Marci’s Medicare Answers: Blood tests covered

Dear Marci,

I am concerned about my risk for getting heart disease. Does Medicare cover blood tests that screen for heart disease?

Sylvia

Dear Sylvia,

Yes, Medicare covers blood tests every five years to test cholesterol, lipid and triglyceride levels. You do not need to show signs of heart disease or have any particular risk factors for Medicare to cover the full cost of these tests.

Original Medicare, the traditional fee-for-service Medicare program offered directly through the federal government, covers 100 percent of its approved amount for these tests, even before you meet the Part B deductible. A deductible is the amount you must pay out-of-pocket before your insurance begins to cover your health care services. You will not have to pay anything for these screenings if you see doctors or other health care providers who accept Medicare and take assignment. Doctors who accept Medicare and take assignment cannot charge you more than the Medicare approved amount.

Keep in mind that Medicare private health plans, also known as Medicare Advantage plans, must cover the same preventive services that Original Medicare covers. Since Original Medicare covers 100 percent of the approved amount for these blood tests, Medicare Advantage plans cannot charge you for these tests, as long as you follow the plan’s rules. Contact your plan to find out what rules apply. If you do not follow your plan’s rules, you may have to pay more for these services.

Marci

Dear Marci,

I heard I can make changes to my Medicare coverage during the Medicare Advantage Disenrollment Period. What is the Medicare Advantage Disenrollment Period?

Rachel

Dear Rachel,

The Medicare Advantage Disenrollment Period takes place from Jan. 1 until Feb. 14 of each year. During this time, you can change your Medicare coverage and switch from a Medicare private health plan, also known as a Medicare Advantage plan, to Original Medicare. You can only make changes to your Medicare coverage during this time if you have a Medicare Advantage plan and you would like to switch back to Original Medicare.

Remember, there are two different ways you can receive your Medicare benefits. If you have a Medicare Advantage plan, you are receiving your Medicare benefits through a private health plan. If you have Original Medicare, the government pays directly for the health care services you receive.

Changes made during the Medicare Advantage Disenrollment Period will take effect on the first of the following month. For example, if you switch from a Medicare Advantage plan to Original Medicare in February, you will have Original Medicare coverage beginning March 1.

During this time, you can also enroll into a Medicare prescription drug plan (Part D) that works with Original Medicare. Keep in mind that Medicare Advantage plans generally provide prescription drug coverage, while Original Medicare does not. If you want Original Medicare and you do not have creditable prescription drug coverage (coverage that is as good or better than Medicare’s prescription drug benefit), you will most likely need to have a Part D plan that works with Original Medicare.

It’s best to call 800-MEDICARE when switching from a Medicare Advantage plan to Original Medicare. To learn more about different Part D plans available in your area, you can call or use the Medicare Plan Finder tool online at www.medicare.gov.

Marci

Dear Marci,

I cannot afford my Medicare Part B premium. Are there any programs that can help me?

Cathy

Dear Cathy,

Yes, you may qualify for the Medicare Savings Program, which can help pay your Medicare costs if you have limited finances. Savings plans can help pay your Medicare Part B premium (the amount you pay each month to have medical insurance) and may also pay other Medicare costs.

To qualify for a Medicare Savings Program, you must have Medicare Part A (hospital insurance) and meet your state’s income and asset eligibility guidelines. Savings plan eligibility limits vary by state, so you should contact your State Health Insurance Assistance Program to find out whether you qualify for a Medicare Savings Plan.

Marci

Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare.

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