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Marci’s Medicare Answers

July 2013

Dear Marci,

Does Medicare cover hepatitis B shots?

—Igor

Dear Igor,

Yes. Medicare Part B covers the hepatitis B vaccine if you have a high or medium risk for hepatitis B. People who are considered to have a high or medium risk for hepatitis B may include:

  • Those with End-Stage Renal Disease (ESRD) or kidney failure
  • Hemophiliacs
  • Clients and staff at institutions for the developmentally disabled
  • Health care professionals who have frequent contact with blood or bodily fluids during work

Original Medicare, the traditional Medicare program offered directly through the federal government, covers 100 percent of its approved amount for the hepatitis B vaccine, even before you meet the Part B deductible. A deductible is the amount you must pay out-of-pocket before your insurance begins to cover your health care services. You will not have to pay anything for the hepatitis B vaccine if you see doctors or other health care providers who accept Medicare and take assignment. Doctors who accept Medicare and take assignment cannot charge you more than the Medicare approved amount. Call 800-MEDICARE or visit www.medicare.gov to locate doctors who accept Medicare and take assignment.

Medicare Advantage plans, also known as Medicare private health plans, may cover the hepatitis B vaccine; however, they may do so with different costs and rules. Contact your plan to see what costs and rules apply.

Keep in mind that Medicare Part D, the Medicare prescription drug benefit, covers the hepatitis B vaccine if you are at low risk for hepatitis B. Contact your Part D plan to see what costs and rules apply.

—Marci

Dear Marci,

My mother has difficulty leaving her home and needs skilled care. What types of home health care does Medicare cover?

—Gretchen

Dear Gretchen,

If your mother meets certain requirements, Medicare may cover the following home health services:

  • Skilled nursing services, such as tube feedings and wound care
  • Skilled therapy services, such as physical therapy and speech therapy
  • Home health aide services, such as help bathing or dressing
  • Medical social services ordered by a doctor to help with social and emotional concerns related to an illness
  • Medical supplies, such as wound dressings
  • Durable medical equipment

Medicare will only pay for the home health services listed above, if your mother is homebound (i.e. it is extremely difficult for her to leave her home and she requires help to do so) and has a need for skilled nursing care or skilled therapy services. Skilled care is when the care can only be provided by a licensed nurse or therapist.

Your mother must also have a face-to-face visit with a health care professional within 60 days before she gets home care or 30 days after she receives care. Her doctor must sign a home health certification confirming that she has had this visit and that she qualifies for home care because she is homebound and needs skilled care. Keep in mind that her doctor will need to approve her plan of care every 60 days.

Lastly, Medicare will cover home health care if your mother receives certified care from a Medicare-certified home health agency (HHA). Call 800-MEDICARE or visit www.medicare.gov to locate Medicare-certified home health agencies.

—Marci

Dear Marci,

I recently received a letter saying that I have Extra Help. I went to the pharmacy, and they told me they could not tell whether I had Extra Help or not. Is there any way I can pick up my medications at the pharmacy and pay Extra Help copays?

—Beza

Dear Beza,

If you have Extra Help, the federal assistance program that helps people with limited incomes pay for their Medicare drug costs, you will pay lower copays at the pharmacy for your medications. Your Extra Help status should be documented in the system.

However, in some instances, a person’s Extra Help status may be incorrectly documented in the system, and your pharmacist may not know that you have Extra Help. If you do have Extra Help, you can use what’s called “Best Available Evidence” to show your pharmacist that you have Extra Help. Examples of Best Available Evidence may include:

  • Your Medicaid card
  • Your Medicare Savings Program award letter
  • Your Extra Help award letter

If you present this information to your pharmacist, he/she should update the system to reflect that you have Extra Help. You should also be able to pick up your medications and pay Extra Help copays at the pharmacy.

—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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Last Modified: 09/19/2013 14:08:42
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