Marci explains what Medicare does, doesn't cover

Dear Marci, I am over 65 and have a family history of diabetes. Am I eligible for a diabetes screening? Paloma Dear Paloma, Yes. Medicare covers blood tests to screen people at risk for diabetes. You are considered at risk and eligible for one Medicare-covered diabetes screening every 12 months if you have hypertension, dyslipidemia, high cholesterol, a prior blood test showing low glucose tolerance or are obese (body mass index of 30 or more), or meet at least two of the following

• you are overweight (body mass index between 25 and 30);
• you have a family history of diabetes;
• you have a history of diabetes during pregnancy (gestational diabetes) or have had a baby over nine pounds;
• you are 65 years of age or older.The Medicare-covered diabetes screening test includes a fasting blood glucose test and/or a post-glucose challenge test. Medicare will pay for 100 percent of its approved amount for the test even before you have met the Part B deductible. If you have been diagnosed with pre-diabetes, Medicare will cover two diabetes screening tests per calendar year. Having pre-diabetes means you have blood glucose (sugar) levels that are higher than normal, but are not high enough to be classified as diabetes. Marci Dear Marci, Will Medicare cover the H1N1 flu vaccine? Eugene Dear Eugene, Yes. This year, in addition to the routine seasonal flu shot, people with Medicare are entitled to the H1N1 flu vaccine (also known as the swine flu vaccine). H1N1 vaccinations are subject to the same coverage rules and regulations as the seasonal flu vaccine. Like seasonal flu shots, Medicare covers 100 percent of the cost of the H1N1 flu shot once every flu season with no Part B deductible required, if you go to a doctor or other health care provider who accepts assignment. Medicare will pay for the shot no matter where you get it, as long as the health care provider agrees not to charge you more than Medicare pays. (If you are in a Medicare private health plan HMO or PPO you may have to get your flu shot from a provider in the plan's network and you may have a co-pay for this service. Call your plan to find out what you will have to pay.) The flu season usually runs from November through April. Therefore, Medicare may cover a flu shot twice in one calendar year. For example, if you get a shot in January 2010 for the 2009/2010 flu season, you could get another shot in October 2010 for the 2010/2011 flu season.Older adults are not among those most vulnerable to the H1N1 flu virus, unless they have underlying medical conditions. For more information, check the Centers for Disease Control and Prevention's web site: www.cdc.gov/h1n1flu/qa.htm. Marci Dear Marci, I was recently enrolled in Medicaid, and I am worried about paying for my prescription drugs. How will my Medicaid and Medicare drug coverage work together? Bernice Dear Bernice, If you have Medicare and Medicaid, in most cases you must get your drugs covered by the Medicare prescription drug benefit (Part D). When you become eligible for Medicaid, you will automatically get Extra Help, the federal program that pays for most of the costs of Medicare drug coverage. Medicare will automatically enroll you in a Medicare drug plan retroactive to the date you got Medicaid unless you choose a plan and enroll in it yourself or you have certain kinds of employer, retiree or union prescription drug coverage and do not actively enroll in a Part D plan. When you get the letter from Medicare telling you what plan you have been enrolled in, you should call 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. Make sure to ask whether Extra Help will cover the plan's full premium (the amount you pay each month for coverage). Not all plans' premiums are fully covered by Extra Help. If you have Medicaid, you have the right to change your Medicare private drug plan once a month if your current plan does not meet your needs. In most states, Medicaid wraps around the Medicare drug benefit (Part D) to cover some drugs that are excluded from Medicare coverage by law. For more information about how Medicaid wraps around Medicare prescription drug coverage in your state, and how much these prescriptions will cost, visit www.medicareinteractive.org and search for "Medicaid Coordination with Part D (By State)." 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 subscribe to "Dear Marci,"e-mail dearmarci@medicarerights.org or visit www.medicareinteractive.org.