Marci's Medicare Answers

January 2010

Dear Marci,

Does Medicare cover glaucoma testing?

—Mildred

Dear Mildred,

Medicare will not generally pay for routine eye care. However, if you are at high-risk for glaucoma, Medicare covers 80 percent of the cost of an annual (every 12 months) glaucoma screening, after you pay your annual Part B deductible ($155 in 2010). Those at high risk for the disease include people with diabetes or high blood pressure, people with a family history of glaucoma, African Americans age 50 and older, and Hispanic Americans age 65 and older. The screening must be performed or supervised by an eye doctor who is licensed to provide this service in your state.

—Marci

Dear Marci,

I recently turned 65, but I missed my window to enroll in Medicare. When will I get another chance to enroll?

—Muhammad

Dear Muhammad,

You can actively enroll in Medicare at anytime during the Initial Enrollment Period, which is the seven-month period including the three months before, the month of, and the three months following your 65th birthday.

If you missed the Initial Enrollment Period and have employer insurance from your or your spouse’s current job, you may be eligible for a Special Enrollment Period. With a Special Enrollment Period, you can enroll in Medicare without penalty at any time while you have group health coverage and for eight months after you lose your group health coverage or you (or your spouse) stop working, whichever comes first.

If you do not have insurance from a current job and missed the Initial Enrollment Period, you can apply for Medicare during the General Enrollment Period, between January 1 and March 31 of each year. Your coverage will not start until the following July, and you will have to pay a Part B premium penalty.

The penalty will be 10 percent of the Part B premium for each 12-month period you delay enrollment in Part B. In most cases you will have to pay that penalty every month for as long as you have Medicare. If you are enrolled in Medicare because of a disability and pay premium penalties, once you turn 65, you no longer have to pay the premium penalty.

—Marci

Dear Marci,

I’m having trouble paying for my Medicare, and I’ve heard that a Medicare Savings Program could help me out. What do these programs cover, and what are the eligibility requirements?

—Jan

Dear Jan,

Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs or Medicare Premium Payment Programs, help pay your Medicare costs if you have limited finances. There are three main programs, and each has different income eligibility limits. Not all states have all programs.

1. Qualified Medicare Beneficiary (QMB): Pays for Medicare Part A and B premiums, deductibles and coinsurances or co-pays. If you have QMB, you will have no coinsurance or copayment for Medicare-covered services you get from doctors who participate in Medicare or Medicaid or are in your Medicare private health plan’s network.
2. Specified Low-income Medicare Beneficiary (SLMB): Pays for Medicare's Part B premium.
3. Qualifying Individual (QI) Program: Pays for Medicare's Part B premium.

To qualify for an MSP, you must have Medicare Part A and meet income and assets guidelines. If you do not have Part A but meet QMB eligibility guidelines, your state will have a process to allow you to enroll in Part A and QMB. Many states allow this throughout the year, but others limit when you can enroll in Part A.

States use different rules to count your income (money you take in, for example, Social Security payments that you get or wages that your earn) and assets (resources such as checking accounts, stocks and some property) to determine if you are eligible for an MSP. Certain income or assets may not count. Some states do not have an asset limit. Because rules vary by state, if your income or assets seem to be above the MSP guidelines, you should still apply if you need the help.

If you enroll in a Medicare Savings Program, you will also automatically get Extra Help, the federal program that helps pay most of your Medicare prescription drug costs (Part D).

—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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