Questions & Answers

My mother is on Medicare and Medicaid. She recently received a bill from a doctor’s office for the amount leftover after Medicare paid their part on a doctor’s visit. Is she supposed to pay the balance?

No. Patients who have both Medicaid and Medicare (including Medicare Advantage) should never be charged for services covered under Medicare. Balance billing is illegal under both federal and state law. Notify the provider by phone or letter that your mother has Medicaid and therefore is not responsible for the balance billed.

Can my parents' medical expenses be deducted for income tax purposes?

Yes. As a general rule, medical expenses in excess of ten percent (10%) of a person’s adjusted gross income are deductible on Schedule A of the 1040. For seniors born before January 2, 1951, the threshold is lower – 7.5% through 2016. Certain conditions apply so check with your CPA.

Is the Annual Wellness Visit (AWV) the same as a beneficiary's yearly physical?

No, this visit is a preventive wellness visit and not a "routine physical checkup" that some seniors may receive every year or two from their physician or other qualified non-physician practitioner. Medicare does not provide coverage for routine physical exams. 

When is a beneficiary eligible for the Annual Wellness Visit?

Medicare provides coverage of an Annual Wellness Visit (AWV) for a beneficiary who is no longer within 12 months after the effective date of his or her first Medicare Part B coverage period and who has not received either an Initial Preventive Physical Exam (IPPE) or an AWV within the past 12 months. Medicare pays for only one first AWV per beneficiary per lifetime, and pays for one subsequent AWV per year thereafter. 

Is there a deductible or coinsurance/copayment for the Annual Wellness Visit (AWV)?

No, coverage for the AWV is provided as a Medicare Part B benefit, and both the coinsurance or copayment and the Medicare Part B deductible are waived for the AWV.~

 

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