Oct. 2009:Marci's Medicare Answers

Dear Marci, I have struggled my whole life with dental problems, and now I need dentures. Does Medicare cover dental care? Joyce Dear Joyce, Unfortunately, Medicare will never pay for dentures. Medicare also does not cover dental care that you need primarily for the health of your teeth. For example, Medicare will not cover routine checkups, cleanings or pay for you to get fillings. However, Medicare will cover some dental services if they are required to protect your general health, or if you need dental care for another Medicare-covered health service to be successful. Medicare will also pay for some dental-related hospitalizations. Some Medicare private health plans offer routine dental coverage as part of their benefits package. If you are in a private health plan (such as an HMO or PPO), call your plan to find out what dental services, if any, it covers. If you are considering joining a Medicare private health plan, make sure it covers the doctors and hospitals you prefer to use and the medications you take at a cost you can afford. Marci Dear Marci, What does the term "benefit period" mean in Part A of Original Medicare? LaVonne Dear LaVonne, A benefit period (sometimes called a "spell of illness") is the way that Original Medicare measures your use of inpatient services in a hospital. A benefit period begins the day you enter a hospital and ends after you have been out of the hospital for at least 60 days in a row. You pay different amounts depending on where you are in the benefit period. In a hospital benefit period, you pay a deductible and then Original Medicare will cover you in full for days one to 60 of your hospital stay. You pay daily coinsurance for days 61-90. Once you have used up your 90 days of hospital coverage in a benefit period, Medicare pays for up to 60 additional hospital days in your lifetime with a high daily coinsurance. If you go into the hospital and are discharged and out for less than 60 days and then readmitted, you are still in the same benefit period. For example, if you go into the hospital on May 1st and go home on May 15th (14 days in the hospital), but you need to go back into the hospital on June 30th (after 46 days out of the hospital), you are still in the same benefit period. You do not have to pay another hospital deductible and, since you will be on day 15 of your hospital benefit, you will not have to pay any coinsurance. If you had been out of the hospital for more than 60 days, a new benefit period would begin, and you would have to pay the hospital deductible for a new admission. There is no limit to the number of benefit periods you can have. - Marci Dear Marci, I am over 65 and living on a fixed income. A friend told me I can receive discounted care at a "federally qualified health center." What is that? Raymond Dear Raymond, There are hundreds of government-funded health centers around the country that provide medical care and charge based on your income. Some of these are referred to as Federally Qualified Health Centers (FQHCs), which are located in areas defined as "medically underserved areas." People with Medicare are eligible to receive services from these centers. FQHCs provide some Medicare-covered services (they may waive the annual Part B deductible) and some preventive services that Medicare does not cover. Some health centers may also provide dental services. These clinics may also waive or reduce the 20 percent coinsurance for Medicare-covered benefits based on a sliding fee scale. People with an annual income of up to 200 percent of the federal poverty level ($21,672 for an individual, $29,160 for a couple in 2009) qualify for some discount. To find the FQHC nearest you, visit the Health Resources and Services Administration's (HRSA) website at http://findahealthcenter.hrsa.gov/ or call 888-ASK-HRSA. Marci Marci's Medicare Answers is a service of the Medicare Rights Center the nation's largest independent source of information and assistance for people with Medicare. To speak with a counselor, call (800) 333-4114. To subscribe to "Dear Marci," the Medicare Rights Center'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.