En español | When is a physical not a physical? That's what William Schmitz wanted to know after he went to his doctor for what he thought would be a free Medicare exam and was later charged $70 for it. Other patients who had the same experience say they've been charged up to $400.
Schmitz, a retired engineer from Portland, Maine, was pleased when he read that, under the new health care law, Medicare had begun covering annual physicals free of charge. But after he had one, Medicare denied his claim.
"When I asked the doctor's office what had happened, they clued me in that I was mistaken about the difference between [Medicare's] wellness exam and a physical," he says. "I was upset that the way it's set up is misleading."
The official handbook, "Medicare & You 2011," says that "Medicare covers two types of physical exams — one when you're new to Medicare and one each year after that." It describes these as the initial "Welcome to Medicare" physical exam and the yearly "wellness" exam.
Both have value, but neither are what patients and physicians usually regard as a physical. "The annual wellness visit can be performed without the patient ever having to undress, and that sums up the problem," says Yul D. Ejnes, M.D., a practicing internist in Rhode Island and chair of the board of regents of the American College of Physicians.
The federal Centers for Medicare & Medicaid Services (CMS) now acknowledges that using the term "physical exam" in the 2011 handbook is misleading. "This description of the wellness visit has been clarified in the latest Medicare handbook, which is currently being printed for mailing in September," CMS spokesperson Ellen Griffith tells the AARP Bulletin.
Until Jan. 1 this year, Medicare did not cover any routine exams except for the "Welcome to Medicare" exam for new beneficiaries. The Affordable Care Act created the once-a-year wellness visit as a new benefit, paying doctors to perform it and making it free to patients. By the end of June, Medicare had paid for nearly 1 million such visits, according to CMS.