Your Weekly Medicare
Consumer Advocacy Update
Surveying Our Readers
February 7, 2013
Volume 4, Issue 6
Medicare covers blood tests every five years to test cholesterol, lipid and triglyceride levels and screen for heart disease. Heart disease is also referred to as cardiovascular disease. You do not need to show signs of heart disease or have any particular risk factors for Medicare to cover the full cost of these tests.
Original Medicare will pay 100 percent of its approved amount for these tests, even before you have met the Part B deductible. That means you will not pay a copay or a deductible for these screenings if you see doctors or other health care providers who take assignment. Doctors who take assignment cannot charge you more than the Medicare approved amount.
If you are in a private health plan, also known as a Medicare Advantage (MA) plan, you should contact your plan to find out what rules and costs apply. MA plans cover all preventive services the same as Original Medicare. This means MA plans will not be allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for, as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.
The Centers for Medicare & Medicaid Services (CMS) recently announced the participation of over 500 organizations in the Bundled Payments for Care Improvement initiative. This initiative will test how bundling payments for episodes of care can result in more coordinated care for Medicare beneficiaries and lower costs for the Medicare program. CMS will use four different methods (or “models”) to bundle payments for services during an episode of care. This will encourage hospitals, physicians, post-acute facilities, and other providers to work together to improve health outcomes and lower costs. Providers participating in the initiative will provide CMS a discount from expected payments for each episode of care, and then the provider partners will work together to reduce readmissions, duplicative care, and complications, thus lowering costs through improvement.