Medicare & Annual Well visit

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amother

OP ↓

Tue, Sep 24 2024, 4:00 am

I have Medicare right now as well as my husband's work insurance.

I had an annual exam during which they did a bunch of blood work just to check it all out.

I got a Medicare statement where the bloodwork was denied and it was $1,300
(I believe my secondary insurer picked it up)

I was about a day away from stopping my secondary and switching that to medigap. (Since that piece alone cost me 1,000 per month).

But Medicare doesn't pay for annual physicals? For blood tests that aren't for a specific purpose?

So what do people do? Do I not switch now?
I'm so confused Sad

Bluepink ↓

Sat, Sep 28 2024, 7:19 pm

Medicare only pays for certain labs at certain intervals, and there has to be a medical necessity and appropriate code. They are stricter than many other insurances regarding labs. Not a good idea to drop your medigap. Ask a broker for a cheaper plan with a higher deductible if needed. Or maybe look into Medicare Advantage plans, which have their own problems.

amother

↑ OP

Sat, Sep 28 2024, 7:30 pm

Thank you. I don’t want to drop medigap. I want to drop my private secondary from husband work that cost me 1k to join medigap. Do they do different rules re labs? I doubt it. They cover 20 percent of medicar approved no? And this would be Medicare denied

↑ Bluepink

Sat, Sep 28 2024, 7:35 pm

Correct sorry I misread
Yes they would follow same rules.
Most doctors know to be careful in what they order, and I don’t know if most labs can collect the money from you unless they provide an ABN (advanced notice of non coverage)
But definitely speak to a broker if you can

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