The "Dear Marci" feature is from the Medicare Rights Center...there is always some great info published! Dear Marci, I was told that Medicare covers certain preventive services for free. However, my doctor told me I will need to pay for the preventive service I received, because it became a diagnostic service. What is the difference between a preventive and diagnostic service? - Al (Springfield, MO) Dear Al, Preventive services are health care services meant to prevent illness or detect a medical condition at an early stage (i.e. before you shows symptoms of the condition). Examples of preventive services include breast cancer screenings, colon cancer screenings and heart disease screenings. Diagnostic services are services used to treat or address medical symptoms or conditions you already have. Diagnostic services may include the treatment of cancer, heart disease or a medical condition that was previously diagnosed by your doctor. Medicare coverage of health care services differ, depending on whether the care is preventive or diagnostic. Due to the Affordable Care Act, Medicare covers many preventive services free of charge. If a service is considered to be diagnostic, Medicare may cover the service. However, charges, such as a coinsurance or copayment for the service, will most likely apply. For example, charges may apply if your doctor needs to investigate or treat a new or existing health problem during your Annual Wellness Visit. Similarly,if you get a preventive colonoscopy screening and your doctor removes a polyp during the screening, Medicare will consider the polyp removal to be a diagnostic service. Therefore, the colonoscopy will no longer count as a preventive service under Medicare rules, and costs may apply. Keep in mind that while many preventive services are covered under Medicare for free, additional treatment given during or after the preventive service may come with a fee. For example, charges may apply if your health care provider meets with you to discuss other health care needs before or after you receive a Medicare-covered preventive service.Charges may also apply if your health care provider detects a problem and provides additional services or treatments. Medicare covers preventive and diagnostic services whether you have Original Medicare or a Medicare Advantage plan, as long as you meet certain rules and requirements. Original Medicare is the traditional Medicare program administered directly through the federal government. Medicare Advantage plans, also known as Medicare private health plans, are offered through private insurance companies. Click here for a helpful flier on Medicare-covered preventive services. -Marci
Posted on: Wed, 14 Aug 2013 15:18:41 +0000
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