Marci's Medicare Answers

January 2009

Dear Marci,

I became eligible for Medicare this past summer and am going to my eye doctor for my annual checkup soon. Does Medicare cover glaucoma screenings?

—Gareth

Dear Gareth,

Medicare will not generally pay for routine eye care, but if you are at high risk for glaucoma, Medicare will cover 80 percent of the cost of an annual (once every 12 months) glaucoma screening after you pay your annual Part B deductible. The screening must be performed or supervised by a state-licensed eye doctor. You are considered at high risk for the disease if you have diabetes or high blood pressure, have a family history of glaucoma, are African American and 50 or older, or are Hispanic American and 65 or older.

—Marci

Dear Marci,

I didn’t apply for Medicare when I turned 65 even though I did not have health coverage from my job or my husband’s. I am now 68. I know that there is a penalty for enrolling late. Is there any way I can avoid this?

—Kath

Dear Kath,

It is possible if you have low income. If you apply for and are accepted into one of the Medicare Savings Programs (MSP) that help pay for Medicare, you will not have to pay the Part B premium penalty. The Medicare Savings Programs (QMB, SLMB or QI-1), also known as Medicare Buy-In programs, will pay your full Part B premium—including the penalty—for you.

You can apply for an MSP at any time through your local Medicaid office. Your Medicare coverage will begin when your MSP takes effect.

—Marci

Dear Marci,

I have had Medicare for a few years and was going to sign up for a Medicare Part D drug plan but I missed the enrollment period that ended in December. Is it too late to sign up for a plan now?

—Mabel

Dear Mabel,

After you first qualify for Medicare, most people can only sign up for the Medicare drug benefit during the Annual Coordinated Election Period that runs between November 15 and December 31 every year. But in some cases you may qualify for a Special Enrollment Period (SEP). For example, you may qualify for an SEP if you have certain other kinds of drug coverage (such as benefits from a current or former employer, or a state pharmaceutical assistance program). However, if you are joining Part D after you were first eligible for the benefit, and have not had coverage as least as good as Part D (“creditable coverage”), you may pay a penalty when you join. If you have low income, and apply for and are approved for Extra Help, a federal program for people with low incomes and few assets, you can enroll in a Medicare private drug plan outside of standard enrollment periods. Your drug coverage will begin the month you became eligible for the assistance. Extra Help helps pay for some or most of the costs of Medicare drug coverage. You can apply for Extra Help through the Social Security Administration, using either the agency’s print or online application (available at www.ssa.gov). Even if you are enrolling in Part D after you were first eligible for the benefit, if you get Extra Help, you will not have to pay a late-enrollment penalty, as long as you enroll in a Medicare private drug plan.

For more information on other SEPs please go to: http://www.medicareinteractive.org/uploadedDocuments/sep_chart.pdf

—Marci

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Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to “Dear Marci,” MRC’s free educational e-newsletter, click here.

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