March 08- Marci's Medicare Answers

Dear Marci, I just got a bill from my physical therapist that is much higher than usual. What's going on? Bernard Dear Bernard, If you receive your physical therapy as an outpatient, you may have reached Medicare's limit on outpatient therapy. In 2008, Medicare will cover up to $1,810 worth of outpatient physical and speech therapy combined, and another $1,810 for occupational therapy. The therapy limits only apply in certain outpatient facilities, such as therapists or physicians offices or at home (if you are not receiving them as part of Medicare's home health benefit). They do not apply if you are receiving outpatient therapy at a hospital's outpatient department. If you need more therapy, ask your provider. If she agrees, she should provide the service and bill Medicare, using a special code. Marci Dear Marci, My doctor says I need a colonoscopy to screen for colon cancer. Will Medicare cover the cost? Janice Dear Janice, If you are not at high risk for colorectal cancer, Medicare will cover 80 percent of the colonoscopy cost every 10 years. If you are at high risk (have had colorectal cancer or have a family history of it, or have had colorectal polyps or inflammatory bowel disease), Medicare will cover 80 ppercent of the cost every two years. If the procedure is done in an ambulatory surgical center or hospital outpatient department, Medicare will cover 75 percent of the cost. You do not have to meet the Part B deductible before Medicare will cover this service. There is no minimum age requirement for a Medicare-covered colonoscopy unlike other colon cancer screenings. Marci Dear Marci, I am having trouble paying for my Medicare out-of-pocket costs. Are there any programs that can help? Hugh Dear Hugh, If your monthly income is below $1,190 and your assets are below $4,000 (below $1,560 income/$6,000 assets for a couple), then you qualify for a Medicare Savings Program (MSP), a government program that will help you pay your Medicare premiums, deductibles and copays. In some states you can qualify for an MSP no matter how high your assets, and some states allow you a higher income. There are several kinds of MSPs, and each has different income eligibility limits and provides different levels of assistance. If you enroll in an MSP you will also automatically get Extra Help, a federal program that helps pay most of your Medicare prescription drug costs. If you think you might be eligible, go to your local Department of Social Services to apply. 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.