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MediCare Advantage and PSA testing

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Posted 8/19/2015 2:52 PM (GMT 0)
I just started MediCare A/B on 8/1/15.
On 9/1/15 I will be starting MediCare Advantage (BCBSM PPO or something like that).

Anyway, the MediCare material says they cover PSA testing once a year.

Is this true even if you have PC??

Mel
Posted 8/19/2015 3:46 PM (GMT 0)
WHAT??? NO RESPONSES???

One would think that with all the very old geezers here...

Mel
Posted 8/19/2015 3:52 PM (GMT 0)
Mel, my Medicare Advantage plan does cover PSA testing. I do it once per year during my regular blood tests. I don't know if they would cover it more frequently as I've never tried.

Jim
Posted 8/19/2015 3:59 PM (GMT 0)
OK Mel,you win. Medicare makes a distinction between PSA screening tests and diagnostic tests. The lab assays may be identical but the coding is different. Screening is allowed once a year but diagnostics can be as frequent as necessary. The ICD codes are different for the two tests. Make sure they get it right in the doctor's office.

Actually there aren't that many old geezers. We don't claim that status until 80.

Carlos
Posted 8/19/2015 4:02 PM (GMT 0)
Mel, I can't speak for zero premium or near zero premium Medicare Advantage, but Medicare Supplement Plan F albeit at a higher premium has been paying for a monthly PSA test ever since i turned 65 two years ago.

A plan F pays all co-pays and deductibles too.

My guess would be the once a year rule is for guys not yet diagnosed and once diagnosed even Medicare advantage pays for more frequent testing
Posted 8/19/2015 4:55 PM (GMT 0)
I'm on medicare and get tested every 3 weeks along with chemo treatment...while on Zytiga I was tested every month. My Onc. wants one for every appointment I'm on but as carlos said....has to do with the way they code it.
Posted 8/19/2015 5:55 PM (GMT 0)
some of old geezers still have to get our backsides to work in the mornings... ;)

There are rules and then there are the expectations and appeals. The rules change based on DX and medical condition and who you're talking to at medicare.

and how well your doctor can write and what codes they use in the computer. At least that was my experience with my brother. They should cover you for all the PSA testing you want.

If they do, appeal, complain, call your congressman, they pay for it.
Andrew
Posted 8/19/2015 7:27 PM (GMT 0)
This is a good thread as I am starting Medicare A this month, but still working and covered by a "creditable" group plan. When I retire next year, I plan to go with the Plan F supplemental and the best Part D I can get because of the very high costs of these drugs. Good to know my monthly PSA tests are covered as long as they code it right. The person at council on aging here told me that if I started off with a Medicare Advantage plan and then later wanted to switch to original Medicare, then I could be subject to underwriting for the supplemental policy. That would mean I would be denied coverage due to preexisting conditions. So I plan to go with Original Medicare + Supplemental Plan F when I retire.
Posted 8/19/2015 8:07 PM (GMT 0)
Medicare and Anthem BC/BS Medicomp III here. Pays for diagnostics seemingly whenever.
Posted 8/19/2015 9:29 PM (GMT 0)
It pays for mine Mel, but I see an Oncologist. One time a year would be plenty for me if I wasn't this far a long.
Michael
Posted 8/19/2015 10:00 PM (GMT 0)
Thanks folks. That was very useful information!

Mel
Posted 8/19/2015 10:04 PM (GMT 0)
I'm getting mine done without any issue twice a year. I'm working with my primary for follow-up digital exam and psa tests (my choice since I wasn't happy with the urologist/surgeon). We're on Medicare + Unitedhealthcare Medicare Advantage.

Take care,
Jake
Posted 8/19/2015 11:06 PM (GMT 0)
Mel, I am on Medicare and also have a plan F. I see my Onco every three months and anything he orders is covered. I don't pay anything out of pocket with the plan F.

When I came off HT back in February I wanted something more than every 3 months though.

The gym I belong to is part of the County Hospital System. They own the gym and staff it. They have a blood draw lab at the gym. I found out that I could self prescribe a PSA and Testosterone test. Costs me $10 for the PSA and $20 for the T levels.

One month I ran both on the same day that I was having a blood draw at my Onco facility. The PSA differed by 0.02, so I am quite comfortable just paying $10 and not having to drive the 40 miles to my Onco's office.

Maybe there is something like that in your area if you find that the tests won't be covered.

Sonny
Posted 8/19/2015 11:31 PM (GMT 0)
Sonny et. al:

Thanks again. I asked the question because the MediCare literature that I received talks about covering a PSA test once a year.

But now I see it depends on how it's coded. We shall see.

I also need to see if my plan will also cover my gym membership (that I have been paying). Apparently, there is a feature that does this, but not for all plans. That would be a neat thing.

Mel
Posted 8/20/2015 2:52 AM (GMT 0)
Mel, I was on medicare Advantage last year and had my PSA tested twice and it was covered.
Posted 8/20/2015 10:13 AM (GMT 0)
Mel,
I start Medicare in January and I read the same thing. I mentioned it last month at my surgeon's office when I had my yearly visit. The doctor laughed and said they had no problem for any of their patients to have several PSa test a year.after a PCa Dx.

I am considering AARP's United Healthcare's supplement. I talked to an insurance agent referred to me by another Forum member who lives here in Boynton Beach and the agent said that the new plans for 2016 come out in October of this year and he said to call at that time for an appointment. He said it would be useless to talk now because things change quite a bit every year in October.

Bill from Florida cool
Posted 8/20/2015 1:46 PM (GMT 0)
Mac:

Thanks for the feedback. I dd read that the plans change every year. Why do I think the coverage will not be better?

Mel
Posted 8/20/2015 2:29 PM (GMT 0)

compiler said...
Mac:

Thanks for the feedback. I dd read that the plans change every year. Why do I think the coverage will not be better?

Mel

I've been on Blue Cross Medicare Advantage PPO for 4 years and have been tested 3-4 times per year with no problems.

As for plan changes, strange but true, my plan did actually get remarkably better two years ago. They eliminated the $500 annual deductible for both in and out of network and eliminated co-pays for x-rays etc.
Jim
Posted 8/20/2015 4:26 PM (GMT 0)
Jim:

WOW!
I think my annual deductible is in the $600-$700 range, but I'm not sure.
The web-site has all of that, but it won't let me access those features until 9/1.

Mel
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