AMARILLO – Many people might not know they have already paid through Medicare for certain medical services and supplies in hospitals, health providers’ offices and other health-care settings, according to a Texas AgriLife Extension Service specialist.
Andrew Crocker, AgriLife Extension gerontology health program specialist, said these services are either covered under Medicare Part A, in-patient hospitalization, or Medicare Part B, the optional, outpatient health coverage.
“If you have both Part A and Part B, you are eligible for the full range of Medicare-covered services,” Crocker said. “While most individuals must be age 65 or older to qualify for Medicare, some individuals with certain medical conditions or disabilities may qualify for Medicare at any age.”
Part B helps cover medically necessary services like health providers’ services, outpatient care and other medical services, as well as some preventive services, he said.
“You pay the Part B premium each month. It will be $96.40 in 2009 and it is usually deducted from your Social Security check,” Crocker said. “You also pay a Part B deductible each year before Medicare starts to pay its share, which will be $135 in 2009.”
Costs for Part B services vary depending on whether the individual has original Medicare or is in a Medicare health plan, he said.
“You generally have to pay for the doctor’s visit, even if there is no cost for the service itself. If the Part B deductible applies, you must pay all costs until you meet the deductible. Once the deductible is met and Medicare begins paying its share, you typically pay 20 percent of the Medicare-approved amount of the service.”
In the original Medicare, the “Medicare-approved amount” is the amount a health provider that accepts assignment can be paid, Crocker said. It includes what Medicare pays and any deductible, coinsurance or co-payment. It may be less than the actual amount a provider charges.
Many screenings and preventive health services are available under Medicare Part B, he said. Health care that prevents or detects illness at an early stage leads to early treatment and often renders better health.
The “Welcome to Medicare” physical exam is a one-time review of health for new Medicare beneficiaries and includes education and counseling about preventive services, certain screenings, shots and referrals for other care if needed, Crocker said.
In 2009, Medicare will cover this exam within the first 12 months of enrolling in Part B, he said.
“You pay 20 percent of the Medicare-approved amount, and the Part B deductible will not apply,” Crocker said.
Colorectal cancer screenings may help identify precancerous growths and help prevent or find cancer early, when treatment is most effective.
One or more of the following tests is covered under Part B:
– Fecal occult blood test once every 12 months if age 50 or older. No cost for the test, but generally the patient pays 20 percent of the Medicare-approved amount for the office visit.
– Flexible sigmoidoscopy, generally once every 48 months if age 50 or older, or for those not at high risk, 120 months after a previous screening colonoscopy. The patient pays 20 percent of the Medicare-approved amount.
– Colonoscopy generally once every 10 years (high risk every two years) or four years after a previous flexible sigmoidoscopy. The patient pays 20 percent of the Medicare-approved amount.
– Barium enema once every four years if age 50 or older (high risk every two years) when used instead of a sigmoidoscopy or colonoscopy. The patient pays 20 percent of the Medicare-approved amount.
– Mammograms once every year for women with Medicare age 40 and older. Medicare covers one baseline mammogram for women between 35 and 39. The patient may pay 20 percent of the Medicare approved amount.
– Pap tests and pelvic exams once every two years, or once every year for women at high risk for cervical and vaginal cancers, and for women of child-bearing age who have had an exam that indicated cancer or other abnormalities in the past three years. There is no cost for the pap lab test, but the patient may pay 20 percent of the Medicare-approved amount for pap test collection and pelvic exam.
– Prostate cancer screenings help detect prostate cancer. Medicare covers a digital rectal exam and prostate specific antigen test once every year for all men with Medicare over age 50. The patient may pay 20 percent of the Medicare-approved amount for the office visit. There is no cost to you for the test.
“Talk to your health provider to determine if you may be high risk for any of these conditions and warrant additional screenings,” Crocker said. “Also, you may wish to note that the amount Medicare pays for many of these procedures may be reduced if you receive them in an ambulatory surgical center as opposed to a hospital setting.”
Copies of “Medicare and You 2009” are in the mail, Crocker said, and will help navigate the services entitled under Medicare. The information also can be accessed through the Medicare Web site: http://www.medicare.gov . The Medicare Web site and its publications are available in Spanish.
For other information regarding Medicare coverage, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048. -30-