What preventive screenings are available to Medicare patients and with what frequency?
The most common preventive/screening services covered by Medicare and a summary of the frequency and patient liability associated with these services can be downloaded here: Medicare Preventive Screening Frequency.
Information provided by Medicare
I manage my parent's business affairs and would like to have their statements and routine mailings from Medicare to be sent to my address. How can this be authorized?
You should contact the Social Security Administration at 800-772-1213. You have two options as to how to handle this based upon the ability of your parent to handle their affairs.
- If your parent is unable to manage their affairs, then you should contact the Social Security Administration and apply to be your parent's Representative Payee. This will put everything in your name for your parent.
- If your parent is not at the level that you need to be her representative, then you could have your parent change their address to your address. Again, this would need to be done by the Social Security Administration. In this situation, your parent must make the call. Social Security will not change the address based on your request alone. If you call, Social Security will ask that your parent get on the line and agree to the change or have them send in a statement that it is alright to change their address to yours.
How do I sign up for Medicare?
IF YOU ALREADY RECEIVE BENEFITS FROM SOCIAL SECURITY:
If you already get benefits from Social Security or the Railroad Retirement Board, you are automatically entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) starting the first day of the month you turn age 65. You will not need to do anything to enroll. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If your 65th birthday is February 20, 2004, your Medicare effective date would be February 1, 2004. (Note: if your birthday is on the 1st day of any month, Medicare Part A and Part B will be effective the 1st day of the prior month. For example, if your 65th birthday is February 1, 2004, your Medicare effective date would be January 1, 2004.)
IF YOU ARE NOT GETTING SOCIAL SECURITY BENEFITS:
If you are not getting Social Security benefits, you can apply for retirement benefits and Medicare online. If you would like to file for Medicare only, you can apply by calling 800-772-1213.
IF YOU ARE UNDER AGE 65 AND DISABLED:
If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You will not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date. (Note: If you are under age 65 and have Lou Gehrig's disease (ALS), you get your Medicare benefits the first month you get disability benefits from Social Security or the Railroad Retirement Board.) For more information about enrollment, call the Social Security Administration at 800-772-1213 or visit their website at www.socialsecurity.gov.
Should I sign up for Medicare Part A and B if I am still working?
Even if you keep working after you turn 65, you should sign up for Medicare Part A. If you have health coverage through your employer or union, Part A may still help pay some of the costs not covered by your group health plan. Call the Social Security Administration at 800-772-1213 to sign up. However, you may want to wait to sign up for Medicare Part B if you or your spouse are working and have group health coverage through you or your spouse's employer or union. (See note below if you work for a small company.) You would have to pay the monthly Medicare Part B premium, and the Medicare Part B benefits may be of limited value to you as long as the group health plan is the primary payer of your medical bills.
Note: If you are age 65 or older and working for a small company (fewer than 20 employees), you should talk to your employee health benefits administrator before making any decision not to take Medicare Part B. If your employer has less than 20 employees, Medicare is the primary payer and your group health insurance would be the secondary payer.
Why am I being billed for drugs I received while I was in the hospital for an outpatient procedure?
Medicare Part B (medical insurance) only covers certain drugs in the outpatient setting. Drugs given by infusion or injection would be examples of covered drugs. Medicare regulations have determined that self administered drugs, or drugs that the patient is able to administer to themselves are not covered by Medicare Part B and the hospital must bill the patient for those charges. Some Part D Plans will reimburse the patient for self administered charges. Please contact your Part D Drug plan for information about how to submit a claim. You may contact the PFS Call Center at 217-788-3162 for an itemized list of any self administered drugs that may appear on your outpatient bill.
What cancer screening does Medicare currently cover?
Medicare covers many health screenings and most have frequency limitations, however, high risk patients may be covered for more frequent testing than those patients with a lower risk. For a complete listing, please refer to Medicare’s website at www.medicare.gov.
Some of the covered preventive services include:
Mammograms – Women age 40 and older covered by Medicare can get a screening mammogram every 12 months.
Colorectal Cancer Screening – All people with Medicare who are aged 50 and older are covered for colorectal screenings:
- Fecal Occult blood tests – Once every 12 months.
- Flexible Sigmoidoscopy – Once every 48 months.
- Screening Colonoscopy – Once every 120 months (or every 24 months for those at high risk).
- Barium Enema – Once every 48 months.
Prostate Cancer Screening – All Men with Medicare who are age 50 and older are covered for a Digital Rectal exam once every 12 months. PSA tests - Covered once every 12 months.
Cardiovascular screening – (Lab tests for cholesterol, lipid and triglyceride levels) – Once every five years
Cervical and Vaginal Cancer Screening – Women with Medicare are covered for these screening tests once every 24 months. Women in high risk categories may be covered once every 12 months.
Bone Mass Measurements: All people with Medicare whose doctors believe they may be at risk for osteoporosis are covered once every 24 months.
I have more than one insurer; how do I know which one pays first?
If any of the following situations apply to you, your other insurance may be primary to Medicare, meaning the other insurance pays first:
- You have Medicare; are still working; and are covered by your employer’s health insurance plan
- You have Medicare, are retired, but your spouse is working and has a health plan that also covers you; or
- You are injured on the job, in an automobile accident, or slip and fall at a shopping center (worker’s compensation, auto insurance or liability insurance may cover the cost of medical care related to the accident).
You can contact the Coordination of Benefits Contractor at 800-999-1118 for questions about, or to report changes in, your primary insurance. Medicare has a dedicated "Coordination of Benefits Contractor" that keeps track of when Medicare is primary or when another insurer is primary.
If you have other insurance and it pays after Medicare, it is called your supplemental insurance. Supplemental insurance often covers the deductible and/or co-payments required by Medicare. Examples include:
- Retiree insurance from your former employer or union;
- Medigap insurance;
- Tricare for Life (for military retirees); and
If you change your supplemental insurance, or are experiencing problems with supplemental insurance payments, you need to call your old and new supplemental insurance companies. If you have questions about how your supplemental insurance works with Medicare, contact the supplemental insurer.
Why am I being asked to sign an Advanced Beneficiary Notice?
An Advanced Beneficiary Notice (ABN) is a form designed by Medicare, presented to you before receiving certain services notifying you that:
- Medicare may deny the procedure or service
- You will be responsible for the full payment if Medicare denies payment.
You have the option to receive or refuse the services.
If you sign the ABN and choose to have the services, you will be responsible for the charges. An estimate of the cost of the service will be printed on the ABN.
- If you chose to have the services but refuse to sign the ABN, two witnesses will sign the ABN form and you will most likely be held responsible for those charges.
- If you chose to not sign and refuse services, you would want to notify your physician of your decision.
More information about the ABN and your Medicare coverage, please contact Medicare at 800-633-4227 or www.medicare.gov.
Do you Accept my Medicare Advantage Plan?
Memorial Medical Center does accept patients enrolled in Medicare Advantage Plans, and proudly participates in network agreements with the following Medicare Advantage plans:
- Health Alliance Medicare Advantage Plan
- Humana Medicare Advantage Plan
- Universal American/Pyramid Life/Today’s Options Medicare Advantage
It is important to communicate with your Medicare Advantage Plan to determine your out of pocket responsibilities. If your Medicare Advantage Plan is not listed above, you may be considered “out of network” and would perhaps have a greater financial responsibility for the services provided by the hospital and other healthcare professionals at Memorial. Questions regarding your benefits and coverage should be directed to your Managed Care health plan.
Where can I go for the most up-to-date information about changes in Medicare?
For up-to-date information and answers to your questions, call 800-MEDICARE 800-633-4227, or visit
Click here to download a PDF with Medicare-related phone numbers.