Oct 08 Marci's Medicare Answers

Dear Marci, I went in for my annual mammogram last month, but my doctor wants me to come in for another one because he saw an abnormality. Do I have to pay out of pocket for the second mammogram? Sally Dear Sally, No. Your second mammogram is what is known as a diagnostic mammogram, and Medicare covers as many diagnostic mammograms as necessary. In addition to diagnostic mammograms, Medicare covers 80 percent of the cost of one screening mammogram (what you had last month) every 12 months for women who are 40 or older. Medicare will also pay for one baseline mammogram for women 35 to 39 years of age. Screening and baseline mammograms will be covered with no Part B deductible required. Marci Dear Marci, I have been homebound and receiving physical therapy at home for several months. I am now well enough to leave my house and get out and about on a regular basis. My doctor wants me to continue physical therapy at his office. Will Medicare pay? Arnold Dear Arnold, Yes, Medicare will pay as long as your doctor submits a new plan of treatment stating that you now need to get therapy at his office. In 2008, if you get therapy at a doctor's office or at home, Medicare will cover up to $1,810 for physical and speech therapy combined, and another $1,810 for occupational therapy. Exceptions to the limits are allowed if more therapy is medically necessary. No matter where you receive your therapy, your doctor must periodically review your plan of treatment and state whether your needs have changed. Marci Dear Marci, My mother has cancer. We know that Medicare will not cover the costs of an aide to clean her house and cook her meals. But now that my mother is in declining health, and needs a nurse to visit her at home, will Medicare pay for that? - Terry Dear Terry, If your mother qualifies for the home health benefit, Medicare will pay in full for skilled nursing, which includes services and care that can only be performed safely and effectively by a licensed nurse. Such services may include medication administration, tube feedings and regular observation and assessment of your mother's condition. Your mother qualifies for the home health benefit if (1) her doctor certifies that she is homebound (it takes considerable and taxing effort for her to leave home); and (2) she needs skilled physical, speech or occupational therapy services, or skilled nursing on an intermittent (less than seven days a week) or part-time (less than eight hours a day) basis. If she required only skilled nursing, she must either need it fewer than seven days a week (even as little as once every 60 to 90 days) or daily (seven days a week) for a short period of time (usually two to three weeks); and (3) her doctor certifies her need for home care; and (4) she receives her care from a Medicare-certified home health agency (HHA). If your mother's condition were to be diagnosed as terminal and she elected palliative care, Medicare would continue to cover skilled nursing for her as part of Medicare's hospice benefit. 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 Medicare works with Medicaid, log on to Medicare Interactive Counselor at the Medicare Rights Center's website at www.medicareinteractive.org