Medicare and Your Patient 2002
Who is covered?
People age 65 or older, some people with disabilities under age 65 and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
How are they covered and do they pay for this coverage?
Medicare Part A (Hospital Insurance)
helps cover inpatient care in hospitals (semiprivate room, meals, general nursing, and other hospital services and supplies). Most people do not pay a premium for Part A because they or a spouse paid Medicare taxes while they were working.
Medicare Part B (Medical Insurance)
helps cover doctors’ services, outpatient hospital care, diagnostic tests, second surgical opinions, outpatient mental health care, and some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists. The patient pays the Medicare Part B premium of $54 per month in 2002.
What preventive services are covered?
Bone Mass Measurements
- certain Medicare patients at risk for losing bone mass (i.e. a woman who is estrogen deficient and at clinical risk for osteoporosis based on her medical history and findings).
Colorectal Cancer Screening -
- Fecal Occult Blood Test - once every 12 months.
- Flexible Sigmoidoscopy - once every 48 months.
- Colonoscopy
- once every 24 months if at high risk for colon cancer or once every 10 years, but not within 48 months of a screening flexible sigmoidoscopy if not at risk for colon cancer.Mammogram Screening
- once every 12 months. Medicare also covers new digital technologies for mammogram screening.
- Pap Test and Pelvic Examination (Includes a clinical breast exam)
- once every 24 months or once every 12 months if at high risk for cervical or vaginal cancer or of childbearing age with abnormal Pap test in the past 36 months.
Prostate Cancer Screening:
- Digital Rectal Examination - once every 12 months.
- Prostate Specific Antigen (PSA)Test –once every 12 months.
What services are not covered?
Medicare does not pay for most outpatient prescription drugs, routine dental services, routine physical examinations, vision services, cosmetic surgery, health care outside of the United States, orthopedic shoes or routine foot care.
For more information
The information offered here is only a small example of the information available to you and your Medicare patients regarding their coverage. For more information about your patient’s Medicare coverage visit http://www.medicare.gov/Publications/Pubs/pdf/mandy.pdf or call Neil Walsh in the Billing Compliance Department at ext. 2-9377.