| Q |
I'm starting Medicare soon and I want to know more
about what medical care it pays. Where can I find more information?
Medicare created a searchable coverage
database on its website:
Visit the
website, select your state
from the drop down menu and then search through a list of present
options like hospital bed, artificial limbs and eyes, blood tests,
chiropractic services, seat lifters, and much more. Select a topic and
a new screen will open detailing whether Medicare pays for the item and
the percentage the patient will owe.
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| Q. |
I feel fine, so why should I go to the doctor for an
Annual Wellness Visit?
Medicare Part B
and Medicare Advantage Plans (Part C) pay the full
cost for an Annual Wellness Visit for people who have had Medicare Part
B longer than 12 months. There is no cost for the visit because the
Part B deductible and 20% coinsurance do not apply and neither does the
Part C copayment. The Wellness Visit is not a routine physical
examination. The visit is available to develop or update a prevention
plan with your doctor based on your current health. Preventive care is
designed to prevent and identify disease early to increase the
effectiveness of treatment.
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| Q. |
At what age should I stop getting an annual mammogram?
Get a mammogram
every year and be sure to perform self checks every month. Breast
cancer has no respect of age. Medicare pays the full cost of a
screening mammogram once a year for all women age 40 and older and more
often if it's medically necessary.
A discouraging
but noteworthy cost worth mention is if there are clinical findings as
a result of your mammogram (or any cancer screening). If the provider
finds something abnormal, then the mammogram is considered a diagnostic
exam and it is no longer free. A 20% coinsurance will be charged to the
patient after payment of the $140 annual deductible.
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| Q. |
Does Medicare pay for eye care?
Medicare pays
for eye care on a very limited basis for chronic eye conditions. People
at high risk for glaucoma receive an annual routine eye exam. Those
considered high risk include people with diabetes, those with a family
history of glaucoma, African Americans age 50 and older, and Hispanics
age 65 or older. In addition, Medicare pays for the cataract surgery to
replace the eye's natural lens with a man-made intraocular lens. After
cataract surgery, Medicare will pay for one pair of eye glasses.
Finally, Medicare will pay for an eye exam to diagnose potential vision
problems if the problems indicate a serious eye condition.
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| Q. |
Which vaccines are covered by Medicare Part B vs.
Medicare Part D?
Medicare Part B
pays the full cost, no out-of-pocket costs, for the following vaccines:
influenza (flu), H1N1 flu, pneumococcal pneumonia, nd hepatitis B virus
(HBV). The HBV vaccine is only covered for people with medium to high
risk including health care workers with frequent contract with blood,
those with end-stage renal disease or hemophilia, or persons living in
the same household as an HBV carrier.
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| Q. |
I was recently diagnosed with
breast cancer and I'm concerned about being sick and being able to pay
my medical bills. What can I expect?
These
are the costs related to common
therapies for all types of cancer. Medicare Part A pays for inpatient
hospitalization and surgery if required. Medicare Part A has a
deductible of $1,156 which covers up to 60 days of in-patient care.
Medicare Part B pays 80% of the cost
for chemotherapy and anti-emetic
(nausea) medications administered in-office by a provider as well as
paying for prescriptions you may take at home (known as
self-administered drugs). You may need to educate your pharmacy about
billing Medicare Part B (not your Part D Drug Plan) for these
medications. You will pay 20% of the cost of the medication after a
$140 annual deductible.
If you have a
Medicare Advantage (MA) Plan your copayments and
deductibles will vary from the costs listed above. Be sure your MA Plan
pays for self-administered anti-cancer and anti-emetic medication
through its health coverage vs. its drug coverage.
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| Q. |
My uncle has cancer and the doctor recommended hospice
care. How do we find a hospice service that will accept my uncle's
Medicare Advantage Plan?
The hospice
benefit is paid by Original Medicare. Even though your uncle has a
Medicare Advantage plan, if he chooses hospice it will be paid for by
Original Medicare. His doctor may have some recommendations for
providers but be sure to check the comparison tool at medicare.gov to view report cards for hospice providers. Medicare
will help pay for hospice care if these criteria are met:
- Patient has Part A
- Your doctor certifies that you
have a terminal illness and are expected to live six months or less
- You sign a statement electing to
have Medicare pay for palliative care such as pain management, rather
than care to try to cure your condition
- Your terminal condition is
documented in your medical record
- You receive care from a
Medicare-certified hospice agency
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| Q. |
I
heard I'll get a raise in my Social Security check in 2012. How much
will the Medicare Part B premium increase and will it take my raise
back?
The
Social Security Administration announced a Cost of
Living Adjustment (COLA) of 3.6% in 2012.
The COLA for more than 60 million Americans begins January 2012. The
Medicare Part B premium is withheld from Social Security. The
Medicare Part B premium in 2012 will be
$99.90 each month, which represents a quarter of the full
cost. The
premium is an increase for some and
decrease for others; if started Medicare prior to 2009 the premium is
an
increase of $3.50, if started Medicare in 2010 the premium is $14.10
less, and
if started Medicare in 2011 the premium is $19.00 less. People
with higher incomes pay higher Part B
premiums. For a full list of the 2012
premiums, deductibles and copayments, click here.
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| Q. |
My
doctor gave me a form to sign stating I would pay the full cost of a
test if Medicare didn't pay for it. Is this allowed?
There are a couple of reasons
you may be asked to sign this form. The first is if your doctor does
not accept Medicare payments. If this is the case, you may have to sign
a contract with your doctor and pay for your care.
The second reason is a form
called an Advanced Beneficiary Notice (ABN). Providers of health-care
services or equipment must give to you and have you sign an ABN before
you receive a service that they think Medicare will not cover. The
purpose of this form is to protect Medicare beneficiaries from
unexpected medical bills. The form lists the item(s) or service(s) as
well as the estimated cost.
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| Q. |
Medicare denied my claim as a non-covered service but I
didn't receive an Advanced Beneficiary Notice (ABN). Do I still have to
pay the bill?
Providers are not required to
give you an ABN for excluded services such as personal care items
(hygiene products), self-administered drugs, cosmetic surgery, or
routine dental, hearing or eye exams.
- Common reasons Medicare does
not cover items may include experimental or investigative procedures or
the number of services exceeds the norm. If the provider did not know
and could not have anticipated the Medicare denial and the provider
submits evidence that the service is medically necessary the Medicare
may pay. However, if the provider knew Medicare wouldn't pay but did
not provide and require you to sign an ABN, then the provider is
responsible for the charges, not you.
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| Q. |
My Medicare Summary Notice Says Medicare denied my
doctor bill. Do I have to pay the full amount of the bill?
Possibly, but
you have the
right to file an appeal for a denied item or service if you think
Medicare should pay but didn't or if you think Medicare didn't pay the
right amount. There are five appeal levels and you should keep
appealing until you exhaust the process.
-
To start the
process, request a
Redetermination within 120 days of receipt of your Medicare Summary
Notice (MSN). The MSN states you should circle the item(s) in question,
explain in writing why you disagree, sign the MSN, and mail it to the
Medicare contractor listed on the MSN. Keep a copy and mark your
calendar as you should receive a written response from the contractor
within 60 days.
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|
Q.
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I
am happy with the Medicare plan I have.
Do I have to do anything during the Medicare Open Enrollment Period?
The Medicare
Open Enrollment
Period is earlier this year and
runs Oct. 15 – Dec. 7 and allows time to join, switch or drop
Medicare
Advantage (Part C) or Drug Plans (Part D). Changes are effective Jan.
1, 2012. Insurance
companies change the deductible, copayments, and premiums every year
and
sometimes a cheaper plan is available. However, if you’re happy
with your plan
and do nothing, then it will continue in 2012.
There are more
than 50 drug and
advantage plans available in Arkansas. Free and unbiased comparison
help is available from the Arkansas Insurance Department (AID). Trained
counselors can compare available plans but do not sell insurance. For
more information call 1-800-224-6330.
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|
Q.
|
What
is the difference between Medicare Advantage and Original or
Traditional Medicare?
Medicare
Advantage (MA) is an
insurance policy available from a private insurance company vs.
Original Medicare provided by the federal government. People enrolled
in MA still pay their Medicare Part B premium ($99.90 in 2012) and have
copayments for medical and hospital services. MA must cover the same
services Original Medicare covers but the out-of-pocket costs can
differ. In addition, MA may offer vision, dental or hearing coverage
not available in Original Medicare. Some MA plans include drug
insurance and some do not. Some MA plans are HMO or PPO plans and
require patients to use network doctors and hospitals.
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|
Q.
|
Can
I
switch my Medicare Supplement Policy (Medigap) during Medicare Open
Enrollment?
A Medicare
beneficiary can
apply for a Medigap policy at any
time. There is no specific annual period for Medigap enrollment.
Medigap
policies are sold by private insurance companies which require medical
underwriting and may deny coverage based on pre-existing conditions
(there are
limited exceptions). The Arkansas Insurance Department (AID) Senior
Health
Insurance Information Program (SHIIP) produces a publication called Bridging
the Gaps which lists all the companies approved to sell policies in
Arkansas
and their rates. To download a copy of
this comparison guide, simply click "Bridging the Gaps" above or click here to email the
Medicare Man.
|
| Q. |
What is the difference between a Long-term Care
Partnership Policy and a Long-term Care Policy?
A Partnership
Policy provides
asset protection. Medicaid is the largest payer of long-term care
(LTC). Medicaid-paid LTC requires meeting financial criteria (income
and assets) and non financial criteria. The highest level of assets
allowed in Arkansas for LTC is currently $2,000. A LTC Partnership
Policy would allow you to keep assets above the $2,000 level and still
meet Medicaid asset limits. For example, a policy with $200,000 of
asset protection would allow a person to keep $202,000 in assets and
still meet asset criteria for Arkansas Medicaid-paid LTC.
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| Q. |
My husband was very ill but the hospital refused to
admit him. He didn't get better and later the same evening we went to
another hospital where he was admitted. This doesn't seem right.
If a hospital
denies admission,
it must give you a form called a Hospital Issued Notice of Non-coverage
(HINN). The HINN states the reason for denying admission or why they
believe Medicare will not pay. It also includes your right to appeal or
question the decision. If you receive a HINN, request an immediate
(expedited) review of the decision from the Arkansas Foundation for
Medical Care (AFMC). AFMC is an independent, nonprofit group of doctors
and other professional who are not affiliated with the hospital. AFMC
contracts with the government to ensure Medicare beneficiaries receive
quality care. You can request review of the hospital's decisions from
the AFMC either in writing or over the phone. AFMC's toll free number
phone number is 888-354-9100. The number is also listed on the HINN.
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| Q. |
My daughter encouraged me to complete an advanced
directive. What is it and how will I use it?
An advanced
Directive is
written
instructions provided by individuals to define what actions are to be
taken for their health, in the event that they are not able to make
decisions due to illness or incapacity. It can also appoint a person to
make such decisions for them. Several free forms are available online,
search Advanced Directive, Living Will or do not resuscitate order to
find one you like. Give a copy of the signed document to family members
and your doctors.
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