What Does "Once Every 12 Months" Mean?

This is a Medicare rule in the US. They apparently avoided using "once every 365 days" on purpose which, if it had been used, would mean if you did X on Nov 15, 2011, you could not do it earlier than Nov 15, the next year. Instead they worded the rule "once every 12 months" and apparently mean you could do it anytime in

November, but not earlier (like October).

I asked the question because my medical group ( 2 people) has the notion that the date can't be earlier in subsequent years (the 365 day rule) and Medicare has both notions (2 people w/ differing opinions).

Since I cannot really know what is true unless I violate the rule and get punished by the Medicare computer,

I am just trying to guess what is really true but was curious how one would word the rule so that everyone

would agree. I don't see how unless some concrete examples accompanied the rule.

Clive,

As I mentioned in my previous post, I asked 2 people in the Medicare office(via toll free call) and got 2 different answers....which really doesn't surprise me anymore with any customer-service-related questions

in any industry. Since it is impossible for these folks to know everything, they become searchers of a computer database looking for answers. Thus they are at the mercy of the English language and those who have written the script. That's why I asked here wondering if there was any precise meaning to the words. I suppose if I asked N times where N was a large enough number , eventually I could get a statistically hopeful answer (but still not a certain one). Perhaps things are different in Canada?

Many years ago my doctor told me that "every 12 months" refers only to months, not days (smart doctor!). Since qualifying for Medicare (7 years ago), I have made many "every 12 months" appointments earlier than the specific day in the previous year (e.g. June 28, 2017 and then June 13, 2018). This includes mammograms, annual wellness vists, etc. Medicare has not questioned any of them and has paid the full costs. The same is true for "every 24 months" procedures such as bone density scans. So for Medicare, "months" mean months, not days, and "every 12 months" does not mean "every 365 days." Thus, 12 months from June 2017 is June 2018. The specific day doesn't matter. It just has to be in June. This has always been my experience with Medicare.

Thank you so much!!

That's a good question. Medicare pays for an "annual wellness visit" to my care provider once every 12 months. I had a visit on 11/5/2018. Next year I had a visit on 11/23/2019 and Medicare would not pay because the interval needed to be 12 full months.