I’ve heard that some drug companies will offer their drugs at a discount for people with low incomes. Is that true?
Yes. Some drug companies offer free or low-cost drugs through programs called Patient Assistance Programs (PAPs). In most cases, your doctor must apply to the program for you. While many patient assistance programs do not allow you to apply if you are eligible for the Medicare drug benefit (Part D), some do.
Generally, PAPs require your doctor to be involved in the application process. You may be required to pay a co-payment. If you have Part D, your PAP co-payments will count toward meeting your Part D plan’s out-of-pocket limit ($4,550 in 2010), but you will need to submit your receipts to your plan, as well as any other required documentation, in order for what you pay to count. What your PAP pays for your prescription drugs will not count toward the $4,550 in out-of-pocket costs that you must spend before catastrophic coverage begins and your drug costs go down significantly. To look up details about PAPs using an alphabetical list of drugs, go to medicare.gov/pap.
Does Medicare cover screenings for prostate cancer?
Yes. Medicare covers one prostate screening per year (for men age 50 and older. Prostate cancer screenings can detect prostate cancer, which affects one in six men, in its early stages. The screening includes a Prostate-Specific Antigen (PSA) blood test and a digital rectal exam. Medicare will cover these services more than once per year if your doctor says you need them for diagnostic purposes. Medicare covers 80 percent of the cost of the digital rectal exam, after you pay your annual Part B deductible, and 100 percent of the cost of the PSA test, with no Part B deductible required. If you are in a Medicare private health plan — HMO or PPO — you may have a co-pay for the PSA test or the digital rectal exam. Call your plan to find out what you will have to pay.
If I have an emergency and call an ambulance, will Medicare pay for it?
Yes. Medicare will generally cover ambulance services in an emergency, as long as an ambulance is the only safe way to transport you, and you are transported to and from certain locations.
An emergency is when your health is in serious danger and every second counts to prevent your health from getting worse. If the trip is scheduled as a way to transport you from one location to another when your health is not in immediate danger, it’s not considered an emergency.
If it’s not an emergency, Medicare coverage of ambulance services is very limited, but Medicare may cover non-emergency ambulance services in certain instances. For example, non-emergency services may be covered if you are confined to your bed or if you need vital medical services during your trip that are available only in an ambulance. Lack of access to alternative transportation alone will not justify Medicare coverage.
If covered, Medicare will pay for 80 percent of its approved amount for the ambulance service. You or your supplemental insurance policy will be responsible for the remaining 20 percent. All ambulance providers must accept Medicare assignment, meaning they must accept the Medicare-approved amount as payment in full. Medicare will never pay for ambulette services.
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.