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Marci’s Medicare Answers

September 2013

Dear Marci,

I heard that due to the Affordable Care Act, Medicare covers preventive screenings at low or no cost to people with Medicare. Does Medicare cover obesity screenings and counseling?

—Carlos

Dear Carlos,

Yes, Medicare covers Body Mass Index (BMI) screenings and behavioral counseling for people who are obese and have Medicare. Medicare covers these screenings and counseling sessions if you receive them in your doctor’s office or in another primary care setting.

If your primary care doctor or other health care provider finds that you are obese (i.e. you have a BMI of 30 or more), then Medicare will cover behavioral counseling and therapy so you can lose weight through proper diet and exercise. Specifically, Medicare will cover doctor’s office visits every week for the first month of your behavioral therapy. During months two through six, Medicare will cover doctor’s office visits every other week.

At your six-month visit, you will be re-screened for obesity, meaning your doctor will measure how much weight you have lost since your initial screening. If you have lost at least 6.6 pounds during the first six months of therapy, Medicare will cover a monthly office visit for six more months. If you have not lost at least 6.6 pounds during the first six months of therapy, your therapy may end. Your doctor can re-screen you for another Medicare-covered obesity screening after another six months have gone by.

If you have Original Medicare, the traditional Medicare program administered directly through the federal government, it is best to receive the screening from a doctor who accepts Medicare and takes assignment. A doctor who takes assignment accepts the Medicare-approved amount for the service as full payment. If you have a Medicare Advantage plan, also known as a Medicare private health plan, it may be best to see an in-network provider. Contact your plan for more specific costs and rules.

—Marci

Dear Marci,

Are Medicare Advantage plan agents allowed to visit my house to get me to sign up for their particular plan?

—Khalid

Dear Khalid,

Plan agents can make a marketing appointment with you and talk to you about a particular Medicare Advantage plan. However, plan agents are not allowed to come to your home without an invitation.

If you do make a marketing appointment with a plan agent and allow the agent to enter your home, you must complete a scope of appointment. A scope of appointment form includes information you would like to discuss with the plan agent during the meeting. The plan can also call you and record your scope of appointment.

During the meeting, the agent is not allowed to discuss anything that is not on the scope of appointment form. If they do discuss something else with you at the appointment, they must fill out another scope of appointment form at that time. Plan agents are allowed to provide you with plan materials, tell you where you can find further information about the plan, and collect or give you enrollment forms.

Plan agents may not discuss anything outside of the scope of your appointment, market non-health related products to you, or ask you for referrals of other people who may be interested in the plan. In addition, plan agents are prohibited from taking an application for enrollment if you are not eligible to enroll into Medicare or make changes to your Medicare coverage during that time.

If a plan agent violates any of the mentioned rules, you can contact your State Department of Insurance and call 800-MEDICARE to file a complaint.

—Marci

Dear Marci,

I have a Medicare Advantage plan. Can I have both a Medicare Advantage plan and a Medigap?

—Oslo

Dear Oslo,

 No. If you have a Medicare Advantage plan, also known as a Medicare private health plan, you cannot sign up for a Medigap plan. You can only have a Medigap if you have Original Medicare, the traditional Medicare program administered directly through the federal government.

A Medigap plan is a health insurance plan that works with Original Medicare to cover some health care costs that Original Medicare does not cover. For more information on the different types of Medigap plans in your area, you can contact your local State Department of Insurance or State Health Insurance Assistance Program (SHIP).

—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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