Marci’s Medicare Answers
September 2008

Dear Marci,
I heard that Medicare covers the cost of a routine physical just once. What exactly is included in this physical?
— Doris

Dear Doris,
Yes, Medicare covers 80 percent of the Medicare-approved amount (after meeting the Part B deductible) of a one-time routine physical examination during the first six months after you enroll in Medicare Part B regardless of your age. The exam includes measurement of height, weight and blood pressure, an electrocardiogram (EKG), ultrasound screening for abdominal aortic aneurysms (AAA) if you are at risk, as well as education, counseling and referral related to other preventive services covered by Medicare. Payment for clinical laboratory tests, however, are not included in this physical exam benefit. Some Medicare private health plans (such as HMOs or PPOs) may cover routine physicals.
— Marci

Dear Marci,
I am going to have cataract surgery next month, but my friend just told me that Medicare does not cover eye care. Is this true?
— Paulo

Dear Paulo,
Medicare will not generally pay for routine eye care, but it will cover surgery to remove the cataract and replace your eye’s lens with a man-made intraocular lens. Medicare will also cover the dark glasses you must wear immediately after surgery to protect your eyes, and a standard pair of untinted prescription eyeglasses or contacts if you need them after surgery. If it is medically necessary, Medicare may pay for customized eyeglasses or contact lenses.
— Marci

Dear Marci,
I applied for a Medicare Savings Program a few months ago, and was told that I did not qualify because I had too much in my savings account. My sister applied for one recently, and was told she qualified. But she has a little more savings than I do. Was I given wrong information?
— Beatrice

Dear Beatrice,
Does your sister live in a different state? Eligibility for Medicare Savings Programs (MSPs)—programs that help pay for the out-of-pocket costs of Medicare—is based on your income and assets. However, income and asset limits can vary by state. Most states deny MSP coverage to individuals with incomes above $1,190 per month ($1,595 for a couple) in 2008. But in some states, including New York, there is no asset limit eligibility requirement for some or all MSPs. For programs that have no asset test, savings will not be counted. Call your local Medicaid office or SHIP (State Health Insurance Assistance Program) for more information about eligibility requirements.
— Marci

Medicare Rights Center (www.medicarerights.org) is the nation’s largest independent source of information and assistance for people with Medicare. To speak with a counselor, call (800) 333-4114. For MRC’s free educational e-newsletter, simply e-mail dearmarci@medicarerights.org. To learn more about the services that Medicare will cover and how Medicare works with Medicaid, log on to Medicare Interactive Counselor at the Medicare Rights Center’s website at www.medicareinteractive.org.