Health Column: Medicare provides for hospice care

11/01/2011 2:00 AM |

Dear Marci,
Does Medicare cover hospice care?
Anu

Dear Anu,
Yes, Medicare will help pay for your hospice care if you meet all of the following criteria:
• You have Part A;
• the hospice medical director and your doctor, if you have one, certify that you have a terminal illness with a life expectancy of six months or less;
• you sign a statement electing to have Medicare pay for palliative care such as pain management, rather than care to try to cure your condition;
• your terminal condition is documented in your medical record; and
• you receive care from a Medicare-certified hospice agency.

The hospice benefit is always covered under Original Medicare. If you have a Medicare Advantage plan, but  elect hospice, your hospice care will be paid for by Original Medicare.
The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods. Starting April 1, 2011, you must have a face-to-face meeting with a hospice doctor or nurse practitioner if you reach your third benefit period.

Dear Marci,
I have hypertension and am at high risk for diabetes. Will Medicare pay for diabetes screenings?
Niamh

Dear Niamh,
Yes, Medicare will pay for diabetes screening tests once a year if you are considered high risk. You are considered high risk if you have hypertension, dyslipidemia or any kind of cholesterol problem; have a prior blood test showing low glucose tolerance or are obese with a body mass index of 30 or more.

Also, you must meet at least two of the following criteria:
• you are overweight with a body mass index between 25 and 30;
• you have a family history of diabetes;
• you have a history of gestational diabetes during pregnancy or have had a baby weighing over nine pounds;
• you are 65 years of age or older.

Medicare will pay for 100 percent of its approved amount for the diabetes screening test even before you have met the Part B deductible. You will pay no co-pay or deductible for these tests if you see doctors who take assignment. Doctors and other health care providers who take assignment can’t charge you more than the Medicare-approved amount. If you are in a Medicare Advantage plan, you should check with your plan to see what costs and rules apply.

Starting in 2012, Medicare Advantage plans will cover all preventive services the same as Original Medicare. This means Medicare Advantage plans won’t be allowed to charge cost-sharing fees — coinsurances, co-pays or deductibles — for preventive services that Original Medicare does not charge for as long as you see a network provider.

Dear Marci,
My income is too high for me to qualify for Extra Help, but I still can’t afford the cost of my drugs. Are there any other programs that can help me?
Benedict

Dear Benedict,
Even if you don’t qualify for Extra Help, you may be able to get help paying for your prescription drugs if your state has a State Pharmaceutical Assistance Program (SPAP). Many states offer an SPAP to help their residents pay for prescription drugs. Each program works differently.

Many states coordinate their drug assistance programs with Medicare’s Part D drug benefit. If you don’t have Part D but qualify for your state’s SPAP, you will have the chance to sign up for Part D, and may be required to enroll in a Part D plan. If a drug is covered by both your SPAP and your Part D plan, both what you pay for your prescriptions plus what the SPAP pays will count toward the out-of-pocket maximum you have to reach before your Medicare drug costs go down significantly. Your SPAP may also help pay for your Part D plan’s premium, deductible, co-payments and coverage gap. Many SPAPs give you coverage during your Part D plan’s coverage gap, also known as the doughnut hole.

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.