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Marci's Medicare Answers - March 2012 (online only)

March 2012

By Medicare Rights Center

I have cataracts, and I would like to set up an appointment with an eye doctor. When does Medicare cover eye care? —Lily

Dear Lily,

While Medicare will not generally pay for routine eye care, it will pay for some eye care services if you have a chronic eye condition, such as cataracts or glaucoma. In that case, Medicare will cover:

• Surgical procedures to help repair the function of the eye due to these conditions. For example, Medicare will cover surgery to remove the cataract and replace your eye’s lens with a synthetic intraocular lens.

• Eyeglasses or contacts only if you have had cataract surgery during which an intraocular lens was placed into your eye. Medicare will cover a standard pair of untinted prescription eyeglasses or contacts if you need them after surgery. If it is medically necessary, Medicare may pay for customized eyeglasses or contact lenses.

• An eye exam to diagnose potential eye disease. If you are having vision problems that indicate a serious eye condition, Medicare will pay for an exam to see what is wrong, even if it turns out that you don’t have an eye disease.

Medicare will cover yearly preventive eye exams at 80 percent (after the Part B deductible) only if you have diabetes or are at high risk for glaucoma. —Marci

Dear Marci,

My doctor told me I am eligible to get colon cancer screenings for free. Is this true? —Liam

Dear Liam,

Yes, your doctor is correct. Medicare covers most colon cancer screenings at 100 percent (except barium enemas, which are covered at 80 percent) for people with Medicare aged 50 and older if your provider takes assignment. The Part B deductible does not apply to any of the colon cancer screenings. Medicare will cover these tests:

• Fecal occult blood test - once a year (every 12 months) for people aged 50 and older.

• Flexible sigmoidoscopy - once every four years (48 months) for people at high risk, and less frequently for other people.

• Colonoscopy - once every two years (24 months) if you are at high risk for colorectal cancer (e.g. you have a family history of the disease or have had colorectal polyps or colorectal cancer, or have had inflammatory bowel disease). If you are not considered high-risk, Medicare covers colonoscopies every 10 years (but not within 48 months of a flexible sigmoidoscopy screening).

• Barium enema - once every two years for people at high risk and once every four years for others (but not within 48 months of a flexible sigmoidoscopy screening). —Marci

Dear Marci,

I missed my initial enrollment period, and I need to sign up for Medicare Part B right away. Is there a time of the year when anyone can enroll in Medicare Part B, even if they missed their initial enrollment period? —Lavender

Dear Lavender,

Yes, there is. If you do not enroll in Medicare or if you refused Medicare when you originally became eligible for it, you can sign up during the General Enrollment Period, or the GEP. The GEP takes place from January 1 to March 31 of every year. Your coverage will begin July 1 of the year you sign up. You will have to pay a Part B premium penalty for every year you delayed enrolling in Medicare Part B.

Under certain circumstances, you may also be eligible for a Special Enrollment Period (SEP) to sign up for Medicare Part B outside of the usual enrollment periods. If you have coverage from your or your spouse’s current employer, you can sign up for Part B while you still have current employer coverage and up to eight months after you lose your health coverage, or you or your spouse stops working, whichever comes first. You must enroll in Part B during your SEP, or you may have to pay a late enrollment penalty. —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.