Medicare Coverage of Allergy Shots
Toni:
I am turning 65 this October and currently am enrolled in a Blue Cross/Blue Shield $4,000 deductible individual health insurance plan. My biggest medical expense is from shots that I receive from 2 doctors.
One is allergy shots taken 3 times a week from my allergist that are not too expensive, but the shot of lucentis for macular degeneration is over $2,000 per shot. It does not take me too many months or treatments for me to make the $4,000 deductible.
My concern is what or how does Medicare Part B pay for these 2 medical procedures? Look forward to your answer, Sharon from Sugar Land area
Great question, Sharon:
Most Americans do not realize what is covered under Medicare Part B which is the medical insurance part of Medicare.
On page 42 of the 2016 Medicare and You handbook, it discusses “What does Part B cover?” It states that Part B “helps to cover medically necessary doctors’ services, outpatient care, home health services, durable medical equipment and other medical services.
Many preventative services covered under Part B are listed on page 69 of the Medicare and You handbook. More services covered under Part B are found on pages 43-71.
Sharon, you mentioned that you have a concern about whether expensive macular degeneration shot for your eye and also the allergy testing and shots can be covered under Part B. As long as these procedures are medically necessary, then Medicare will pay for those procedures.
“Medically necessary” as defined by Medicare means “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”
On page 52 of the handbook under “Doctor and other health care provider services”, it states that “Medicare covers medically necessary doctor services (including outpatient services and some doctor services you get when you’re a hospital inpatient) and covered preventative services. Medicare covers other health care providers like physician assistants, nurse practitioners, social workers, physical therapists and psychologists.
The 2016 Part B medical/doctor deductible is $166.00 with Medicare paying 80% of the approved amount and you (the beneficiary) paying 20% of the Medicare approved amount.
To help pay for the 20% out of pocket after the $166 deductible, many enrolled in Medicare chose a Medicare Supplement to help defray the Medicare Parts A and B deductibles and out of pocket charges. With a Medicare Supplement, Sharon, you will have low or no out of pocket for Medicare medically necessary approved amounts depending on which Medicare Supplement plan you are enrolled.
The Medicare handbook states that “if you’re in a Medicare Advantage Plan (like a HMO or PPO) or have other insurance, your costs may be different. Contact your plan or benefits administrator to find out the costs.”
Part B has a monthly premium of $121.80 for those new to Medicare who enrolled in Part B in 2016. Many Medicare beneficiaries that are enrolled in Part B prior to 2016 pay $104.90 monthly. Some on Medicare with income more than $85,001.00 for an individual or $170,001.00 for a couple will pay more than premium of $121.80 each month; the range for the higher income earners’ Part B monthly premium in 2016 is from $170.50 to $389.80.
Confused about Medicare Workshop are beginning Tuesday September 13th in Friendswood. Check the Toni Says website atwww.tonisays.com for a Medicare/Social Security workshop in your area. Please RSVP 832/519-8664.
Toni King, author of the new Medicare Survival Guide®, which is a simple guide that puts Medicare in “people” terms, is on sale atwww.tonisays.com Email questions to info@tonisays.com or call 832/519-TONI (8664).
