NEWS RELEASE
Pearl W. Stanley
Extension Agent
Family and Consumer Sciences, CFCS
Bolivia, NC 28422
April 2003
Medicare, like most health insurance policies, was not designed to cover 100 percent of all medical expenses. It began as a catastrophic health insurance plan for persons age 65 and older and later developed as a health insurance to include Social Security disability recipients, end stage renal disease (or permanent kidney failure) and ALS or Lou Gehrig’s Disease patients. While Medicare does cover most inpatient and outpatient services under Part A (hospital insurance) and Part B (medical insurance), most routine dental, vision and hearing services are not covered.
For dental services, Medicare Part A may cover some dental care received while a patient is in the hospital. For example, Medicare will cover surgery related to the jaw, setting fractures of the jaw or facial bone or removing tumors. Medicare does not cover most routine dental care or procedures such as cleanings, fillings, or tooth extraction.
For vision services, Medicare will pay for one pair of glasses (lens and standard frames) or contact lenses after each cataract surgery with the implant of an intraocular lens. This benefit is covered at 80 percent after satisfying the yearly Part B deductible, which is currently $100. If someone chooses deluxe lenses or frames, they will be responsible for any costs above Medicare’s approved amount for the standard lens and frames.
Medicare also covers glaucoma screening once every 12 months for those at risk for glaucoma. Those considered to be at risk include African-Americans who are age 50 and older, people with diabetes or a family history of glaucoma. The benefit is 80 percent of what Medicare approves after the $100 annual Part B deductible has been satisfied.
Medicare does not cover routine eye exams; however, it will pay 80 percent for non-routine eye exams after the annual $100 Part B deductible has been met. Medicare Part B may also pay for certain procedures for persons with macular degeneration.
For hearing services, Medicare does not cover routine hearing exams or hearing aids but may cover some diagnostic hearing exams. Persons with Medicare should consult their doctors about Medicare coverage for certain hearing tests.
While Medicare does not cover most dental, vision or hearing services, there may be other coverage options. If you or your spouse are eligible for an employer group health plan, the policy may cover some services that Medicare does not cover. You may have to purchase a dental, vision or hearing policy in addition to your medical policy under the employer group health plan. If you are eligible for VA coverage or Tricare (for military retirees and their dependents), check with these policies regarding their coverage of dental, vision and hearing services.
Some Medicare HMOs and PPOs may cover limited dental, vision and hearing services beyond original Medicare’s coverage. Federally Qualified Health Centers, usually located in inner city and rural areas, provide both Medicare covered and non-covered services with no deductible. The Seniors Eye Care Program, Salvation Army and Lions Club may offer some assistance for vision services. There are also local programs in each county that may help to cover these services.
“It is important to inquire before any medical services are provided what Medicare covers and what expenses you, the Medicare beneficiary, may have to pay out of your pocket,” said Commissioner of Insurance Jim Long.
For answers to your Medicare questions or any senior health insurance questions call SHIIP's toll-free Consumer Line (1-800-443-9354). You may also visit www.ncshiip.com or e-mail shiip@ncdoi.net for answers to your questions. In addition, SHIIP trains volunteers in local communities who are available for free, one-to-one counseling sessions. To reach a SHIIP counselor in your area, contact:
Pearl Stanley
Extension Agent
Family and Consumer Education, CFCS
P. O. Box 109,Bolivia, NC 28422
Telephone: (910) 253-2610
Fax: 910-253-2612
E-mail: Pearl Stanley
(The Seniors' Consumer Column is written monthly by the SHIIP staff. The column is a service of SHIIP, which is a division of the North Carolina Department of Insurance -- Jim Long, Commissioner.) P. O. Box 26387, Raleigh, NC 27611; 1-800-443-9354, (919) 733-0111; www.ncshiip.com
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Date Created 5/6/2003