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The NSPA Blog

Medigap and Medicare’s Annual Wellnesss Visit

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Posted on August 11th, 2019 by Bettina Carlson, under Insurance & Billing, Medicare, Patient Advocacy, Patient Tools, Take Charge

Now, that we covered the Basics of Medicare and the Changes to Medicare 2020 in our previous blog posts, today let’s take a look at a couple of features of Medicare that people always seem to be confused about: Medigap and the Annual Wellness Visit. Again, I will not reinvent the wheel but gather the information from a few vetted sources, which you can turn to for further reading.

For Medigap:  Medicare, https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap. Investopedia, https://www.investopedia.com/articles/personal-finance/071014/medigap-vs-medicare-advantage-which-better.asp (this is not an endorsement of Investopidia’s services, but they did a nice job in providing an easy overview of Medigap vs Medicare Advantage).

For the Annual Wellness Visit: Medicarehttps://www.medicare.gov/coverage/yearly-wellness-visits; Medicare Interactive, https://www.medicareinteractive.org/get-answers/medicare-covered-services/preventive-services/annual-wellness-visit; AARP, https://blog.aarp.org/the-annual-wellness-visit-10-things-medicare-enrollees-need-to-know

MEDIGAP

Definition

Medigap is also called Medicare Supplement Insurance. It’s an optional health insurance coverage you can purchase from private insurance companies. It’s designed to protect people who buy traditional Medicare against many of the additional costs not covered by Medicare. The costs a patient might have to pay, are such as deductibles, co-pays, and other medical expenses (the three big ones are dental, vision and hearing coverage) that can easily exceed your savings if you should become seriously ill. 

Eligibility

The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you’re 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more. For more information on eligibility read here: https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap

Details 

Medigap charges a premium in addition to premiums already paid for Medicare Parts A, B, and D. The premiums vary depending on coverage. 

Medigap offers various coverage options, and similar to Medicare, they are sorted by letter – Plans A, B, C, D, F, G, K, L, M and N. Their premiums vary, with Plan F being the most expensive and covering almost all gaps, eliminating almost all out-of-pocket expenses. Be aware though, that in 2020, Plan F will no longer be available to new Mediare enrollees. 

Medigap insurance will cover you wherever Medicare is accepted. In other words, if a medical provider does not accept Medicare, your Medigap insurance is not covering your expenses. 

Medigap vs Medicare Advantage

Reading the above, you may think that Medigap is not different than Medicare Advantage plans. But there are some key differences. These are nicely summarized in the following article, and I list them below, https://www.investopedia.com/articles/personal-finance/071014/medigap-vs-medicare-advantage-which-better.asp:

Cost: Medigap coverage usually has a higher monthly premium, but could result in lower out-of-pocket expenses that some Medicare Advantage plans. Medicare Advantage plans, on the other hand, generally cost less and cover more services, which can be better for your budget. If you are critically ill and require extensive and expensive treatments, Medigap can help you save significant money. 

Choice: Medicare Advantage plans generally limit you to the doctors and facilities within the HMO or PPO, and may or may not cover any out-of-network care. Traditional Medicare and Medigap policies cover you if you go to any doctor or facility that accepts Medicare. If you require particular specialists or hospitals, check whether they are covered by the plan you select. 

Lifestyle: Medicare Advantage plans often only operate within a certain region. If you are a snowbird living in more than one state throughout the year, traditional Medicare plus Medigap is probably a better choice than an Advantage plan. This may also be true if you travel frequently: Some Medigap plans provide coverage when traveling outside of the United States and cover you in all 50 states; Advantage plans generally do not. 

As mentioned earlier, Medigap will be affected by some changes in 2020. For information on those, you can read an easy to understand overview here: https://blog.medicarerights.org/medigap-changes-in-2020/. In the following link, you can read some concerns and questions and their answers that current and new enrollees had regarding Medigap, https://www.senior65.com/medicare/article/medigap-changes-for-2020-no-new-plans-c-and-f (this is not meant to be an endorsement of their services, but I thought, you might benefit from the “Reader comments and answers” section). 

MEDICARE’S ANNUAL WELLNESS VISIT

Definition 

The Annual Wellness Visit (AWV) has been around since 2011. It is a covered appointment with your primary care provider (PCP) to create or update a personalized prevention plan.  It is designed to identify a future health risk and refer the patient to an appropriate provider for treatments that may help prevent illness based on your current health and risk factors. 

Covered Services

You are eligible for your first Annual Wellness Visit, the “Welcome to Medicare” preventative visit within the first 12 months of enrolling in Medicare Part B. This first Annual Wellness Visit will be different from subsequent Annual Wellness visits, in that during this visit, your doctor will perform a more thorough exam to establish a personalized plan of care outlining screenings and other preventative services you may need. During subsequent Annual Wellness visits, your provider will basically follow up on all these findings, with the exception of screening for depression and functional ability. (https://blog.aarp.org/the-annual-wellness-visit-10-things-medicare-enrollees-need-to-know):

  • Health risk assessment (a questionnaire on the patient’s health status and medical history
  • Medical and family history
  • List of current health care providers
  • Height, weight, body ass index, waist circumference, and blood pressure measurements
  • Screening for cognitive impairment
  • Screening for depression (only at Welcome to Medicare visit)
  • Screening for functional ability (only at Welcome to Medicare visit)
  • Creating, or updating, a written screening plan for the next 5-1o years
  • Creating, or updating, a list of risk factors and health conditions
  • Referrals to health eduction services, counseling programs, or lifestyle interventions if appropriate
  • Advance care planning (a discussion between patient and clinician about the patient’s preferences for medical treatment if they are unable to speak or make decisions in the future)

Annual Wellness Visit vs Annual Physical Exam

The Annual Wellness Visit is different from an Annual Physical Exam in that the Annual Physical Exam is an extensive examination of the patient to determine how the body is performing and if there are any existing physical problems, versus the above described preventive approach of the Annual Wellness Visit, which is designed to serve as future wellness planning. The Physical Exam includes, but is not limited to, examining of: vital signs, lungs, abdomen, neck and head, musculoskeletal system, nervous system functions, and may involve blood-work or other tests. For more information read here: https://www.healthline.com/health/getting-physical-examination#screening-tests.

Finally

The information above is not conclusive, but meant to be an overview of the topics addressed and hopefully providing you with a better understanding. If only to know what questions to ask in order to proceed in making the best choices for your health care.

Sources

Medicare, https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap, and https://www.medicare.gov/coverage/yearly-wellness-visits

Investopedia, https://www.investopedia.com/articles/personal-finance/071014/medigap-vs-medicare-advantage-which-better.asp 

Medicare Interactive, https://www.medicareinteractive.org/get-answers/medicare-covered-services/preventive-services/annual-wellness-visit

AARP, https://blog.aarp.org/the-annual-wellness-visit-10-things-medicare-enrollees-need-to-know

Senior65+, https://www.senior65.com/medicare/article/medigap-changes-for-2020-no-new-plans-c-and-f

Healthline, https://www.healthline.com/health/getting-physical-examination#screening-tests

ICOPA CONFERENCE 2019

On another note we at NShore Patient Advocates would like to share some of our latest news with you… The Patient Advocacy Symposium is back but bigger, better, and brighter than ever before! It has evolved into the International Conference on Patient Advocacy (ICOPA), and will be held right here in Northfield, IL on October 3rd-5th, 2019! We hope you will join us! Please see below for a link with more information: 

Home ICOPA 2019

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