February 1998
DID YOU KNOW...
...that when you sign up with a
Medicare HMO, you are actually cancelling your coverage through Medicare. Most people that
I have discussed Medicare HMOs with were unaware that they were terminating their coverage
with Medicare. When you sign up with an HMO, the carrier you sign with (i.e., Humana,
BC/BS, etc.) becomes your primary insurance and Medicare is completely out of the picture
in providing you with medical coverage. Medicare now pays that insurance carrier a
predetermined amount per month to have you on their plan.
Another item to be aware of is the
ability to get back on Medicare if you are not satisfied with the HMO system.
Representatives of HMO carriers inform you that you can switch back to Medicare at any
time. This is true; however, the process may not be as hassle free as implied. Social
Security informs me that it can take 4-6 weeks for Medicare to update their files to show
you as a covered insured; thus you need to inform your doctors’ staff of your actions
so they understand why Medicare is telling them you do not have coverage. It is also
advisable to inform Social Security in writing that you wish to cancel your HMO coverage
and return to the traditional Medicare system.
The reason I am informing you of this is because all
the literature you receive in the mail trying to sign you up can be very confusing-only
when the fine print is read can one really understand the process.
Q
& A
Question
What are the changes in deductibles and co-pays for
Medicare in 1998?
Answer
For Medicare Part A the changes are
as follows:
Inpatient Hospital Deductible (a
stay of up to 60 days) changes from $760.00 to 764.00. Inpatient Hospital Co-Insurance
(days 61-90) changes from $190.00 per day to $191.00 per day. Skilled Nursing Facility
Co-Days (days 21-100) changes from $95.00 per day to $95.50 per day.
MEDICARE UPDATE
Changes in Medicare benefits:
Starting January 1, 1998
Medicare will provide coverage for
annual mammogram screenings for all Medicare eligible women age 40 and over and the Part B
deductible will not apply.
Medicare will provide coverage for
pap smears screenings every three years as well as pelvic exam screenings every three
years or yearly for women at high risk. The Part B deductible will not apply.
Medicare will cover colorectal
cancer screenings for individuals over age 50.
Starting July 1, 1998
Medicare will cover glucose
monitors and test strips for beneficiaries with diabetes regardless if they are insulin
dependent or not.
Medicare will also cover the cost
of diabetes education when provided by a certified provider and referred by their doctor.
Medicare will cover bone
mass tests for individuals at clinical risk of osteoporosis.
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