What should I bring to my planning visit?
When you come in for your Medicare Annual Wellness Visit, please bring the following:
- Any medical records you have, including immunization records.
- Any family health history you have, in as much detail as possible.
- A complete list of medications you take, including vitamins, supplements, and herbs. For each medication, write down how often and how much of each you take.
- A list of healthcare providers and suppliers currently involved in your care.
What is preventive care and why do I need it?
Preventive care is what we do to prevent or delay medical problems. Getting preventive care saves you the time, money, and the worry that come with medicals problems. And if you avoid medical problems, you'll be more independent and have a better quality of life for a longer time.
Why do I need a personalized plan?
Preventive care is not the same for everyone. What's best for you depends upon your medical history. your family's medical history, and how you live.
For example, for most people a colonoscopy is recommended every 10 years. If someone in your family has had color cancer, you're at greater risk for color cancer than most people. Having a colonoscopy more often than other people could save your life.
It's the same with many other conditions. Considering your history and your current situation helps us create an individualized plan for you.
Do I have to pay for this visit?
No. Medicare pays the entire cost of this visit if:
- You have had Medicare Part B coverage for more than 12 months, AND
- You have not had a Medicare initial Preventive Physical Examination or an Annual Wellness Visit within the last 12 months.
If you're not sure if these are true for you, please ask.
I already go in for a routine physical check up every year. Is this the same thing?
No. During your Annual Wellness Visit you'll make an overall plan for future visits. During your routine physical checkup (a separate visit), you can take some of the steps to carry out that plan.
The plan you make during your Annual Wellness Visit will help your routine checkups run more smoothly. As soon as you arrive at your routine checkup, your doctor can look at your plan and know what is the most important to do. This will give you more time in your routine checkup to talk about how you're feeling.
What will happen during the visit?
During your Annual Wellness Visit, we'll gather more information about your health situation. We'll discuss what medical problems you may need to watch out for, and how we can help prevent them. You may be given some preventive care, such as a flu immunization, but you will not be given an actual physical exam.
What if my health situation changes in the future? Will my prevention plan change too?
Yes. Medicare will pay for you to come in every year and update your plan according to your current needs.
If I have other health concerns, can I ask about them during this visit?
If you have specific concerns about your health, you need to schedule another appointment.
The new changes to medicare
As a Long Island medical practice that accepts Medicare, we feel it is extremely important that you understand your coverage. Our patients traveling from both Nassau County and Suffolk County find that we provide the best in Cardiac, Primary, and Podiatry preventative and corrective care. Understanding your coverage is critical getting the treatment you deserve.
Medicare covers people who are 65 and older, anyone under 65 with specific disabilities as well as individuals with end-stage renal disease.
It is composed of several parts:
- Part A (Hospital Insurance)
- Part B (Medical Insurance), including preventive services
- Part C (Medicare Advantage Plans – plans that combine Part A, Part B, and usually Part D coverage)
- Part D (prescription drug coverage)
Part A Coverage:
- Hospital Stays: Semi-private room, meals, general nursing, and other hospital services and supplies. It also includes care in critical access hospitals and inpatient rehabilitation facilities.
- Skilled Nursing Facility Care: Semi-private room, meals, skilled nursing and rehabilitation services, and other services and supplies.
- Home Health Care Services: Typically includes part-time or intermittent skilled nursing care, and physical therapy, speech-language pathology, and occupational therapy.
- Hospice Care: Includes drugs for pain relief, and medical and support services from a Medicare-approved hospice.
Part B Coverage:
- Medical and Other Services: Doctors’ services, outpatient medical and surgical services and supplies, diagnostic tests, durable medical equipment, and more.
- Clinical Laboratory Services: Blood tests, urinalysis, and some screening tests.
- Home Health Care Services: Can include part-time or intermittent skilled care and physical therapy, speech-language pathology, and occupational therapy.
- Outpatient Hospital Services: Hospital services and supplies you get as an outpatient of a hospital.
- Many Preventive Services
Part B covers many preventive services to help you live a longer, more vibrant life. You won’t have for most preventive services if you get the services from a doctor or other health care provider. Some services are covered only for people with certain conditions or risk factors, so check with your doctor about what’s right for you.
- Yearly “Wellness” Visit
- Preventive Visits
- Abdominal Aortic Aneurysm Screening
- Bone Mass Measurement
- Various Cardiovascular Screenings
- Colorectal Cancer Screenings
- Diabetes Screenings
- Flu, Hepatitis B, and Pneumococcal Shots
- Glaucoma Tests
- Pap Test and Pelvic Exam
- Prostate Cancer Screenings
- Smoking Cessation
Part C Coverage (Advantage Plans):
Advantage Plans (like an HMO or PPO) are a way to get coverage through Medicare approved private companies These plans typically will include Part A, Part B, and usually similar coverage like prescription drugs (Part D). You will usually pay a monthly premium (in addition to your Part B premium) and a copayment or coinsurance amount for covered services. Costs, extra coverage, and rules vary by plan. If you choose not to join an Advantage Plan, in most cases, you will get your Medicare health coverage through Original Medicare.
Part D Coverage (Prescription Drug Coverage):
In general, Medicare offers prescription drug coverage through Part D. This coverage is offered by approved private companies. You can also join an Advantage Plan that includes drug coverage. Generally, you will have to pay a premium for Medicare prescription drug coverage. If you don’t join a Medicare drug plan when you’re first eligible you can enroll late but with a late fee.
Special Enrollment Period
You should check with your employer or union benefits administrator to know if you need to sign up for part b. You are exempt from the late enrollment penalty if you meet the following requirements.
- You’re 65 or older, and you or your spouse is currently working, and you’re covered by an employer or union group health plan based on that employment.
- You’re under 65 and disabled, you or a family member is working, and you’re covered by an employer or union group health plan based on that employment.
You can sign up for Part B anytime while you’re covered by an employer or union group health plan based on current employment, or for up to 8 months after the group health plan coverage or the employment ends, whichever happens first.
Note: If you have COBRA coverage or a retiree health plan, you don’t have coverage based on current employment. You’re not eligible for a Special Enrollment Period when that coverage ends
Who do I want my coverage provider to be?
If you decide to keep Part B, you have two main choices for getting your health coverage:
Original Medicare (Part A and Part B):
- Medicare provides this coverage directly.
- You have your choice of doctors and hospitals that are enrolled in Medicare and accepting new Medicare patients.
- Generally, you or your supplemental coverage pay deductibles and coinsurance.
- You will pay a monthly premium for Part B.
- If you want drug coverage, you must choose and join a Prescription Drug Plan or Part D.
- You can buy a Supplement Insurance (Medigap) policy to fill gaps in coverage.
Advantage Plan (also known as Part C)
Includes BOTH Part A and Part B.
- Private insurance companies approved by Medicare provide this coverage.
- In most plans, you need to use plan doctors, hospitals, or other providers. If you do not, you may need to pay more or all of the costs.
- You may pay a monthly premium (in addition to your Part B premium) and a copayment or coinsurance for covered services.
- Most plans include drug coverage. If not, you may be able to join a Medicare Prescription Drug Plan.
- If you join a Medicare Advantage Plan, you won’t need/ cannot use a Medigap policy.
More About Original Medicare
Original Medicare is one of your health coverage choices. You will have Original Medicare by default unless you choose to join a Medicare Advantage Plan or other Medicare health plan. You may see any doctor or provider who’s enrolled in Medicare and accepting new patients.
In most cases, you will not need a referral. In Original Medicare, if you have Medicare Part A and/or Part B, you get all the Part A and/or Part B-covered services listed. You must pay a monthly Part B premium to get Part B-covered services. You may also have to pay additional costs (like deductibles, coinsurance, or copayments) for most Medicare-covered services. If you have limited resources, you may qualify for financial assistance.
In addition to Original Medicare, you can get more coverage to help pay your healthcare costs:
- A Medicare Prescription Drug Plan
- A Medicare Supplement Insurance (Medigap) policy
Prescription Drug Coverage
Medicare offers prescription drug coverage (also called “Part D”) to everyone with Medicare. However, it isn’t automatic for most people – you must opt in.
You will get Medicare prescription drug coverage either by joining a Medicare Prescription Drug Plan or through an Advantage Plan that offers drug coverage. Both types of Medicare drug coverage are called “Medicare drug plans”. Medicare drug plans are privately run that contract with Medicare. There may be dozens of different plans available where you live. These plans cover a wide variety of brand-name and generic prescription drugs.
All Medicare drug plans offer at least a standard prescription drug coverage, but costs and coverage will vary within each plan. You can join a Medicare drug plan when you’re first eligible for Medicare. After this Initial Enrollment Period, you can change your plan from October 15–December 7 each year. If you make a change during this period, your new coverage will begin January 1 of the following year.
If you have or are eligible for prescription drug coverage from an employer or union, trICARE, the Department of Veterans Affairs (VA), the Federal Employees Health Benefits (FEHB) Program, or a state program, read all the materials you get from your insurer or plan provider. In some cases, joining a Medicare drug plan might cause you to lose employer or union coverage.
How Much Does Medicare Prescription Drug Coverage Cost?
Your exact costs will depend on the Medicare drug plan you choose and the drugs you take. Most Medicare drug plans have premiums, deductibles, and copayments that you pay in addition to your Part B premium.
Medicare Prescription Drug Coverage Costs?
If you already have prescription drug coverage, you can wait and sign up for Medicare drug coverage later without a penalty as long as you don’t go 63 days or more in a row without creditable drug coverage.
Creditable prescription drug coverage refers to prescription drug coverage that’s expected to pay approximately as much as Medicare’s standard prescription drug coverage or more. . Examples of creditable coverage could be prescription drug coverage from an employer or union, trICARE, the Department of Veterans Affairs (VA), the Federal Employees Health Benefits (FEHB) Program, or a state program.
How Much Is the Penalty to Join a Medicare Drug Plan Later?
The late enrollment penalty amount changes each year. In most cases, the late enrollment penalty will apply as long as you have Medicare prescription drug coverage.
Can You Join A Medicare Drug Plan Later?
If you already have other creditable prescription drug coverage, you can wait and sign up for Medicare drug coverage later without a penalty as long as you don’t go 63 days or more in a row without creditable drug coverage. Creditable prescription drug coverage is prescription drug coverage that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. Examples of creditable coverage could be prescription drug coverage from an employer or union, trICARE, the Department of Veterans Affairs (VA), the Federal Employees Health Benefits (FEHB) Program, or a state program. If you don’t join a Medicare drug plan when you’re first eligible for Medicare, and you go without creditable prescription drug coverage for 63 days or more in a row, you may have to pay a late enrollment penalty to join a plan later. The penalty amount may change each year. In most cases, you will have to pay it as long as you have Medicare prescription drug coverage. You may also have to wait until October 15–December 7 to sign up. Coverage would begin January 1 of the next year.
How Much Is the Penalty to Join a Medicare Drug Plan Later?
The late enrollment penalty amount changes each year. In most cases, the late enrollment penalty will apply as long as you have Medicare prescription drug coverage. If you qualify for Extra Help paying for Medicare prescription drug costs, you can join a Medicare drug plan at any time without a penalty. See page 30 to learn more about Extra Help and other programs for people with limited income and resources.
Decision Checklist: Should You Join a Medicare Prescription Drug Plan?
Here are some questions to help you decide if a Medicare Prescription Drug Plan is right for you:
❑ Do you need drug coverage? Even if you don’t take a lot of drugs now, you still may want to join a Medicare Prescription Drug Plan to avoid being without coverage. If you don’t join when you’re first eligible, and you go 63 days or more in a row without other creditable drug coverage, you may have to wait to sign up and pay a penalty.
❑ Do you already have drug coverage? If you have other creditable drug coverage (such as from an employer or union), you may not need to join now. You can join a Medicare Prescription Drug Plan later without a penalty as long as you don’t go 63 days or more in a row without creditable drug coverage.
❑ Are you planning to join an Advantage Plan that includes drug coverage? Many Advantage Plans include Medicare prescription drug coverage. If you’re joining a plan that includes drug coverage, you don’t need to join a Medicare Prescription Drug Plan.
Compare the different lists of covered drugs (formularies) and costs of the Medicare Prescription Drug Plans in your area. Check which plans cover the drugs you take, and make sure you understand any rules or limits that apply.
How to Choose and Join a Medicare Advantage or Medicare Prescription Drug Plan
Your first step is to find out which plans are available in your area. Here’s how:
- Visit www.medicare.gov/find-a-plan.
- Look at your “Medicare & You” handbook. Plans available in your area are listed in the back.
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Once you’ve considered your options, you can join an Advantage Plan or Medicare Prescription Drug Plan by visiting www.medicare.gov or contacting the plan directly. If you need help deciding, visit www.medicare.gov/contacts or call 1-800-MEDICARE to get the contact information for your State Health Insurance Assistance Program (SHIP). You may want to make a list of all the drugs and health care services you use, and calculate how much you would spend under each plan you’re considering.
Decision 4 – Decide if You Want or Need a Medicare Supplement Insurance (Medigap) Policy
For individuals who decide to go with Original Medicare, you are eligible to sign up for Medicare Supplement Insurance or Medigap. Medigap are a private insurance company that are used to supplement your out of pocket costs such as coinsurance. Medigap policies can also offer benefits not covered under Original Medicare. You need both Part A and Part B Medicare to qualify in enrollment.
Medigap policies must have standardized benefits which makes it easier to make a decision. Medigap policies typically do not cover long-term care, vision, dental, private duty nursing and prescription drug coverage. Coverage options will vary by state.
How Much Does a Medigap Policy Cost?
Costs will vary from location and company you pick. You will pay a monthly premium directly to your supplementary insurance provider. Medigap policies only cover one individual. Couples must purchase their plans separately.
Decision Checklist: Do You Need a Medigap Policy?
❑ Are you thinking of joining a Medicare Advantage Plan? Medicare Advantage Plans members will not need and can’t use Medigap policies.
❑ Will you need extra benefits and coverage? If you stay in Original Medicare, a Medigap policy may help lower your out-of-pocket costs and give you more health insurance coverage.
If you decide to buy a Medigap policy, you can buy it directly from the insurance company. You can find out which insurance companies sell Medigap policies in your area by visiting www.medicare.gov/medigap. For more information about Medigap, visit www.medicare.gov/publications to view the booklet “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare".
You should buy a Medigap policy during the 6-month time period that begins with the first month you’re officially 65 or older and enrolled in Part B. This is called your Medigap Open Enrollment Period. You may during this time buy any Medigap insurance policy sold in your state. If you wait til after you will have to pay more and may have less plan options.
Medicare and Employer Coverage
If you are retired and are receiving health insurance from a former employee or union, Medicare will become your primary insurance in most cases. Any amount not covered by Medicare can be submitted through your employer’s plan.
Help for People with Limited Financial Resources
Medicare Savings Programs: States have programs that pay Medicare premiums for people with limited income and resources and, in some cases, may also pay Medicare deductibles and coinsurance. For more information, call your State Medical Assistance (Medicaid) office. You can get the phone number by visiting www.medicare.gov/contacts or by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Medicaid: Medicaid is a joint Federal and state program that helps pay medical costs for some people with limited income and resources. For more information, call your State Medical Assistance (Medicaid) office. You can get the phone number by visiting www.medicare.gov, or by calling 1-800-MEDICARE.
Supplemental Security Income (SSI): SSI is a monthly benefit paid by Social Security to people with limited income and resources who are disabled, blind, or 65 or older. For more information, visit www.socialsecurity.gov, or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Extra Help with prescription drug costs: If you have limited income and resources, you may qualify to get help paying for your drug plan’s monthly premium, yearly deductible, and copayments. To apply for this program, visit www.socialsecurity.gov/i1020, or call Social Security at 1-800-772-1213.