May 08: Marci's Medicare Answers

Dear Marci, I have been more forgetful than usual these past few months, and would like to go see my doctor. Does Medicare cover screenings for dementia or Alzheimer's disease? Eliot Dear Eliot, Yes, Medicare will cover medically necessary visits to the doctor and laboratory tests needed to diagnose any suspected disease or condition, including dementia or Alzheimer's disease. Methods to diagnose these conditions include a consultation with a primary care physician and/or with a neurologist or other specialist, a mental status evaluation, a physical examination, a brain scan and a psychiatric evaluation. Medicare will cover 80 percent for your initial mental health visit, 80 percent for medication management and 50 percent for ongoing mental health treatment like psychotherapy. If a full diagnostic evaluation fails to clearly show whether your symptoms are the result of Alzheimer's disease or frontal-temporal lobe dementia, Medicare will pay for a PET scan to clarify the diagnosis. Marci Dear Marci, My family has a history of osteoporosis, and I had a bone density test last year. My doctor says I need to have another bone density test soon. Will Medicare pay for it? Yvonne Dear Yvonne, If your doctor believes you are at risk for osteoporosis and orders the test, Medicare will cover 80 percent of the cost of one bone density test (also known as bone mass measurement) every two years (24 months), after you pay your annual Part B deductible. Medicare will also cover follow-up measurements or more frequent screenings if your doctor prescribes them. Those at high risk for osteoporosis include people who have a family history of the disease, spinal abnormalities, particular conditions (such as thyroid disorders) or have taken certain medications for a prolonged period of time (such as a steroidal anti-inflammatory drugs). Marci Dear Marci, I just heard that some states have programs to help people with drug costs. How do these work? Tim Dear Tim, Most states offer a state pharmaceutical assistance program (SPAP) for their residents. Each state can design their program differently, but many states coordinate their drug assistance programs with Medicare's drug benefit (Part D) and require members to join a Medicare private drug plan. Call your State Health Insurance Assistance Program (SHIP) office to find out if your state has an SPAP and how it works with the Medicare drug benefit. You can get the number for your SHIP by calling 800-MEDICARE. If your state's SPAP works with Part D, it may help pay for a drug plan in a number of ways. You may get assistance paying for your monthly premium and copays. You may get help paying for your deductible (the amount you pay out of pocket before your drug coverage begins). In most cases, what the SPAP helps pay for your prescriptions will count toward reaching your "catastrophic coverage limit", the amount you must pay out of pocket in your plan before your costs go down substantially. The out-of-pocket limit in all Part D plans in 2008 is $4,050. You should always check with the SPAP directly to see if and how it will work with Part D. Marci>/i> 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 screenings for dementia and Alzheimer's disease, bone density tests and State Pharmaceutical Assistance Programs, log on to Medicare Interactive Counselor at the Medicare Rights Center's website at www.medicarerights.org/help.html.