What about hearing aids?

Every so often we get questions about hearing aids.  Does Medicare cover them?  If not, will my insurance cover them?  If not, can I buy stand-alone hearing insurance?  And not surprising either, since hearing aid costs can range up to $10,000 for a set.  So what’s the scoop?

First, Medicare does not cover hearing aids.  Medicare will cover hearing and balance tests when ordered to treat you for a medical condition, but not to determine a need for hearing aids.  Since Medicare Supplements are bound by law to only fill in the gaps within Medicare (and not provide extra coverage), they are unable to pay for hearing aids.  Some people choose to receive their Medicare benefits via a Medicare Advantage Plan rather than through Original Medicare hoping to receive extra benefits.  However, most Medicare Advantage Plans in Idaho do not include hearing benefits either, and those that do typically only cover one hearing exam per year, and offer no coverage for hearing aids. 

However, all hope is not lost!  There is the option to purchase a stand-alone hearing insurance coverage.  While these policies aren’t just falling off trees, we do have one option in Idaho.  It is a combination Dental-Hearing-Vision policy and offers up to $2,000 per year in benefits.  The best part about this coverage is that it allows you to see any dentists, optometrist, or audiologist you wish, unlike many plans that restrict you to a network of providers.  This can prove to be a huge advantage in that it allows you to shop all kinds of retailers, including large discount chains like Costco where prices can be half of those found at hearing aid specialty stores.  If you would like more information about this coverage, please call or email us anytime at:  800-817-9223 or info@tweedyinsurancegroup.com.

Medicare Covered Preventive Screenings

We get a lot of questions about what Medicare does and does not cover in the realm of preventive services.  So, we've decided to provide a list of the current services that Medicare covers.  Unless otherwise noted in the list, these services are covered 100% by Original Medicare (Part A & Part B).

• Abdominal Aortic Aneurysm Screenings: A one-time screening ultrasound for people at risk.
• Alcohol Misuse Counseling: Medicare covers one alcohol misuse screening per year. Counseling may be covered if your screening result is positive.
• Bone Mass Measurements: Helps to see if you are at risk for broken bones. This service is covered once every 24 months (more often if medically necessary) for people who have certain medical conditions or meet certain criteria.
• Cardiovascular Screenings: Helps detect conditions that may lead to a heart attack or stroke. This service is covered every 5 years to test your cholesterol, lipid, and triglyceride levels.
• Colon Cancer Screenings (Colorectal): Medicare covers colorectal screening tests to help find pre-cancerous polyps (growths in the colon) so they can be removed before they turn into cancer.
  • You pay 20% of the Medicare-approved amount for barium enemas.  The Part B deductible does not apply.  If done in a hospital facility, you will also have to pay the hospital copay.
• Depression Screenings: Medicare covers depression screenings by your primary care doctor once every 12 months.
• Diabetes Screenings: Diabetes screenings are covered if you have any of the following risk factors: high blood pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar (glucose). Based on the results of these tests, you may be eligible for up to two diabetes screenings every year. 
  • You pay 20% of the Medicare-approved amount after the yearly Part B deductible for any glucose monitors, test strips, and lancets.
  • Insulin and syringes are covered under Part D.
• Diabetes Self-Management Training: Your doctor or other health care provider must provide a written order. 
  • You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
• EKG Screenings: Medicare covers a one-time screening EKG if you get a referral for it as a result of your one-time "Welcome to Medicare" Preventive Visit.
• Flu Shots: Covered once a flu season in the fall or winter.
• Glaucoma Tests: Covered once every 12 months for people at high risk for glaucoma. 
  • You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
• Hepatitis B Shots: This is covered for people at high or medium risk for Hepatitis B. Your risk for Hepatitis B increases if you have hemophilia,End-Stage Renal Disease (ESRD), or a condition that increases your risk for infection. Other factors may increase your risk for Hepatitis B, so check with your doctor. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
• HIV Screenings: Medicare covers HIV screening for people with Medicare who are pregnant and people at increased risk for the infection, including anyone who asks for the test. 
  • You pay nothing for the tests, but you generally have to pay 20% of the Medicare-approved amount for the doctor visit.
• Mammograms: Medicare covers screening mammograms once every 12 months for all women with Medicare age 40 and older. Medicare covers one baseline mammogram for women between ages 35–39.
• Medical Nutrition Therapy Services: Medicare may cover medical nutrition therapy and certain related services if you have diabetes or kidney disease, or you have had a kidney transplant in the last 36 months, and your doctor refers you for the service.
• Obesity Screening and Counseling: If you have a body mass index of 30 or more, Medicare covers intensive counseling to help you lose weight. This counseling may be covered if you get it in a primary care setting, where it can be coordinated with your comprehensive prevention plan. Talk to your primary care physician or practitioner to find out more.
• Pap Tests and Pelvic Exams: Medicare covers these screening tests once every 24 months, or once every 12 months for women at high risk, and for women of child-bearing age who have had an exam that indicated cancer or other abnormalities in the past 3 years.
• Preventive Visits: Medicare will cover two types of preventive visits—one when you’re new to Medicare and one each year after that. 
  • You pay nothing for the yearly “wellness” visit if the doctor or other health care provider accepts assignment. If you get additional tests or services during the same visit that aren’t covered under these preventive benefits, you may have to pay coinsurance, and the Part B deductible may apply.
• Pneumococcal Shots: Most people only need this preventive shot once in their lifetime.
• Prostate Cancer Screenings: Medicare covers a digital rectal exam and Prostate Specific Antigen (PSA) test once every 12 months for all men with Medicare over age 50. 
  • Generally, you pay 20% of the Medicare-approved amount for the digital rectal exam after the yearly Part B deductible.
• Smoking Cessation (counseling to stop smoking): Medicare covers smoking cessation counseling as a preventive service and you'll pay nothing for the counseling sessions.

This information was provided by Medicare.  For more detailed information on these services, visit the Medicare Preventive Services page by clicking here.

Does Medicare cover bone mass measurements?

Bone mass measurements (sometimes called "bone density tests") are given to evaluate your bone’s health by assessing your bone quality, calculating your bone mass and detecting any bone loss. Bone mass measurements can help determine if you need medical treatment for osteoporosis, a condition that causes "brittle bones" in many older adults. Starting January 1, 2011, if you are in Original Medicare and meet certain criteria that put you at risk for osteoporosis, a bone mass measurement is covered as a preventive service. This means you will have no coinsurance or deductible if you see a doctor who takes assignment. Doctors who take assignment are doctors who cannot charge you more than the Medicare approved amount.

According to Medicare.gov, you have to meet one of the following criterions that put you at risk for osteoporosis for Medicare to cover the bone mass measurement test:

1. A woman whose doctor (or other health care professional) is treating her for estrogen-deficiency and is at risk for osteoporosis based on her medical history or other findings 
2. A person with vertebral (spinal) abnormalities as demonstrated by an x-ray 
3. A person getting (or expected to receive) steroid treatments for more than three months 
4. A person with hyperparathyroidism 
5. A person taking an osteoporosis drug  

This test is covered as a preventive service once every 24 months if you are at risk. Medicare will also cover follow-up measurements or more frequent screening if your doctor prescribes them and says that they are medically necessary. In this case, Medicare will cover the screenings but you will have to pay a 20 percent coinsurance.

*source: adapted from "Dear Marci." Medicare Rights Center Volume 10, Issue 11.  Online.  http://www.medicarerights.org/medicare-answers/dear-marci.php viewed on 5/31/2011.

The ABC's of Diabetes

Diabetes is a serious illness that affects almost every part of the body. Good diabetes management can relieve daily symptoms and even help prevent other health problems such as heart disease, stroke and nerve damage, along with vision and kidney problems.  Has your doctor diagnosed you with diabetes? Then ask your doctor about these three checks.

A1c: Diabetes is characterized by abnormally high blood glucose levels. An A1c test reveals your blood sugar levels over the past three months.  A score of 7 or less is typically an ideal level, but you’ll want to discuss your results with your doctor.  Your doctor can also tell you if you need regular A1c testing.

Blood Pressure: The goal for most people with diabetes is a blood pressure reading below 130 over 80.  Do you know yours?  It’s important to track your blood pressure closely because an increased number can lead to heart attack or stroke. Your doctor should check your blood pressure at every visit, or at least annually.

Cholesterol: Like high blood pressure, cholesterol build up can cause a heart attack or stroke. On average, your LDL, the bad cholesterol, should be less than 100.  Your HDL, the good cholesterol, should be more than 40.  Ask your doctor how often you should check your cholesterol levels.

* source: "The ABCs of Diabetes." Blue Cross of Idaho: One to One Spring 2011: 6. Print.

Social Activity Correlated with Reduced Disability

Being active can help prevent disability, a recent study from Rush University Medical Center in Chicago shows. The study found that participating in social activities can help keep disabilities at bay.

Researchers studied 954 adults participating in the Rush Memory and Aging Project, with an average age of 82 years old.

When the study began, none of the participants had any disabilities. Each year, the participants had a physical exam and filled out a questionnaire about their social lives. The questionnaire asked how often they went out for meals, traveled, and saw friends and relatives. They were also asked if they could perform certain activities of daily living on their own.

The results showed that people who took part in a lot of social activities were twice as likely as people who did not participate in as many social activities to avoid disabilities that impacted their activities of daily living. They were also one and a half times as likely to avoid disabilities that impacted mobility. “The findings are exciting because social activity is potentially a risk factor that can be modified to help older adults avoid the burdens of disability,” said Bryan James, the lead researcher on the study, in a news release.

Read the full story here.

The above summary of the survey was provided by the Medicare Rights Center