Marci’s Medicare Answers

                     January 2010

 Dear Marci,

Does Medicare cover glaucoma testing?

—Mildred

 Dear Mildred,

Medicare will not generally pay for routine eye care. However, if you are at high-risk for glaucoma, Medicare covers 80 percent of the cost of an annual (every 12 months) glaucoma screening, after you pay your annual Part B deductible ($155 in 2010). Those at high risk for the disease include people with diabetes or high blood pressure, people with a family history of glaucoma, African Americans age 50 and older, and Hispanic Americans age 65 and older. The screening must be performed or supervised by an eye doctor who is licensed to provide this service in your state.

—Marci

 Dear Marci,

I recently turned 65, but I missed my window to enroll in Medicare. When will I get another chance to enroll?

—Muhammad

 Dear Muhammad,

You can actively enroll in Medicare at anytime during the Initial Enrollment Period, which is the seven-month period including the three months before, the month of, and the three months following your 65^th birthday.

                If you missed the Initial Enrollment Period and have employer insurance from your or your spouse’s current job, you may be eligible for a Special Enrollment Period. With a Special Enrollment Period, you can enroll in Medicare without penalty at any time while you have group health coverage and for eight months after you lose your group health coverage or you (or your spouse) stop working, whichever comes first.

If you do not have insurance from a current job and missed the Initial Enrollment Period, you can apply for Medicare during the General Enrollment Period, between January 1 and March 31 of each year. Your coverage will not start until the following July, and you will have to pay a Part B premium penalty.

The penalty will be 10 percent of the Part B premium for each 12-month period you delay enrollment in Part B. In most cases you will have to pay that penalty every month for as long as you have Medicare. If you are enrolled in Medicare because of a disability and pay premium penalties, once you turn 65, you no longer have to pay the premium penalty.

—Marci

 Dear Marci,

I’m having trouble paying for my Medicare, and I’ve heard that a Medicare Savings Program could help me out. What do these programs cover, and what are the eligibility requirements?

—Jan
Dear Jan,

Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs or Medicare Premium Payment Programs, help pay your Medicare costs if you have limited finances. There are three main programs, and each has different income eligibility limits. Not all states have all programs.

1. Qualified Medicare Beneficiary (QMB): Pays for Medicare Part A and B premiums, deductibles and coinsurances or co-pays. If you have QMB, you will have no coinsurance or copayment for Medicare-covered services you get from doctors who participate in Medicare or Medicaid or are in your Medicare private health plan’s network.
2. Specified Low-income Medicare Beneficiary (SLMB): Pays for Medicare’s Part B premium.
3. Qualifying Individual (QI) Program: Pays for Medicare’s Part B premium.

To qualify for an MSP, you must have Medicare Part A and meet income and assets guidelines. If you do not have Part A but meet QMB eligibility guidelines, your state will have a process to allow you to enroll in Part A and QMB. Many states allow this throughout the year, but others limit when you can enroll in Part A.

States use different rules to count your income (money you take in, for example, Social Security payments that you get or wages that your earn) and assets (resources such as checking accounts, stocks and some property) to determine if you are eligible for an MSP. Certain income or assets may not count. Some states do not have an asset limit. Because rules vary by state, if your income or assets seem to be above the MSP guidelines, you should still apply if you need the help.

If you enroll in a Medicare Savings Program, you will also automatically get Extra Help, the federal program that helps pay most of your Medicare prescription drug costs (Part D).

—Marci

Marci’s Medicare Answers

                     July 2010

 Dear Marci,

I get sunburned very easily, and I would like to get screened for skin cancer. Will Medicare cover these screenings?

—Tatiana

 Dear Tatiana,

No, Medicare will not cover screenings for skin cancer. If, however, you see a suspicious-looking mole, you should make an appointment with your doctor as soon as possible. Medicare will cover a diagnostic doctor’s visit and any diagnostic tests your doctor considers medically necessary. You may be able to find a doctor who will give you a free skin cancer screening by visiting the American Academy of Dermatology’s website (www.aad.org/public/exams/screenings/index.html).

—Marci

 Dear Marci,

I heard that there are new Medigap plans available this year. How are these different from the current plans?

—Joel

 Dear Joel,

You heard correctly. Starting June 1, 2010, two new Medigap plans will be sold. Medigap plans are supplemental coverage policies that fill gaps in Original Medicare.

The new plans, Plan M and Plan N, will cover the basic Medigap benefits and some additional benefits. The basic benefits include:

• hospital coinsurance coverage,
• 365 additional days of full hospital coverage
• Full or partial coverage for the 20 percent coinsurance for doctor charges and other Part B services
• Full or partial coverage for the first 3 pints of blood you need each year
• Full or partial hospice coinsurance for respite care and prescription drugs

New Plan M will pay all of your costs for the basic benefits and also cover half of the Part A deductible, skilled nursing facility coinsurance, and some of the cost of foreign travel emergencies. New Plan N will also pay all of your costs for the basic benefits except for $20 copayments for office visits and $50 copayments for emergency room visits. Plan N will also offer foreign travel emergency coverage and cover the full Part A deductible as well as skilled nursing facility coinsurance.

Remember that not all Medigap plans are available in all areas.

—Marci

 Dear Marci,

My most recent Medicare Summary Notice lists some services that I never received. What should I do?

—Fran

 Dear Fran,

If you think a mistake has been made in a bill, call your doctor, hospital or other provider first. It may have been a simple, honest error.

If the provider’s answer does not satisfy you, you can call Medicare at 800-MEDICARE (800-633-4227) or the Inspector General’s fraud hotline at 800-HHS-TIPS (800-447-8477). When it investigates the potential fraud, Medicare will not use your name if you do not want it to.

—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 speak with a counselor, call (800) 333-4114. To subscribe to “Dear Marci,” the Medicare Rights Center’s free educational e-newsletter, simply e-mail dearmarci@medicarerights.org.

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.