RHODE ISLAND SENIOR BEAT
RELEASE: Friday, September 5, 2008
BY: Larry Grimaldi, Chief of Information & Public Relations
MEDICARE OFFERS LIMITED BENEFITS FOR EYE CARE
AND AMBULANCE SERVICES
CRANSTON--- This week's Rhode Island Senior Beat offers two columns for the price of one.
Question One: Does Medicare pay for routine eye care and glasses?
Medicare does not generally pay for routine eye care. However, there is limited coverage for eye care if you have a chronic condition such as cataracts or glaucoma. In these situations, Medicare will cover these services:
Surgical procedures that help repair the function of an eye due to glaucoma or cataracts. For example, Medicare will cover the surgery to remove a cataract and replace your eye lens with a man-made intraocular lens.
Eyeglasses or contacts for persons who have cataract surgery where the lens was placed in your eye. Medicare will also pay for dark glasses that you must wear immediately after surgery to protect your eyes and a standard pair of untinted prescription glasses or contact lenses if you need them after your surgery. If it is medically necessary, Medicare may pay for customized eyeglasses or lenses.
An eye exam to diagnose potential vision problems. If you are having vision problems that may indicate a serious eye condition, Medicare will pay for the diagnosis of this condition, even if it turns out that nothing is wrong.
Medicare will only pay for routine eye care in these specific circumstances:
If you have diabetes, Medicare will pay for an eye exam once every 12 months to check for loss of vision due to this condition. If you are high risk for glaucoma, Medicare covers an eye exam once a year by a Medicare-approved eye doctor. You are considered to be at high risk if you have these conditions:
 Diabetes. Have a family history of glaucoma
Are African-American age 50 and older
Are Hispanic and age 65 and older.
Question Two: Does Medicare pay for routine trips to the doctor or for regular trips for medical treatments or therapy?
In an emergency, Medicare will cover ambulance services if an ambulance is the only safe way to transport you for medically necessary treatment and you are transported to and from certain locations.
An emergency is defined as a situation where your health is in serious danger and immediate treatment is necessary to prevent your health or condition from getting worse. If the trip is scheduled as a way to transport you from one location to another when your health is not in immediate danger, it is not considered to be an emergency.
Medicare may cover non-emergency ambulance services if these criteria are met:
You are confined to your bed and are unable to get from bed without help; you are unable to walk; and are unable to sit in a chair or wheelchair.
You need vital medical services during your trip that are only available in an ambulance, such as administration of medications or monitoring of vital functions; or
The hospital where you are receiving treatment is local, or is the closest facility that can provide treatment you need; or
The cost of bringing treatment to your home is less than the cost of transporting you to the hospital and back in an ambulance. For frequent trips, Medicare may require proof that the regular ambulance trips are more appropriate than hospitalization; or
Lack of access to alternative transportation alone will not justify Medicare coverage.
If the ambulance service is covered, Medicare will pay for 80% of its approved coverage for
the service. You or your supplemental insurance will be responsible for the remaining 20%. All ambulance providers must accept Medicare assignment. This means that they must accept the Medicare-approved amount in full for the service.
For more information, contact Medicare at 1-800-633-4227 or go to www.medicare.gov.
Editor's note: This column was adapted from the "Dear Marci" columns published by the Medicare Rights Center. Medicare beneficiaries can get information by calling 1-800-333-4114. Aging network professionals can get Medicare information by calling 1-877-794-3570.
Questions for Rhode Island Senior Beat may be mailed to the Department of Elderly Affairs, John O. Pastore Center, Hazard Building, 74 West Road, Cranston, RI 02920. Questions can also be e-mailed to larry@dea.state.ri.us. For a confidential discussion with a customer service specialist about questions or problems regarding growing older, call the customer information referral and assistance unit at 462-4000. Seniors, families, and caregivers can also call The Point resource center at 462-4444.
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