Medicare Wellness Visit and A1C

Does anyone know if an A1C test can be a part of the blood work done for a Medicare Wellness visit? My husband is scheduled for his Wellness visit, and he would like to have an A1C as one of the tests. Why? He is 69 years old, his mother and paternal grandfather both had diabetes, and lately he has not felt great, so he tested his blood sugar on one of my meters. (I have been T1D for 55 years.) His numbers have been borderline high (130ish fasting to 140-160ish three hours after meals). He would like to know where he stands, but the doctor’s office is saying that an A1C is not covered even though some online sites say it is. Do any of you have knowledge or experience in this matter? Thanks for your help.

@SherryAnn This site may be of help to you … Take the spaces out of the link that are after the / …

https:// www.medicare.gov/ coverage/ diabetes-screenings

Also, check out the cash price, if it is not covered. It may not be unreasonable to pay out-of-pocket.

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Thanks for the suggestion. My husband already has searched that site without any definitive answer. As I write this, he has decided to go to the source. He is on the phone with Medicare right now. (Sadly, we have called them in the past with varying degrees of success. One can get multiple answers depending on how many people one talks to in a given call!) From what I am overhearing, it sounds like an A1C is not included in the Wellness check. Since the check is not mandatory for Medicare coverage, I doubt that I ever will have one again.

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If your time is worth nothing, then you can spend all the time you want on the phone. I would just order the test myself and go for it. The cost of an A1C test is maximum $22 and coupons are available all the time for discounts. Today, for example they are giving 20% off as it is prime day at Amazon. Occasionally I have seen them discount the A1C as low as $10, so for me I would not waste my time trying to get if for “free”
Here is where I order all the tests I selfpay:

https://www.ultalabtests.com/shop

Just type A1C in the search bar. They will have a lab fairly near your residence to take your blood if you are interested

Here is a direct link to their A1C
https://www.ultalabtests.com/shop/items/search?__RequestVerificationToken=mq6uNALYPtn20BOTrOIeMLigkP8cHBfChLvdLrnam8QDPOrZE_Pz5OnNpNnWM7kVC5hFQXerp24nZI0w4pYH0Vp8OVY1&ItemName=A1C

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My a1c was covered by medicare when I was tested at age 67. I was not diabetic at that time. We have traditional Medicare.

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Like @CJ114, UltaLabs also performed well for me. They use an on-staff doctor to authorize the labs and I prepay their fee. I print out a hard-copy lab order and take it to a local Quest lab to draw my blood and send it to a processing center. The results are published on an online UltaLabs site in a few days.

Why did I use this out-of-pocket lab test facility instead of going through the normal route using my doctor and traditional insurance coverage? A few years ago, I concluded that my longstanding hypo-thyroid condition was not being managed well by my endocrinologist.

Instead of just getting the bare minimum thyroid lab checks, I wanted the full panel. My endo refused to order these tests, said they were unnecessary. My research led me to believe that my thyroid disfunction was playing a role in my overall health, including my heart health.

I therefore decided to order the tests myself using UltaLabs. There are other labs that provide this service. Some states, however, do not allow these patient-led lab orders.

These thyroid labs allowed me to become better educated about my thyroid health and led to me changing my medications through consultation with naturopathic physicians and functional medicine MDs.

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Interesting, CJ114. I did not know about this. Thanks.

Thanks for the response. I think we have this covered.

What else is important is that if you do tests periodically, they keep the results on file and you can always download a comparison report of your last 4 or more tests and they show them on pretty color graphs along with full disclosure of the protocol used, what the normal range is with different colors for in range or out of range and I think most importantly a full explanation of what the test is for in laymans terms that anyone can easily understand. The tests are mostly quite reasonably priced and they always have one promoption or another running.

This is the processing lab that most clinics and doctors use unless they are a large hospital with their own testing facilities. You can do much deeper testing than your doctor would ever order. This is also a backup lab for major hospitals

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In addition to their data storage and display capacity, they also represent to me an important philosophical distinction about my health management. I resent the health model that the doctor is king and what the patient thinks or wants is not important.

Now I fully appreciate that the doctor’s knowledge and experience does play an important role. But they are not always right. Medicine evolves over time and human institutions tend to hang onto old ways of thinking that may damage patients. Blood-letting was a widespread medical practice just a few hundred years ago.

Doctors don’t know what I know about living with diabetes. In other words, they are not fully informed. They can’t be. I don’t expect them to be. I value doctors who take my patient point of view into consideration.

I apologize for this off-topic excursion, but using a lab that honors patient-led medicine resonates with me. We should not be afraid to utilize this service.

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Yes, I agree. I don’t use doctors who don’t consider me the boss of my disease.

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I have been lucky with the doctors I have had over the years. It has been a team effort, them and me. They appreciate how active I have been in learning, researching and learning to live with type 2 diabetes. This is true right down to my new PCP. We work together, not at odds with one another.

One type doctor I’ve never had in all these years is an endocrinologist or a diabetic specialist. I don’t think we have the former locally and only 2 endos locally. One is concierge only. I checked him out and he wanted to change my treatment which was working very good, to his pet one. The other I haven’t tried.

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Quest Diagnostics charges 39.00 for a1c

I’d try one of the free trials to test if you have the genetic component for T1D.

I’m not on Medicare, but found this helpful to learn what the Wellness visit entails.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html#

At my last visit, my endo was explaining something about about diabetes and stopped mid sentence to say,” I don’t know why I am explaining this, you have been dealing it since before I was born!”

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When I have had Medicare Wellness visits the receptionist has always been clear when I checked in that I couldn’t add anything to the visit other than the wellness check. With Medicare it would probably be a better idea to have a separate visit to discuss diabetes and have an A1c. My supplemental plan covers part of my physical on top of the Wellness visit so I am not completely sure exactly what is limited by Medicare. Since I get my A1c’s done at the endocrinologist, I have no idea whether it would be covered as part of my physical.

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Update: After much research and many phone calls, we have reached the following conclusions:

  1. My 69-year-old husband (as of today!) cannot be considered for the Diabetes Prevention Program by Medicare. Why? Because he is NOT overweight (BMI is 23), and he has no history of A1Cs above 5.7. (Isn’t that the reason we wanted to get the A1C on file?)
  2. When he initially called the doctor’s office, the receptionist told him he could not have the A1C as part of the Wellness bloodwork or visit. He insisted on talking to a nurse. Now we know he CAN get an A1C as part of the blood work for a Wellness visit… at least according to the nurse who FINALLY called us back. He has it set up for next week. She said they do that all the time.
  3. SINCE he will have the A1C drawn, he now can talk to the doctor during the Wellness visit about his diabetic concerns only because the A1C will be a part of his blood work results.

I swear, if it is not the insurance companies trying to run my healthcare, it is receptionists who are trained to answer phones, make appointments, and keep everyone on schedule. They are NOT trained to make healthcare decisions, and apparently this receptionist was not trained in the policies of her doctor’s clinic.

We got the results that we wanted, but this whole thing is just frustrating. Medicare Wellness visits are pretty useless, in my humble opinion. Since I see my endocrinologist and my rhumatologist three times a year (and they draw blood each time), so I see no reason to ever go to a Wellness visit again.

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SherryAnn, I hope you don’t mind if I share a story here about my frustration with my cardiologist’s nurse.
My husband and I had our tests on the same day. My husband went in for his results. I tired to make an appointment to get mine, and they had said about 2 weeks ago that I wouldn’t need one.
The nurse updated my husband’s prescription list and turned to me and said that the doctor said to tell me that there wasn’t enough plaque on my carotid arteries to worry about. I asked her for percentages, since I wanted to compare them to the results of my last carotid arteries ultrasound. She said that I would have to make an appointment to find out the information. I explained that I had tried to make an appointment earlier, and she replied that I needed an appointment and that they were making them two months out.

I couldn’t believe this and told her that I would ask the doctor who we have both been seeing for several years. She then told me that it was my husband’s appointment and I couldn’t ask any questions about myself. By this time, I was furious and couldn’t even look at her. I am not normally a rude person.

After the doctor talked with us about my husband and his heart, he asked if we had any questions. I asked for my percentages. He opened his computer and gave me the percentages. It was great for us because it lightened our moods, because my husband’s results weren’t as good.

I can certainly understand your frustration.
I am glad that we were both insistent.

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I have a Medicare Advantage plan and A1c was covered in a recent wellness visit.