5 Things Women Should Know About Medicare

Women’s bodies are persistently evolving throughout their whole lives. As women enter their golden years, they may begin developing health conditions, and many services such as a pap smear test, pelvic exam, and clinical breast exam are needed for preventative checkups. You might be wondering if Medicare covers these types of services. So, with that said, here are five things women should know about Medicare.

1. Original Medicare

Original Medicare consists of two parts: Part A and Part B. Each part covers different services based on what they are and where you receive them. For example, Part A will cover chemotherapy if you are an inpatient at a hospital, while Part B covers chemotherapy if it takes place in a doctor’s office or freestanding clinic. Let’s look at what the difference is between Part A and Part B.

Part A

Medicare Part A covers inpatient services if you are admitted to the hospital or staying at a skilled nursing facility (SNF). Part A covers a semi-private room, your meals for your hospital stay, and the medications and lab services you receive as an inpatient.

However, your hospital stays and services do not come free. If you are admitted to the hospital, you must meet the $1,408 Part A deductible before Medicare kicks. However, Medicare will pay 100% for your stay at a skilled nursing facility for up to 20 days.

Part B

Part B is your outpatient coverage that covers services like doctor’s visits, ambulance rides, durable medical equipment, and lab testing. Sometimes Part B will pay instead of Part A when you receive surgery, diagnostic imaging, or dialysis for kidney failure in a hospital setting.

Majority of the services that you receive will list under Part B. However, Medicare Part B does not pay 100% for your services. You must first pay the $198 Part B deductible, and then Medicare will begin to pay its share.

For example, if you receive chemotherapy at the doctor’s office and you have met the Part B deductible, your Part B will pay 80% of your service. Therefore, leaving you responsible for 20% of your bill. That 20% can be thousands of dollars for chemotherapy – which is why many people buy a Medigap plan, which we will discuss later.

2. Breast cancer coverage

According to the Centers for Disease Control and Prevention (CDC), breast cancer is the second most common cancer in women. With that said, Medicare is a huge advocate for preventative services, which is why Medicare Part B covers a mammogram screening once a year.

A mammogram is an x-ray of the breast to detect breast cancer. Medicare covers mammogram screenings at 100% (if your doctor accepts Medicare assignment) and will cover diagnostic mammograms at 80% (after the Part B deductible has been met). Unlike a mammogram screening, you can have a diagnostic mammogram anytime throughout the year with Medicare coverage if it is medically necessary.

Medicare Part A covers surgically implanted breast prostheses after a mastectomy has been performed in an inpatient setting. In contrast, Medicare Part B covers some external breast prostheses, including a post-surgery bra.  

3. Cervical cancer

According to the CDC, around 12,000 women are diagnosed with cervical cancer each year. Fortunately enough, cervical cancer can be quickly detected by preventative services. Pap smears and pelvic exams are two methods of finding cervical cancer and other vaginal issues in females. 

Medicare covers two cervical cancer tests for women once every 24 months at 100%. However, if you are at high risk for cervical cancer and had an abnormal pap smear test in the past 36 months, then Medicare will pay for a cervical test once a year.

If your cervical tests come back with abnormal results, your exam will be considered a diagnostic exam. Therefore, Medicare will only pay 80% of your service and leave you responsible for the additional 20% coinsurance.

4. Osteoporosis

Osteoporosis can make your bones thin, and brittle. Bone density tests can identify a decrease in your bone density, which results in osteoporosis. Medicare Part B will cover one bone density test every 24 months for osteoporosis if you meet one of the many qualifying conditions.

Medicare Part A and Part B will provide coverage for injectable drugs for osteoporosis. Medicare will also cover a home health nurse to come to your home to inject you with the medications if you meet these conditions:

  • You’re a woman
  • You have Part B and meet the home health services criteria
  • You have a bone fracture that relates to postmenopausal osteoporosis
  • Your doctor states that you and a family member are unable to give yourself the injectable drug.

All Medicare deductibles will apply to these osteoporosis services. However, you will pay a 20% coinsurance of the Medicare-approved amount for your injectable drugs. However, you will not have to pay for the home health nurse visit.

5. Medicare Supplements can help cover costs

Since Original Medicare does not cover 100% of your services and leaves you with out-of-pocket costs, many beneficiaries apply for a Medicare Supplement (also known as a Medigap plan). A Medicare Supplement is a type of health insurance sold by private insurance companies that help cover the gaps Medicare leaves with you, such as deductibles, copayments, and coinsurance.

For example, since Medicare Part B only covers 80% of your Medicare-approved outpatient services, many Medigap plans pick up the 20% coinsurance that you are initially responsible for. With that said, if you have Medigap Plan G, the only out-of-pocket spending you will have is the one-time Part B deductible. So, if you receive chemotherapy for breast cancer at an outpatient facility and have already met the Part B deductible, you will not have to pay anything for your treatments.

All in all, Medicare will cover any service that is considered medically necessary by a doctor. Although women might experience health conditions as they age, Medicare is by their side to ensure they receive the healthcare coverage they need to ensure their health and safety.

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