Health Column: Medicare and preventive services

01/31/2011 9:32 AM |

Dear Marci,
I am 65 and just became eligible for Medicare. How much will I pay for preventive services?

Dear Paul,
Starting in 2011, consumers who have Original Medicare will no longer pay coinsurance or a deductible for certain preventive care services recommended by the U.S. Preventive Services Task Force. Recommended services, which are 100 percent covered, include:
• diabetes screening
• medical nutritional therapy
• blood tests for heart disease
• bone mass measurement
• screening mammograms
• pap smears, pelvic exams and clinical breast exams
• colon cancer screening, including fecal occult blood test, flexible sigmoidoscopy and colonoscopy
• prostate cancer screening (PSA test)
• flu, pneumonia and hepatitis B shots
• annual wellness visit
If you have a Medicare Advantage plan, deductibles and co-pays may apply to these preventive services in 2011. However, private plans cannot charge you anything for the flu or pneumonia vaccine. In addition, Medicare Advantage plans cannot require that you get a referral in order to get a screening mammogram or a flu shot. Check with your plan to see how it covers preventive services.
Be sure to follow the Medicare guidelines for receiving these services in order to ensure that Medicare will cover them. Some are covered only once every few years, and others are covered only if you meet specific criteria.

Dear Marci,
I just joined a drug plan that does not cover one of the drugs I’m taking, but I heard I’m supposed to get one prescription refill for that drug. Is that true?

Dear Yan,
Yes. Every drug plan must have a transition policy to ensure that new members have uninterrupted access to drugs they were already taking before they joined. Your plan’s transition policy must cover at least one 30-day supply of drugs not on the formulary (list of covered drugs) and override plan restrictions (such as prior authorization, quantity limits or step therapy) within the first 90 days you are enrolled in the plan. The pharmacist may need to ask the plan for its override code in order to bill correctly.
If you are enrolled in a plan and your plan intends to remove your drug from its formulary for the next calendar year or add new prior authorization or step therapy requirements, it must either help you change to a therapeutic equivalent, complete an exception request before Jan. 1, or provide a 30-day fill of the medication (and waive step therapy requirements if applicable) and transition notice for the first 90 days of the new plan year.
Transition fills are temporary. Take action immediately and have your doctor change your prescription to a covered drug or ask your plan for an exception. This way you will ensure that you continue getting the medications you need after your transition period has ended.

Dear Marci,
How do I apply for a Medicare Savings Program?

Dear Eleanor,
Medicare Savings Programs (MSPs) 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.
You will need to call your local Medicaid office for exact rules on how to apply for an MSP in your state. Many states allow you to submit your application online, through the mail, or through community health centers or other organizations. Some states still require that you schedule an appointment and go in person to the Medicaid office to apply.
The list of documents that you will need to have for your application varies by state. Some states do not require that you submit documentation of your income or assets. Contact your local Medicaid office to find out what documents you need. Examples of documentation that may be required for your MSP application include: your Social Security and Medicare cards; your birth certificate, passport or green card; proof of your address, such as an electric bill or phone bill; proof of your income, such as a Social Security Administration award letter, income tax return or pay stub; and information about your assets, such as bank statements, stock certificates or life insurance policies.

Marci’s Medicare Answers is a service of the Medicare Rights Center, the nation’s largest independent source of information and assistance for people with Medicare.