Using Your Medicare Coverage
Medicare works much like traditional health insurance. However, you should become familiar with the differences between Parts A & B (Medicare), Part C (Medicare Advantage), and Part D (prescription drug plans).
Visiting Your Healthcare Provider
Always make sure your providers accept Medicare. Many providers, that accept Medicare, can accept assignment, which means they will take the Medicare-approved amount as payment, and you will pay the standard 20% coinsurance amount. If providers do not accept assignment, they can charge an additional 15% on top of the Medicare-approved amount. If a provider has opted out completely, you would need to pay the full cost, so you may want to shop around and find providers that accept Medicare.
If you have a private Part C plan, you may need to find a provider in your network and service area. Your plan will provide you with a list of the providers in their network.
All Medicare plans have the benefit of a “Welcome to Medicare Exam” and an annual “Wellness Visit”.
The Welcome to Medicare Exam
During the first year that you have Medicare Part B, you can get a one-time exam that will give you a full review of your health. It will teach you about the preventive services you need to help you stay well, like health screenings and shots. Your doctor may also refer you to other professionals for specialized healthcare.
During the exam, your doctor will record your medical history and check your blood pressure, weight and height. Your doctor may give you a vision test and make sure that your shots are up to date.
Your doctor may also order further tests, if you need them. Your doctor may tell you how to prevent disease, improve your health or stay well. You may also get a written plan when you leave. This checklist will show you know which screenings you should consider getting.
See more about the “Welcome to Medicare” visit at Medicare.gov (https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html)
Get a full list of the preventive services HERE.
The Annual Wellness Visit
After your Welcome to Medicare exam, you can get an Annual Wellness Visit (AWV) every 12 months. The AWV includes a review of your current health, medical needs and can help you create a yearly prevention plan. An AWV may be completed by a physician, a non-physician practitioner (physician assistant, nurse practitioner or certified clinical nurse specialist); or Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals who are working under the direct supervision of a physician (doctor of medicine or osteopathy).
Your doctor will take routine measurements, including weight, height, and blood pressure. Your doctor may also update your screening schedule and again review your health and mental status based on your current health needs.
Getting your prescriptions
First, find out when your plan becomes effective. Find your plan’s formulary and pharmacy network.
Every Part D plan may cover different drugs and may choose to exclude others. It pays to learn about your plan. Make sure to learn about the prescription drugs your Part D plan covers.
Work out any issues with prescription coverage.
- Getting drugs that are not on the formulary
- Switching to generics to save money
- Appealing decisions regarding coverage
