Volume 79, Number 39 | March 3 - 9, 2010
West and East Village, Chelsea, Soho, Noho, Little Italy, Chinatown and Lower East Side, Since 1933

Marci’s Medicare Answers March 2010

Dear Marci,
Does Medicare cover colonoscopies?
— Dennis

Dear Dennis,
Yes. Medicare covers a colonoscopy once every two years (24 months) if you are at high risk for colorectal cancer (e.g., have a family history of the disease or have had colorectal polyps or colorectal cancer, or have had inflammatory bowel disease), or once every 10 years if you are not at high risk (but not within 48 months of a screening flexible sigmoidoscopy). There is no minimum age requirement for this screening.

If you are 50 or older, Medicare also covers the following screenings:

• Fecal occult blood test - once a year (every 12 months)
• Flexible sigmoidoscopy - once every four years (48 months)
• Barium enema - covered only if performed on its own and not in addition to the other tests

Medicare will cover these services with no Part B deductible required. Medicare will cover 100 percent of the cost of the fecal occult blood test. (If you are in a Medicare private health plan—HMO or PPO—you may have a copay for this service. Call your plan to find out what you will have to pay.) For the other tests, Medicare will pay 80 percent of the cost. Medicare will cover 75 percent of the cost of a colonoscopy or flexible sigmoidoscopy if the procedure is done in an ambulatory surgical center or hospital outpatient department.
— Marci

Dear Marci,
When will Medicare pay for care I receive in a skilled nursing facility?
— Yu

Dear Yu,
Medicare may help pay for skilled nursing facility (SNF) care if:

• You need skilled nursing care seven days a week or skilled therapy services at least five days a week;
• You were formally admitted as an inpatient to a hospital* for at least three consecutive days in the 30 days prior to admission in a Medicare-certified skilled nursing facility; and
• You are eligible for Medicare at the time you are discharged from the hospital.

*Note: If you are admitted to the emergency room under observation or receive only emergency room services, this time spent in the hospital does not count toward meeting the three-day prior hospital requirement for SNF coverage.

If you meet these criteria, Medicare will pay the full cost of the first 20 days and part of the cost of another 80 days of care in a Medicare-certified skilled nursing facility each benefit period. A benefit period begins the day you enter the SNF and ends when you no longer receive SNF care for 60 days in a row.
— Marci

Dear Marci,
I’ve heard I can change my Medicare health coverage during the first few months of the year? Is that true?
— Olive

Dear Olive,
Yes. You can switch your health coverage once during the Open Enrollment Period, which runs from January 1 through March 31 every year. Your new coverage starts the first of the month after you make your selection. You cannot decide to add or drop Medicare drug coverage (Part D) during this time. For example, if you have a Medicare private health plan without drug coverage, you can only switch to a private plan without drug coverage or to Original Medicare alone (no stand-alone drug plan).

If you already have a Medicare private health plan and want to switch into a new one, you should enroll in the new plan without disenrolling from your old plan. It is best to enroll in a new Medicare private health plan by calling 800-MEDICARE rather than by calling the new plan. You will be automatically disenrolled from your previous Medicare plan when your new coverage starts.

Under certain circumstances, you may be eligible for a Special Enrollment Period (SEP) to change your drug coverage and/or health plan. For example, you qualify for an SEP if your Medicare private plan committed marketing fraud or abuse, or if you enroll in Extra Help, the federal program that helps people with Medicare pay for their prescription drugs. With Extra Help, you will also be able to change your Medicare drug plan once per month.

If you get an SEP, your new coverage will start the first of the month after you sign up for or disenroll from a Medicare private health plan.
— Marci

Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To learn more about the services that Medicare will cover and how to change plans, log on to Medicare Interactive Counselor at the Medicare Rights Center’s website at www.medicareinteractive.org.

 

 

MARCH 2010


 

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