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How to Use Your Medicare

Many aspects of the Medicare system work in a similar way to the health insurance plans you may be used to. But with Medicare Parts A & B (Original Medicare) and Part D (drug plans), there are some differences you should keep in mind.

Read on for details on getting the most out of the healthcare you receive from Medicare.

Going to the doctor

To keep your costs down, it is important to make sure your providers and healthcare facilities take Medicare. If they have opted out, it may be worth it to find ones that do. Many providers that take Medicare can decide to accept assignment, meaning they’ll take the Medicare-approved amount as payment, and you’ll pay the standard 20% coinsurance. If providers do not accept assignment, they can charge an additional 15% of the Medicare-approved amount. If a provider opts out completely, you will need to pay the full cost.

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 in-network providers from which to choose.

With all Medicare plans, you’ll have a Welcome to Medicare exam and an annual Wellness visit.

What is 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 stay well, like certain screenings and shots. Your doctor can also refer you to other professionals for other 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.

He or she may order further tests if you need them. Your doctor will tell you how to prevent disease, improve your health or stay well. You also will get a written plan when you leave. This checklist will let you know which screenings you should get.

Get a full list of the preventive services you can get during your check-up and learn why they’re important.
Read about the services.

What is 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 with your help, create a yearly prevention plan customized just for you. 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 will 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.

Each Part D plan may cover different drugs, and may choose to exclude others. It pays to learn about your plan. Learn about which drugs Part D 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

Next steps:

Learn How to Pay Your Medicare Premiums or Read the What Matters Today Blog