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Medicare Part B Coverage 2012

Video: What does Medicare B Cover?

Some Medicare Part B Coverage Preventive Services for 2012 are free of charge. Other services require that you to pay a significant amount of the expense.

After reviewing the following, you will see why many seniors supplement their Medicare coverage with a Medigap plan. Some Medigap (Medicare Supplement) plans will pay up to 100% of what Medicare does not cover for you.

Medicare Part B - “Welcome to Medicare” Preventive Visit

During the first 12 months that you have Part B, you can get a“Welcome to Medicare” preventive visit. This visit helps you and yourdoctor or other health care provider develop a personalized plan toprevent disease, improve your health, and help you stay well. Whenyou make your appointment, let your doctor’s office know that you would like to schedule your “Welcome to Medicare” preventive visit.

Medicare Part B Coverage - Yearly “Wellness” Visit

If you’ve had Part B for longer than 12 months, you can get a yearly “Wellness” visit to develop or update a personalized plan to preventdisease based on your current health and risk factors. This visit iscovered once every 12 months.

Your provider may suggest that you fill out a short questionnaire,called a Health Risk Assessment, as part of this visit. Answeringthese questions can help you figure out what to work on to stayhealthy. The questions are based on years of medical research andadvice from the Centers for Disease Control and Prevention (CDC).For more information about the Health Risk Assessment, visitwww.medicare.gov.

Note: Your first yearly “Wellness” visit can’t take place within 12months of you having Medicare or your “Welcome to Medicare”visit. However, you don’t need to have a “Welcome to Medicare”visit before your yearly “Wellness” visit.

You pay nothing for the “Welcome to Medicare” preventive visitor the yearly “Wellness” visit if the doctor or other health careprovider accepts assignment. However if your doctor or otherhealth care provider performs additional tests or services duringthe same visit that aren’t covered under these preventive benefits,you may have to pay coinsurance, and the Part B deductible mayapply.

Medicare Part B Coverage - Abdominal Aortic Aneurysm Screening

Medicare covers a one-time screening abdominal aortic aneurysm ultrasound for people at risk. You must get a referral for it as part of your one-time “Welcome to Medicare” preventive visit. You pay nothing for the screening if the doctor or other health care provider accepts assignment.

Medicare Part B Coverage - Bone Mass Measurement (Bone Density)

This test helps to see if you’re at risk for broken bones. It’s covered once every 24 months (more often if medically necessary) for people who have certain medical conditions or meet certain criteria.You pay nothing for this test if the doctor or other health careprovider accepts assignment.

Medicare Part B - Breast Cancer Screening (Mammograms)

Medicare covers screening mammograms to check for breast canonce every 12 months for all women with Medicare 40 and older Medicare covers one baseline mammogram for women between35–39. You pay nothing for the test if the doctor or other health care provider accepts assignment.

Medicare Part B Coverage - Cardiovascular Screenings

These screenings include blood tests that help detect conditions that may lead to a heart attack or stroke. Medicare covers these screening tests every 5 years to test your cholesterol, lipid, and triglyceride levels. You pay nothing for the tests, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.

Medicare Part B - Cervical and Vaginal Cancer Screening

Medicare covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the exam, Medicare also covers aclinical breast exam to check for breast cancer. Medicare coversthese screening tests once every 24 months. Medicare covers thesescreening tests once every 12 months if you’re at high risk forcervical or vaginal cancer or if you’re of child-bearing age and hadan abnormal Pap test in the past 36 months. You pay nothing forthe Pap lab test, Pap test specimen collection, and pelvic and breastexams if the doctor or other health care provider accepts assignment.

Medicare Part B Coverage - Colorectal Cancer Screenings

Medicare covers these screenings to help find precancerous growths or find cancer early, when treatment is most effective. One or more of the following tests may be covered. Talk to your doctor or other health care provider.

• Fecal Occult Blood Test—This test is covered once every 12 months if you’re 50 or older. You pay nothing for the test.

• Flexible Sigmoidoscopy—This test is generally covered once every 48 months if you’re 50 or older, or 120 months after a previous screening colonoscopy for those not at high risk. You pay nothing for this test if the doctor or other health care provider accepts assignment.

• Colonoscopy—This test is generally covered once every 120 months (high risk every 24 months) or 48 months after a previous flexible sigmoidoscopy. No minimum age. You pay nothing for this test if the doctor or other health care provider accepts assignment.

• Barium Enema—This test is generally covered once every 48months if you’re 50 or older (high risk every 24 months)when used instead of a sigmoidoscopy or colonoscopy. You pay 20% of the Medicare-approved amount for the doctor services. In a hospital outpatient setting, you also pay the hospital a copayment.

Medicare Part B - Diabetes Screenings

Medicare covers these screenings if you have any of the following risk factors: high blood pressure (hypertension), history of abnormalcholesterol and triglyceride levels (dyslipidemia), obesity, or a historyof high blood glucose (blood sugar). Tests may also be covered if youmeet other requirements, like being overweight or having a familyhistory of diabetes.

Based on the results of these tests, you may be eligible for up to twodiabetes screenings every year. You pay nothing for the test if yourdoctor or other health care provider accepts assignment.

Medicare Part B Coverage - Diabetes Self-Management Training

Medicare covers a program to help people cope with and manage diabetes. The program may include tips for eating healthy, beingactive, monitoring blood sugar, taking medication, and reducingrisks. You must have diabetes and a written order from your doctoror other health care provider. You pay 20% of the Medicare-approvedamount, and the Part B deductible applies.

Medicare Part B - Flu Shots

Medicare generally covers flu shots once per flu season in the fall or winter. You pay nothing for getting the flu shot if the doctor or otherhealth care provider accepts assignment for giving the shot.

Medicare Part B Coverage - Foot Exams and Treatment

Medicare covers foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions. You pay20% of the Medicare-approved amount, and the Part B deductibleapplies. In a hospital outpatient setting, you also pay the hospital acopayment.

Medicare Part B - Glaucoma Tests

These tests are covered once every 12 months for people at high risk for the eye disease glaucoma. You’re at high risk if you have diabetes, a family history of glaucoma, are African-American and 50 or older, or are Hispanic and 65 or older. An eye doctor who is legally allowed by the state must do the tests. You pay 20% of the Medicare-approved amount, and the Part B deductible applies for the doctor’s visit. In a hospital outpatient setting, you also pay the hospital a copayment.

Medicare Part B Coverage - Hearing and Balance Exams

Medicare covers these exams if your doctor or other health care provider orders them to see if you need medical treatment. You pay20% of the Medicare-approved amount, and the Part B deductibleapplies. In a hospital outpatient setting, you also pay the hospital acopayment. Note: Original Medicare doesn’t cover hearing aids or exams for fitting hearing aids.

Medicare Part B - Hepatitis B Shots

Medicare covers these shots for people at high or medium risk for Hepatitis B. Your risk for Hepatitis B increases if you havehemophilia, End-Stage Renal Disease (ESRD), or certain conditionsthat increase your risk for infection. Other factors may increase yourrisk for Hepatitis B, so check with your doctor or other health careprovider. You pay nothing for the shot if the doctor or other healthcare provider accepts assignment.

Medicare Part B Coverage - HIV Screening

Medicare covers HIV (Human Immunodeficiency Virus) screening for people at increased risk for the infection, anyone who asks for thetest, and pregnant women. Medicare covers this test once every 12months or up to 3 times during a pregnancy. You pay nothing for theHIV screening.

Medicare Part B Coverage - Medical Nutrition Therapy Services

Medicare may cover medical nutrition therapy and certain related service if you have diabetes or kidney disease, or you have had a kidney transplant the last 36 months, and your doctor or other health care provider refers you for the service. You pay nothing for these services if the doctor or other health care provider accepts assignment.

Medicare Part B Coverage - Pneumococcal Shot

Medicare covers pneumococcal shots to help prevent pneumococcal infections (like certain types of pneumonia).Most people only need this shot once in their lifetime. Talk withyour doctor or other health care provider to see if you shouldget this shot. You pay nothing if the doctor or other health careprovider accepts assignment for giving the shot.

Medicare Part B Coverage - Prostate Cancer Screenings

Medicare covers a Prostate Specific Antigen (PSA) test and a digital rectal exam once every 12 months for men over 50 (beginning the day after your 50th birthday). You pay nothing for the PSA test. You pay 20% of the Medicare-approved amount, and the Part B deductible applies for the digital rectal exam. In a hospital outpatient setting, you also pay the hospital a copayment.

What’s NOT Covered by Part A and Part B?

Medicare doesn’t cover everything. If you need certain services thatMedicare doesn’t cover, you will have to pay for them yourself unlessone of the following applies to you:

You have other insurance (including Medicaid) to cover the costs.

You’re in a Medicare health plan that covers these services.

Even if Medicare covers a service or item, you generally have to paydeductibles, coinsurance, and copayments.

Some of the items and services that Medicare doesn’t cover includethe following:

• Long-term care (also called custodial care).

• Routine dental care.

• Dentures.

• Cosmetic surgery.

• Acupuncture.

• Hearing aids.

• Exams for fitting hearing aids.

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