sup plans E and J do the job. Other than that, you need an MA plan.

I beg to differ with you. Medicare will cover just about everything and by design it provides the very best medical coverage available of any kind regardless of age. The only things I have seen Medicare deny are things like a patient getting their hair done while in the hospital.

I have had an occasional doctor tell a patient that they need to pay he bill up front for the full amount before they leave the office because Medicare won't pay. I have turned in two doctors for doing that who never turned the claim into Medicare because they wanted to collect more money than Medicare would allow and told their patient that since Medicare "wouldn't pay" that they owed the full amount. I reported both and my clients ended up not owing a thing.

"Preventative care" is not only covered by a Med Supp policy but doctors receive an extra 2% payment for doing that. All Med Supp policies not just Plans E and J. Plans E & J suck.

I think you are listening too close to the propaganda that is being spread around by insurance companies.

I know this because Jacqueline works at a 50 doctor clinic and is in the process of working with the doctors urging all of them to begin running tests for suspected illnesses.
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So would it be more beneficial for him to do an advantage plan rather than United American Plan B (which is his only option for medigap) knowing that routine health screenings are a big concern for him?
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How are stress tests, echocardiograms and catheritizations covered under Medicare?

"Routine health screenings". The guy has severe heart problems. Keeping an eye on him by running tests is not considered "routine health screenings" by Medicare or his doctor. Those tests are necessary to insure that his condition is not getting worse.

Things such as echocardiograms and catheritizations, electrocardiograms are covered 100% by Medicare.

One only runs into problems getting an insurance company to pay for such things when the individual has a non Medicare Supplement policy. With a Med Supp policy the doctor and the patient are in charge of the care given or received. With an HMO the HMO administrator is in charge of approving or disapproving tests that are felt to be necessary by the doctor.

HMO administrators are concerned about the "bottom line" and frequently dis-allow tests ordered by doctors. Doctors are concerned about the health of their patients and many deep six the HMOs they were affiliated with for that reason.

You can argue that point if you wish but I have seen it happen too many times to believe all he crap that insurance companies are spreading.

He needs a Med Supp if he wants to be certain that he has the very best medical services available and most learned professionals to choose from.

 

[GreenSky]

Frank, you need to stop holding back and state what's on your mind.

Rick