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2004 Medicare Cancer Coverage In Rhode Island | |
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Coverage Screening / Diagnosis Coverage Colorectal Cancer Screening– Colonoscopy: All people with Medicare age 50 and older are covered. However, there is no minimum age for having a colonoscopy. Medicare covers this test once every 24 months if you are at high risk for colon cancer. If you are not at high risk, Medicare covers this test once every 10 years, but not within 48 months of a screening sigmoidoscopy. You pay 20% of the Medicare-approved amount. You pay 25% of the Medicare-approved amount if the test is done in a hospital outpatient setting. Part B pays for this service, after a $100 deductible is met. Colorectal Cancer Screening– Flexible Sigmoidoscopy: All people with Medicare age 50 and older are covered. Medicare covers this test once every 48 months, but within 10 years of a screening colonoscopy. You pay 20% of the Medicare-approved amount. You pay 25% of the Medicare-approved amount, if the test is done in a hospital outpatient setting. Part B pays for this benefit. Colorectal Cancer Screening– Barium Enema: All people with Medicare age 50 and older are covered. You pay 20% of the Medicare-approved amount. Part B pays for this service. Colorectal Cancer Screening– Fecal Occult Blood Test: All people with Medicare age 50 and older are covered. Medicare covers this test once every 12 months. You pay nothing for a fecal occult blood test. Part B pays for this service. Diagnostic Tests, X-Rays, and Lab Services: Medicare covers x-rays, clinical diagnostic tests and lab services provided by certified laboratories that are participating in Medicare. Some preventive tests and screenings are also covered by Medicare. You pay 20% of Medicare-approved amounts for covered diagnostic tests and x-rays after you meet your $100 deductible. You pay nothing for Medicare-covered lab services. Part B. pays for this service. Mammogram Screening: Medicare covers a mammogram screening once every 12 months for all women with Medicare age 40 and older. You can also get one baseline mammogram between ages 35 and 39. Medicare covers new digital technologies for mammogram screening. You pay 20% of Medicare-approved amounts with no Part B deductibles. Part B pays for this service. Pap Test and Pelvic Exam: Medicare covers Pap Tests and Pelvic Exams (including a clinical breast exam) for all women once every 24 months. If you are at high risk for cervical or vaginal cancer, or if you are of childbearing age and have had an abnormal Pap Test, Medicare covers this test and exam once every 12 months. You pay nothing for the lab Pap test and 20% of Medicare-approved amounts for the part of the exam when the doctor or health care provider collects the specimen and for the pelvic exam. If the pelvic exam is provided in a hospital outpatient department, then you pay a set co-payment amount. Part B covers this service after you pay a $100 deductible. Prostate Cancer Screening: Medicare covers screening tests for all men with Medicare age 50 and older once every 12 months (if you have Medicare coverage). The tests covered are a Digital Rectal Examination and a Prostate Specific Antigen (PSA) test. You pay 20% of the Medicare-approved amount for the digital rectal exam and nothing for the PSA test. However you do not pay 20% of the Medicare-approved amounts for other related services. Part B pays for this service after you meet the $100 deductible. Treatment Coverage Chemotherapy (inpatient): Chemotherapy is covered for patients who are hospital inpatients or outpatients and in freestanding clinics. In the hospital setting, Part A covers chemotherapy. This service is paid for by Part A. However, you must pay a $100 deductible for Part B services and supplies before Medicare begins to pay its share, as stated above, this amount may vary. After the deductible, you pay 20% of Medicare approved amounts. Chemotherapy (outpatient): Chemotherapy is covered for patients in a freestanding facility by Part B. You must pay a $100 deductible and then 20% of Medicare approved amounts. Radiation Therapy (inpatient): Radiation therapy is covered for patients who are hospital inpatients. In the hospital setting, Part A covers radiation therapy. You pay 20% of Medicare-approved amounts. Radiation Therapy (outpatient): Radiation therapy is covered if delivered in a freestanding facility by Part B. However, you must pay a $100 deductible for Part B services and supplies before Medicare begins to pay its share. You also pay 20% of Medicare-approved amounts. Transplant– Cornea and Bone Marrow: Medicare covers bone marrow and cornea transplants under certain circumstances. Transplants are not limited to approved facilities and transplant coverage includes necessary tests, labs, and exams before surgery, for both yourself and the organ donor. Follow up care for you and a live donor is covered as well as the procurement of organs and tissues. Part B pays for this. Other Coverage Breast Prostheses: Medicare covers breast prostheses (including a surgical brassiere) after a mastectomy. You pay 20% of Medicare-approved amounts. Although Part B pays for this service, you must pay a $100 deductible for Part B services and supplies before Medicare begins to pay its share and also actual amounts you must pay may be higher if a doctor, health care provider, or supplier does not accept this assignment. The State of Rhode Island DMERC– Durable Medical Equipment Regional Center acts as the supplier and can be reached at 1-800-633-4227. Some breast prosthesis vendors also accept Medicare. Call our office for a brochure of vendors. Clinical Trials: Medicare covers routine costs, like doctors visits and tests if you take part in an approved clinical trial. Clinical trials test new types of medical care, for instance, how well a new cancer drug works. It is important that you ask what costs you will have to pay before signing up for a clinical trial. In most cases Part A (inpatient) and Part B (outpatient) will not pay for the experimental item being investigated. To find out these costs, you can call 1-800-MEDICARE or visit the Medicare website at: It is important to note that Part B services are voluntary. Therefore, you must choose this Medicare option in order to receive the benefits and coverage of Part B described above. For More Information Contact the Senior Health Insurance Program at: RI Department of Elderly Affairs
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Designed & maintained by: Keith McCain |