Sept. 09 Marci's Medicare Answers

Dear Marci, Does Medicare cover pap smears and pelvic exams? -Dorothy Dear Dorothy, Pap smears can detect cervical or vaginal cancer in its early stages. Medicare covers 100 percent of the lab cost of one Pap smear every two years (24 months) for all women with Medicare. If you are considered at high risk for cervical or vaginal cancer (e.g. have had a sexually transmitted disease, your mother was given the drug diethylstilbestrol [DES] during pregnancy), or are of child-bearing age and have had an abnormal Pap smear in the past 36 months, Medicare covers the cost of one Pap smear a year (every 12 months). When you get your Pap smear, Medicare will cover the full cost of your Pap lab test, and 80 percent of the cost of the Pap test collection, a pelvic exam (used to help find fibroids or ovarian cancers) and a clinical breast exam (you are responsible for 20 percent of these costs). Medicare will cover all of these services with no Part B deductible required. (If you are in a Medicare private health plan-HMO or PPO-you may have a copay for some or all of these services. Call your plan to find out what you will have to pay.) -Marci Dear Marci, I heard that Medicare covers the cost of a routine physical just once. What exactly is included in this physical? -Ralph Dear Ralph, Medicare will pay 80 percent of the Medicare-approved amount of a one-time routine physical examination during the first 12 months after you enroll in Medicare Part B, regardless of your age. The Part B deductible does not apply to this benefit. The initial preventive physical exam, referred to as the "welcome-to-Medicare" exam, includes: An electrocardiogram (EKG) Measurement of height, weight and blood pressure Education, counseling and referral related to other preventive services covered by Medicare Ultrasound screening for abdominal aortic aneurysms (AAA) if you are at risk The "welcome to Medicare" physical exam benefit does not include payment for clinical laboratory tests. Medicare does not cover routine physical exams. You pay 100 percent for annual physical exams. Some Medicare private health plans (HMO, PPO, PFFS) may cover routine physicals. -Marci Dear Marci, I'm on Medicaid and am about to turn 65 in a few months. Will my drugs be covered by Medicaid or Medicare? -Sally Dear Sally, Once you have both Medicaid and Medicare, you must get your drugs covered by the Medicare prescription drug benefit (Part D). You will be automatically enrolled in a Medicare private drug plan if you do not choose one yourself. You will also automatically get "Extra Help," federal assistance that pays for most of the costs of Medicare drug coverage. You do not need to apply for this assistance. If you'd like to choose a Medicare private drug plan yourself, call 1-800-MEDICARE or visit www.medicare.gov and use the Medicare Drug Plan Finder tool. If you'd rather have Medicare choose a plan for you, wait for the letter from Medicare telling you which plan you have been enrolled in. And then call 1-800-MEDICARE or visit www.medicare.gov to make sure your assigned plan covers the drugs you need and that the pharmacies you use regularly are part of that plan's network. If not, ask the counselor to help you enroll in a different plan that meets your needs. People who have both Medicare and Medicaid are allowed to change Medicare private drug plans once a month. In most states, Medicaid will work with the Medicare drug benefit (Part D) and will step in and cover some drugs that are excluded from Medicare coverage by law. To see how Medicaid coordinates with Part D in your state go to: http://www.medicareinteractive.org/uploadedDocuments/mi_extra/medicaid_variables.html -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 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.