Marci's Medicare Answers

April 2010

Dear Marci,

I just had cataract surgery. Will Medicare cover it?

—Jack

Dear Jack,

Yes. Although Medicare will not generally pay for routine eye care, it will pay for some eye care services if you have a chronic eye condition, such as cataracts. Medicare will cover:

• Surgical procedures to help repair the function of the eye due to cataracts. For example, Medicare will cover surgery to remove the cataract and replace your eye’s lens with a synthetic intraocular lens.
• Eyeglasses or contacts, but only if you have had cataract surgery, during which an intraocular lens was placed into your eye. Medicare will cover a standard pair of untinted prescription eyeglasses or contacts if you need them after surgery. If it is medically necessary, Medicare may pay for customized eyeglass or contact lenses.
• An eye exam to diagnose potential vision problems. If you are having vision problems that indicate a serious eye condition, Medicare will pay for an exam to see what is wrong, even if it turns out there is nothing wrong with your sight.

—Marci

Dear Marci,

When will Medicare pay for hospice care?

—Wanda

Dear Wanda,

Medicare will help pay for your hospice care if:

• You have Part A;
• The hospice medical director (and your doctor, if you have one) certify that you have a terminal illness (your life expectancy is six months or less);
• You sign a statement electing to have Medicare pay for palliative care, such as pain management, rather than care to try to cure your condition;
• Your terminal condition is documented in your medical record;

and

• You receive care from a Medicare-certified hospice agency.

You do not need to be homebound to qualify for the Medicare hospice benefit. The benefit is a comprehensive set of services delivered by a team of providers. Many hospice services are provided in the home, but inpatient care is covered under specific circumstances.

—Marci

Dear Marci,

I have Extra Help, and I was told I can change drug plans at any time. Is that true?

—Oliver

Dear Oliver,

Yes. If you receive Extra Help, the federal program that helps pay for the Medicare drug benefit, you get a Special Enrollment Period (SEP) that allows you to join, disenroll from or switch Medicare drug plans once per month. The SEP begins the month that you become eligible for Extra Help, Medicaid or a Medicare Savings Program and continues as long as you have Extra Help.

To switch plans, you should enroll in your new plan without disenrolling from your old plan. It is best to enroll into your new plan by calling 800-MEDICARE, rather than the new plan. You will be automatically disenrolled from your previous Medicare private drug plan when your new coverage starts.

—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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