Dec. 08 Marci's Medicare Answers

Dear Marci, My spouse and I are starting the process of looking for a Medicare private drug plan for him. He is HIV-positive, and he is worried that he may not find a plan that covers his drugs. I have heard that all private drug plans must cover prescriptions for HIV/AIDS treatment. Is this true? Patrick Dear Patrick, Not entirely. Medicare private drug plans must cover "substantially all" antiretrovirals (HIV/AIDS treatment). However, this does not mean they necessarily cover every drug on the market. Plans are also not required to cover all medicines used to treat complications related to AIDS, such as AIDS wasting syndrome, so you should still check to see if the plan covers all his prescriptions and what restrictions, like prior authorization, the plan imposes on the drugs it does cover. If the plan does not cover a drug your partner needs, as long as it is not excluded from Medicare coverage by law, he can make a formal request to his plan to ask it to cover the drug (ask for an "exception"). Marci Dear Marci, I wash my hands often in hopes of staying healthy during flu season. This year I would also like to take the preventive step and get a flu shot. Does Medicare cover flu shots? Gloria Dear Gloria, Yes, Medicare covers 100 percent of the cost of a flu shot once every flu season with no Part B deductible required, if you go to a doctor or other health care provider who accepts assignment (takes the Medicare-approved amount for a service as payment in full). Medicare will pay for the shot no matter where you get it, as long as the health care provider agrees not to charge you more than what Medicare pays. (If you are in a Medicare private health plan such as an HMO or PPO you may have to get your flu shot from a provider in the plan's network. Call your plan if you have questions.) Marci Dear Marci, My husband and I are taking a holiday cruise around the Caribbean for our 50th anniversary. Will Medicare cover any costs if one of us needs medical care during our trip? Rachel Dear Rachel, Usually, Medicare does not cover medical care you get outside the country. However, in limited cases, Original Medicare will cover care you get on a cruise ship. Medicare will cover your care if: (1) the ship is registered to the U.S.; (2) the doctor is registered with the Coast Guard; and (3) you get the care while the ship is in U.S. territorial waters. This means the ship is in a U.S. port or within six hours of arrival at or departure from a U.S. port. Some supplemental insurance, such as Medigap plans C and J, provide some coverage for foreign travel. Marci 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, simply e-mail dearmarci@medicarerights.org. To learn more about the services that Medicare will cover and how to change plans, log on to Medicare Interactive Counselor at the Medicare Rights Center's website at www.medicareinteractive.org.