Marci's Medicare Answers
I heard Medicare covers preventive services. Does Medicare cover glaucoma screenings?
Yes, Medicare covers glaucoma screenings if you are at high-risk for glaucoma. Glaucoma is a group of eye diseases in which damage to the optic nerve results in loss of eyesight.
If you are at high-risk for glaucoma, Original Medicare covers 80 percent of an annual (every 12 months) glaucoma screening, after you’ve met your annual Part B deductible (the amount you must pay out-of-pocket before your health insurance begins to cover your services). Keep in mind that in order for the screening to be covered, the screening must be performed or supervised by an eye doctor who is licensed to provide this service in your state.
People are considered at high risk for glaucoma if they:
- Have a family history of glaucoma
- Have diabetes
- Are African American and age 50 or older
- Are Hispanic and age 65 or older
If you have a Medicare private health plan, also known as a Medicare Advantage plan, you should contact your plan to see what rules and costs apply.
I heard that certain medications that were excluded from Medicare coverage in the past will soon be covered under Medicare Part D in 2013. Is this true?
That’s a great question. Benzodiazepines and barbiturates, medications that were formerly excluded from Medicare coverage, will now be covered under Medicare Part D prescription drug plans beginning January 1, 2013.
Keep in mind that benzodiazepines are covered as a treatment for all medically necessary conditions. However, barbiturates will only be covered in 2013 to treat epilepsy, certain cancers and chronic mental health conditions. Check to make sure the barbiturate or benzodiazepine you take is covered on your drug plan’s formulary.
If your Medicare Advantage or Part D plan does not cover your drug, your plan should provide you with a 30-day transition fill at some time during the first 90 days of the year. A transition fill is a one-time, 30-day supply of a Medicare-covered drug that Medicare prescription drug plans must cover, when you’re in a new plan or when your existing plan changes its coverage. You should also talk to your doctor about switching your drug to one that is covered by your plan or ask for help in sending a formal request to your plan to cover the drug. If you have questions about whether your Medicare Advantage or Part D plan covers those medications and if there are any rules you must follow in order to get the medications, you should contact the plan directly.
I need help paying for my prescription drugs. I do not qualify for Extra Help. Are there any programs that can help me?
If you don’t qualify for Extra Help, the federal assistance program that helps people with Medicare pay their prescription drug costs, you may still qualify for other prescription drug assistance programs.
Some states have State Pharmaceutical Assistance Programs (SPAPs) to help residents pay for their prescription drugs. While most state assistance programs work with Part D plans, not all do. Each program works differently and has different eligibility requirements. To find out if there is an SPAP in your state or if you may qualify, contact your State Health Insurance Assistance Program (SHIP).
You may also want to take a look at Patient Assistance Programs (PAPs), which are pharmaceutical programs that offer low-cost or free prescription drugs to people with low incomes. While many PAPs do not accept people with Part D, some do. Go online and visit www.needymeds.org or www.rxassist.org to learn more about these programs.
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Marci's Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nationís 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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