Medicare Information And Reminder June 6, 2014
Medicare covers many preventive services. As long as you meet basic eligibility standards, you have the right to receive these services no matter if you have Original Medicare or a Medicare Advantage plan (Medicare private health plan).
If you have Original Medicare you will have no coinsurance or deductible for certain preventive care services recommended by the U.S. Preventive Services Task Force if you see a doctor or other health care provider who accepts assignment. Doctors who accept assignment cannot charge you more than the Medicare approved amount.
Although the preventive services itself may be free, you may be charged additional fees for certain services related to preventive care.
– You may have costs for some of these preventive services if your doctor makes a diagnosis during the service or does additional tests or procedures. Doctors do diagnostic tests and procedures when patients have distinct symptoms of a condition or a history of that condition. For example, if your doctor finds and removes a polyp during a colonoscopy, the colonoscopy is diagnostic and costs will apply. Also, if during your annual wellness visit, your doctor needs to investigate or to treat a new or existing problem, costs may apply.
– You may have to pay a facility fee depending on where you receive the service. For example, certain hospitals will often charge separate facilities fees when you are receiving a preventive service.
– You may be charged for a doctor’s visit if you meet with a physician before or after the service.
If you are in a Medicare Advantage plan, your plan will not be able to charge you for preventive care services that are free for people with Original Medicare as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.
Original Medicare still requires its normal deductible and/or a 20 percent coinsurance for some preventive services. Some of these services are glaucoma screenings, diabetes self-management trainings, barium enemas (to detect colon cancer), and digital rectal exams (to detect prostate cancer).
Be sure to follow the Medicare guidelines for receiving these services in order to ensure that Medicare will cover them since some are covered only once every few years and others are only covered if you meet specific criteria.