Medicare covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer.

How often is it covered?

A Pap test and pelvic exam are covered by Medicare once every 24 months. However, if you are of childbearing age and have had an abnormal Pap test within the past 36 months, or if you are at high risk for cervical or vaginal cancer, Medicare will cover a Pap test and pelvic exam every 12 months.

For whom?

All women with Medicare

Your costs in the Original Medicare Plan?

You pay nothing for the Pap lab test. For Pap test collection and pelvic and breast exams, you pay 20% of the Medicare-approved amount with no Part B deductible.

What factors increase risk for cervical cancer?

Your risk for cervical cancer increases if …

• You have had an abnormal Pap test
• You have had cancer in the past
• You have been infected with the Human papillomavirus (HPV)
• You began having sex before age 16
• You have had many sexual partners
• Your mother took DES (Diethylstilbestrol), a hormonal drug, when she was pregnant with you
• You have a diet that is low in fruits and vegetables
• You are overweight or obese
• You had many full term pregnancies

To learn more about cervical cancer, click on the following links:

http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=&dt=8

http://www.cancer.gov/cancertopics/types/cervical/

Breast cancer is the most common non-skin cancer in women and the second leading cause of cancer death in women in the United States. Every woman is at risk, and this risk increases with age. Breast cancer can usually be successfully treated when found early. Medicare covers screening mammograms and digital technologies for screening mammograms to check for breast cancer before you or a doctor may be able to feel it.

How often is it covered?

Once every 12 months

For whom?

All women with Medicare age 40 and older can get a screening mammogram every 12 months. Medicare also pays for one baseline mammogram for women with Medicare between ages 35 and 39.

Your costs in the Original Medicare Plan?

You pay 20% of the Medicare-approved amount with no Part B deductible.

What factors increase risk for breast cancer?

Your risk of developing breast cancer increases if you…

• Had breast cancer in the past
• Have a family history of breast cancer (like a mother, sister, daughter, or two or more close relatives who have had breast cancer)
• Had your first baby after age 30
• Have never had a baby
• Used hormone replacement therapy (HRT) for a long period of time after menopause
• Have 2 or more alcoholic drinks every day
• Are overweight or obese, especially if you gained weight during adulthood
• Don’t exercise

Risk for breast cancer increases with age. It is important to continue with screening, even if you were screened before you entered Medicare.

To learn more about breast cancer, click on the following links:

http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=&dt=5

http://www.cancer.gov/cancertopics/types/breast

PACE is unique. It is an optional benefit under both Medicare and Medicaid that focuses entirely on older people, who are frail enough to meet their State’s standards for nursing home care. It features comprehensive medical and social services that can be provided at an adult day health center, home, and/or inpatient facilities. For most patients, the comprehensive service package permits them to continue living at home while receiving services, rather than be institutionalized. A team of doctors, nurses and other health professionals assess participant needs, develop care plans, and deliver all services which are integrated into a complete health care plan. PACE is available only in States which have chosen to offer PACE under Medicaid.

Eligibility

Eligible individuals who wish to participate must voluntarily enroll. PACE enrollees also must:

• Be at least 55 years of age.
• Live in the PACE service area.
• Be screened by a team of doctors, nurses, and other health professionals as meeting that state’s nursing facility level of care.
• At the time of enrollment, be able to safely live in a community setting.

Services

PACE offers and manages all of the medical, social and rehabilitative services their enrollees need to preserve or restore their independence, to remain in their homes and communities, and to maintain their quality of life. The PACE service package must include all Medicare and Medicaid services provided by that State. In addition, the PACE organization provides any service determined necessary by the interdisciplinary team. Minimum services that must be provided in the PACE center include primary care services, social services, restorative therapies, personal care and supportive services, nutritional counseling, recreational therapy, and meals. Services are available 24 hours a day, 7 days a week, 365 days a year.

Generally, these services are provided in an adult day health center setting, but may also include in-home and other referral services that enrollees may need. This includes such services as medical specialists, laboratory and other diagnostic services, hospital and nursing home care.

An enrollee’s need is determined by PACE’s medical team of care providers. PACE teams include:

• Primary care physicians and nurses.
• Physical, occupational, and recreational therapists.
• Social workers.
• Personal care attendants.
• Dietitians.
• Drivers.

The PACE team has frequent contact with their enrollees. This helps them to detect subtle changes in their enrollee’s condition and they can react quickly to changing medical, functional, and psycho-social problems.

Payment

PACE receives a fixed monthly payment per enrollee from Medicare and Medicaid. The amounts are the same during the contract year, regardless of the services an enrollee may need.

Persons enrolled in PACE also may have to pay a monthly premium, depending on their eligibility for Medicare and Medicaid.

Current Sites

For a listing of PACE organizations nationwide, please visit the following website:

http://www.cms.hhs.gov/pace/pacesite.asp

Some employer and union-provided health insurance policies can continue or switch over to provide coverage for you when you are 65 and retired. Contact your former employer or union for information on your plan.

Medicare has special rules that apply to beneficiaries who have group health plan coverage through their own or their spouse’s current employment. Group health plans of employers with 20 or more employees must offer these people the same health insurance benefits under the same conditions that younger workers and spouses receive. If your group health plan (participation is based on current employment) denies you coverage, or offers you different coverage, call your State Insurance Department. See the Helpful Contacts Medicare website for the phone number of the State Insurance Department in your area.

If you or your spouse stops working and you are already enrolled in Part B:

• Notify your Medicare carrier by phone or in writing that you or your spouse’s employment situation has changed.
• Give the carrier the name and address of the employer plan, your policy number with the plan, the date the coverage stopped and why.
• When receiving health care services, tell the provider that Medicare is now your primary payer and should be billed first. Give the date your group health coverage stopped.

Caution: Joining a Medicare Plan like an HMO or PPO may limit or end your employer or union coverage, both for you and/or any family members covered by your plan. Carefully read any materials your employer or union sends you. If you have questions, visit their website, or contact the office listed in their materials. If you can’t tell whom to contact, contact your benefits administrator or the office that answers questions about your coverage.

Medicare Prescription Drug Plans add coverage to the Original Medicare Plan, some Medicare Cost Plans, and some Medicare Private-Fee-for-Services Plans. These plans are offered by insurance companies and other private companies approved by Medicare.

When you join a Medicare Prescription Drug Plan, you use the plan member card that you get from the plan when you go to the pharmacy. When you use the card, you will get a discount on your prescriptions.

Your costs will vary depending on your financial situation and which Medicare Prescription Drug Plan you choose. If you have limited income and resources, you may get extra help to cover prescription drugs for little or no cost.

To compare Medicare Prescription Drug Plans, go to the Medicare Prescription Drug Plan Finder.

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.

Insurance companies can only sell you a “standardized” Medigap policy. These Medigap policies must all have specific benefits so you can compare them easily.

You may be able to choose up to 12 different standardized Medigap policies (Medigap Plans A through L). Medigap policies must follow Federal and State laws. These laws protect you. A Medigap policy must be clearly identified on the cover as “Medicare Supplement Insurance.” Each plan, A through L, has a different set of basic and extra benefits.

It’s important to compare Medigap policies because costs can vary. The benefits in any Medigap Plan A through L are the same for any insurance company. Each insurance company decides which Medigap policies it wants to sell.

Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company.

You and your spouse must each buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse.

For additional information on Medigap policies, including why you would want to buy a Medigap policy and information about what Medigap policies cover, please read our publication, Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

If you join a Medicare Advantage Plan, your Medigap policy won’t work. This means it won’t pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan. However, you have a legal right to keep the Medigap policy.

To compare Medicare Advantage Plans, go to the Medicare Options Compare.

Medicare covers many of your health care needs. Today’s Medicare is working with private companies health plans provide different ways to get your health care coverage in the Medicare program. The Medicare health plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality. Your Medicare health plan choices include:

• The Original Medicare Plan – This is a fee-for-service plan that covers many health care services and certain drugs. You can go to any doctor or hospital that accepts Medicare. When you get your health care, you use your red, white, and blue Medicare card.

  The Original Medicare Plan pays for many health care services and supplies, but it doesn’t pay all of your health care costs. There are costs that you must pay, like coinsurance, copayments, and deductibles. These costs are called “gaps” in Medicare coverage. You might want to consider buying a Medigap policy to cover these gaps in Medicare coverage. You can also add prescription drug coverage by joining a Medicare Prescription Drug Plan.

  For more information on the Original Medicare Plan, visit the Original Medicare Plan website.

• Medicare Advantage Plans – Available in many areas. If you have one of these plans, you don’t need a Medigap policy. These plans include:
  • Health Maintenance Organizations (HMO),
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service Plans
  • Medicare Special Needs Plans

  These plans may cover more services and have lower out-of-pocket costs than the Original Medicare Plan. Some plans cover prescription drugs. In some plans, like HMOs, you may only be able to see certain doctors or go to certain hospitals to get covered services.

  Click here for more information on Medicare Advantage plans.

• Medicare Prescription Drug Plans – These stand-alone plans add prescription drug coverage to the Original Medicare Plan and to some Medicare Cost Plans and Medicare Private Fee-for-Service Plans. Click here for more information on Medicare Prescription Drug Plans.

The Medicare health plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality. To compare your Medicare health plan choices, go to the Medicare Options Compare. To compare Medicare Prescription Drug Plans, go to the Medicare Prescription Drug Plan Finder.

Help Paying for Health Care Costs

There are wide ranges of health care coverage choices that may help pay for some of your health care costs. These health care choices work with the benefits you have from Medicare. What you choose will affect how much you pay, what benefits you have, which doctors you can see, and other things that may be important to you. For more information about programs that may help pay for some of your health care costs, please read the publication, Health Care Coverage Directory for People with Medicare.

We have good news. You still can sign up for a Medicare prescription drug plan and pay no penalty for 2006 if you qualify for extra help. Once you qualify, you have a special enrollment period between May 15 and December 31, 2006, when you can select the Medicare prescription plan of your choice. If you do not select a plan, the Centers for Medicare & Medicaid Services will do it for you.

And most important, the extra help pays for all or part of your monthly premiums and annual deductibles, and lowers your prescription co-payments. The extra help could be worth an average of $3,700 per year. You may be eligible for the extra help if you are on Medicare and have limited income and resources.

Many people who need long-term care will also need prescription drugs. There are programs that may offer you discounts or free medication.

For more information