Dialysis can be a very important treatment for many people with a medical condition and this is why Medicare takes special steps to assist you with the treatment.  With the Medicare coverage that you have it is possible that much of the dialysis treatment you need will be covered by your policy.  This doesn’t mean that you won’t pay anything, but it could save you a lot of money.

Inpatient dialysis treatments: Medicare Part A covers dialysis if you’re admitted to the hospital for special care.  This means that you need to be in the hospital and there is no other option for you to get treatment and make yourself better.

Outpatient maintenance dialysis treatments: Medicare Part B covers a bundle of dialysis services if you get routine maintenance dialysis from a Medicare-certified dialysis facility. For example, Medicare Part B covers ESRD related laboratory tests, and medications (like erythropoiesis stimulating agents), but excludes ESRD-related medications with only an oral form of administration (like capsules, tablets, or liquids), which are covered only under Part D.

In 2011, your obligation is to pay 20% of the Medicare-approved amount.

Avoiding cancer is hard sometimes when you are at high risk due to family history and this makes it hard on your bank account.  Screenings and testing in trips to the doctor’s office aren’t cheap, but they can become cheaper thanks to your Medicare coverage.  Medicare covers this test once every 24 months if you’re at high risk for colorectal cancer.

You can still get some coverage when you are not at high risk, but the appointments and treatments are not as frequent as when you are at risk.  If you aren’t at high risk for colorectal cancer, Medicare covers the test once every 120 months, or 48 months after a screening flexible sigmoidoscopy.

Starting January 1, 2011, you pay $0 for this test. There is no coinsurance, copayment, or deductible if the doctor accepts assignment.  If a screening test results in the biopsy or removal of a lesion or growth, the procedure is considered diagnostic, and you may have to pay coinsurance or a copayment; however, the Part B deductible doesn’t apply.

Barium Enema: When this test is used instead of a flexible sigmoidoscopy or colonoscopy, Medicare covers the test once every 48 months for people age 50 or over and once every 24 months for people at high risk for colorectal cancer.  This is great news for being able to avoid a terrible onset of cancer.

In 2011, you pay 20% of the Medicare-approved amount for the doctor’s services. In a hospital outpatient setting, you pay a copayment. The Part B deductible doesn’t apply. So you do get the great option of being covered through Medicare, but you will be expected to make a payment.

To appeal a decision made by Medicare there is a 5 level appeals process that is available to you and all Medicare members.  If you feel that some procedure you have had was medically necessary then you will start the appeals process.  Medicare defines it as follows:

“You can ask for a redetermination (first appeal level) from the contractor that handles Medicare claims and a reconsideration (second appeal level) from a Qualified Independent Contractor (QIC). If you disagree with the QIC’s decision you can appeal to an Administrative Law Judge (ALJ). If you disagree with the ALJ’s decision you can appeal to the Medicare Appeals Council (MAC). If you disagree with the MAC’s decision you can file an appeal in U.S. district court.”

You can get tested when the answer is yes to the following questions if you are covered by Medicare.

Have you passed the age of 64?

Do you currently qualify as overweight?

Is there history in your family with diabetes?

Did you have gestational diabetes?  Or was your baby over 9 pounds at birth?

If you said yes to these tests then you could get two diabetes screenings done each year. The only thing that you will be responsible for is 20% of the Medicare approved amount for the doctors visit, nothing for the test. To be able to live a little more comfortable after the test is a great benefit in the face of the small price you had to pay to get the test.

Start Date/End Date – The provider is going to be reimbursed for these important dates. Your job is to ensure that the dates are right before they are submitted to Medicare for payment.

Claim Number – Referencing the right claim is very important and you probably won’t be able to do this without the claim number.

Date/Type of Admission – You still want to ensure that your provider is not charging for more than one session as you could miss out on treatments if they don’t.

Benefit Days Used – Your benefit days can be crucial as much of what you do will be restricted by benefits days in a given period.

Total Amount Charged/Total Non-Covered Charges – You will not have to pay the total amount charged by Medicare as you will be covered. The non-charged amount that is left is your responsibility.

Total Amount You May Be Billed – Co-insurance and deductibles that Medicare does not cover will be listed here.

Here are a few things you can do with MyMedicare.gov:

1. Access your personalized information at any time. As your Medicare claims are processed you will be given access to Medicare-specifics that you may need. Your overall experience with Medicare will then change forever.

2. With MyMedicare.gov you will have access to your preventive service information as well as your entitlement and eligibility. This will give you access to the information that medical offices will want to know and you don’t remember.

3. Your prescription drug enrollment information and your Part B deductible information along with your prescription drug list will be available. An accurate assessment of your medical needs can then be made if you go do the doctor for a medical assessment.

Knowing how this benefit period will affect your return home is of essential knowledge to people that are on Medicare right now. If you have been out of a hospital or facility for 60 days in a row your Medicare benefit period will come to an end, this is what you need to know. Another Medicare benefit period will begin when this 60 days comes to an end and you are admitted to a facility again.

For each benefit period that you have to use there is a separate deductible and this is important for you to know. The number of benefit periods that you have is not limited, but you may want to keep track of when one period ends and another begins. Separating the two benefit periods can be costly so it is a good idea to keep track of the days since you were last released from the hospital.

The coverage with Medicare includes up to 8 face-to-face visits in a 12-month period if you are diagnosed with an illness caused or complicated by tobacco use, or you take a medicine that is affected by tobacco.  In order to see if you would truly qualify it may help to discuss the situation with your doctor.  Advise him or her that you are trying to get over this addiction and need to see if you will qualify for help.

You pay 20% of the Medicare-approved amount, and the Part B deductible applies when it comes to the financial side of handling the health situation.  When you think about the cost in reference to the health benefits of stopping smoking there is really no other way for you to go.  There is no dollar amount you can put on your health, especially when you know how much a service could benefit you.

This referral can only come from your “Welcome to Medicare” physical exam if it is to be covered by the policy and it is one time only.  Of the amount that is charged for the EKG exam by the medical facility, you will pay a total of 20% of the Medicare-approved amount.  This means that you will still have a little bit of a bill to pay but much of the total will be covered. 

Even though this is only covered once by Medicare it is still a very important screening that can diagnose something severe down the road.  You need to get the screening if it is offered to you as it may be your only chance to get it and have it covered.  Discuss it with your physician if you are about to be on Medicare and want to have this procedure covered.