Medicare Information
IMPORTANT CHANGES
We are honored to be your trusted provider for women’s health. As part of our commitment to your care, we believe in providing a thorough, annual preventive gynecological visit—one that goes beyond a brief check-in and truly prioritizes your well-being.
Medicare’s rules unfortunately don’t align with best practices for women’s health. We believe in providing the most comprehensive care possible, which includes a full physical exam, including a breast and pelvic exam. A breast exam should always be performed prior to any imaging study, including a mammogram, because physical exams sometimes reveal abnormalities that imaging alone may not detect. In some cases, these findings can be concerning and may require further evaluation.
At our practice, we go beyond a routine visit. We take the time to thoroughly review your medical, surgical, gynecological, and family history, along with your medications and any concerns you may have. This is to identify any health concerns that make you high risk so that we can be proactive in your health. Timely detection and treatment are essential for a longer, healthier life. Our detailed physical exam not only helps identify gynecological issues but also detects broader health concerns. We have frequently identified heart conditions, lung abnormalities, and other medical issues that required referral to a primary care physician or specialist—problems that might have otherwise gone unnoticed.
Providing this level of personalized, high-quality care takes time, attention to detail, and resources. This is why there is a charge to offset the portions of the visit that Medicare does not cover. If your insurance covers more or less than expected, we will adjust your balance accordingly. We hope you understand why we approach your health this way. If you value a practice that prioritizes thorough, patient-centered care, then this is the practice for you.
We do not vary the care we provide based on insurance. We believe that all women deserve a comprehensive annual exam, because we have seen firsthand how vital it is to your health.
Why There’s a Charge
At Manatee Gynecology, the fee for an annual preventative exam is $300 for new patients and $250 for established patients. A payment of $95 will be collected at the time of your visit to cover services not included under Medicare. Please note that if there is any remaining balance after Medicare coverage, you will receive a billing invoice for the difference. In the event of an overpayment, the credit will be applied to future visits or refunded.
Medicare currently covers a breast and pelvic exam (every 24 months for most women). We recommend that a breast and pelvic exam be performed every 12 months for early detection.
Medicare currently covers a Pap smear (every 24 months for low risk, or annually if you’re high risk). Your need for a pap smear is dependent on your risk analysis completed by your healthcare provider.
The following are all components of your annual visit that is not covered by Medicare:
Medication review
Medical history review
Surgical history review
Gynecologic history review
Obstetric history review
Family history review
Social history review
Comprehensive physical examination
You will be asked to sign an ABN (Advance Beneficiary Notice of Noncoverage).
An ABN is a legal document that informs Medicare beneficiaries that a service is not expected to be paid for by Medicare. By signing the ABN, you acknowledge that you understand these services are not covered and you agree to be financially responsible for them.
You must choose one of three options on the ABN:
Option 1: You want your annual visit and want us to bill your insurance for it, and you agree to pay for whatever is not covered. Option 2: You want your annual visit and don’t want us to bill your insurance for it, and you agree to pay for it in total today. Option 3: You do not want your annual visit because you do not agree to pay for anything today.
Our Philosophy of Care
We understand this can be confusing and frustrating. But we promise this: We will always do what’s best for your health. Many women today only see their gynecologist for wellness care—and we take that role seriously. Even after menopause, gynecologic care remains essential, and we believe in staying proactive, not reactive.
Providing this level of thoughtful, thorough care requires time, training, and attention to detail.
Thank you for entrusting us with your care.