Medicare Provider Specialist

What is Medicare?

Medicare is a health insurance program funded by the government. Most Americans aged 65 and over are eligible for Medicare, and some aged under 65 are eligible too if they have certain illnesses or disabilities that entitle them to social security disability benefits.

Medicare has two parts. Part A covers hospital expenses, and Part B is your medical insurance for primary care and other services. Your Medicare coverage typically takes care of 80% of your qualifying medical expenses.

Enrollment in Medicare is usually automatic once you reach your 65th birthday. You should get your Medicare card around three months before you turn 65.

What is a Medicare provider?

A Medicare provider is a medical practice or person that Medicare pays to provide your health care. Medicare providers must meet the program’s requirements for receiving Medicare payments, which entitles them to Medicare certification and guarantees that you receive high-quality care.

Certification requires a comprehensive application process and a state government agency inspection. Following approval, Medicare providers like Primary Care Doctors of Grand Prairie receive a Medicare billing number and a National Provider Identifier (NPI).

What services does a Medicare provider offer?

Medicare services vary between providers and in different areas. Common services that primary care practices like Primary Care Doctors of Grand Prairie offer include:

Diagnosis and treatment

Medicare covers what's known as medically necessary services. These are tests, procedures, and treatments that you need for a specific medical condition that meet Medicare's medical practice standards.

Screening

Medicare providers carry out screening tests and procedures for cervical, vaginal, colorectal, lung, breast, and prostate cancers, cardiovascular disease, abdominal aortic aneurysms, depression, diabetes, hepatitis B and C, HIV, and STDs (sexually transmitted diseases).

Immunizations

Medicare providers offer vaccinations against diseases like flu, hepatitis B, pneumococcus, and COVID-19.

Healthy living

Medicare providers can help with weight loss, healthier eating, substance misuse, and quitting smoking.

Medicare providers also offer Welcome to Medicare preventive consultations and annual wellness visits.

What are Medicare wellness visits?

You're eligible for an initial Welcome to Medicare visit at Primary Care Doctors of Grand Prairie when you join Medicare. This visit includes:

• Medical and social history review
• Certain health screenings
• Flu and pneumococcal shots
• Recording height, weight, and BMI (body mass index)
• Blood pressure measurement
• Simple sight test
• Assessment for depression
• Assessment of your safety
• Advice on lifestyle changes
• Referrals for other care if required

Your provider draws up a written plan detailing the screenings, vaccinations, and other preventive care you need. If you require further tests or a referral, that would be in addition to your introductory Medicare consultation.

After this initial appointment, you return for a free Medicare wellness visit every year to review your health and update your care plan.

To find out more about the services available from your local Medicare provider, call Primary Care Doctors of Grand Prairie or book an appointment online today.