Marci's Medicare AnswersJune 2009
Dear Marci,
Does the Medicare drug benefit (Part D) cover drugs for erectile dysfunction?
—NoahDear Noah,
No. There are drugs excluded from Medicare Part D coverage by law. These include drugs for: erectile dysfunction, anorexia, weight loss or weight gain (except to treat physical wasting caused by AIDS, cancer or other diseases), fertility, cosmetic purposes or hair growth and relief of the symptoms of colds (like a cough and stuffy nose). Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations), non-prescription drugs (over-the-counter drugs) and certain anti-anxiety drugs (barbiturates and benzodiazepines) are also excluded from Medicare coverage.
—MarciDear Marci,
One of the Medicare-certified hospice agencies in town is not willing to take my mother as a patient, even though she has Medicare. Is this allowed?
—CallieDear Callie,
Medicare-certified hospice agencies are not required to take your mother as a patient simply because she qualifies for Medicare-covered hospice care. Agencies may select which patients they take, provided that they don’t violate discrimination laws. Whether your mother is in Original Medicare or a Medicare private health plan, you should call other agencies. If she is terminally ill and her doctor certifies that she has fewer than six months to live, another agency may take her as a hospice patient.
—MarciDear Marci,
Does Medicare pay for ambulance services?
—GenaDear Gena,
If it is an emergency Medicare will generally cover ambulance services, as long as:
An ambulance is the only safe way to transport you (medically necessary); and
You are transported to and from certain locations.
An emergency is when your health is in serious danger and every second counts to prevent your health from getting worse. If the trip is scheduled as a way to transport you from one location to another when your health is not in immediate danger, it is not considered an emergency.
If it is not an emergency, Medicare coverage of ambulance services is very limited. Medicare will generally only cover non-emergency ambulance transport if it is the only safe way to transport you. Transport by all other means, including ambulettes, must be unsafe given your condition. For example, Medicare may cover non-emergency ambulance services if you need vital medical services during your trip that are only available in an ambulance, such as administration of medications or monitoring of vital functions.
If covered, Medicare will pay for 80% of its approved amount for the ambulance service. You or your supplemental insurance policy will be responsible for the remaining 20%. All ambulance providers must accept Medicare assignment, meaning they must accept the Medicare-approved amount as payment in full.
—MarciMarci’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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