On Jan. 1, 2011, the preventative services provision of the Affordable Care Act was extended, making all Medicare patients eligible for free, important preventive services — including colonoscopies. However, not all colonoscopies are created equal, and this could impact whether it is truly without cost to you. This article explains what you should be aware of when receiving this important and lifesaving test.
Screening vs. diagnostic.
The free Medicare exam only covers screening colonoscopies — not diagnostic colonoscopies. A screening colonoscopy is a procedure performed on a patient of screening age in order to find colon polyps or cancer. A colonoscopy that is performed in order to explain symptoms (e.g. blood in stools, change in bowel movements, etc.) is called a diagnostic colonoscopy, which is not covered under the Affordable Care Act. Patients are usually fully liable for at least 20 percent (and maybe more) of the cost related to a scheduled diagnostic colonoscopy.
There are some cases where a scheduled screening colonoscopy can become a diagnostic colonoscopy, and in those cases a patient becomes responsible for any out-of-pocket costs related to their deductible, co-insurance or co-pays for standard costs like physician and facility fees. A screening colonoscopy becomes a diagnostic colonoscopy when a physician removes a polyp or takes a biopsy during the procedure. For Medicare patients, a family history of colon cancer or polyps will not automatically transform a screening colonoscopy into a diagnostic one. Some private insurers, however, will do this.
Related services not always covered.
Medicare patients who are eligible to have a colonoscopy screening will pay no deductible, co-pay or co-insurance. However, please be forewarned; patients may still be responsible for other services, such as anesthesia or medication, associated with the procedure. Some of those who have taken advantage of the “free services” have been unpleasantly surprised to receive hefty bills. If you receive a bill after a “free” Medicare exam, contact the Elderly Benefit Specialist in your county immediately. He or she can help you determine if these charges are allowable.
How often is it covered?
These are “free” screening colonoscopies for Medicare patients.
Flexible sigmoidoscopy: Generally, once every 48 months, or 120 months after a previous screening colonoscopy for people not at high risk.
Screening colonoscopy: Generally once every 120 months (once every 24 months if you’re at high risk), or 48 months after a previous flexible sigmoidoscopy.
Barium enema: Your doctor can decide to use this test instead of a flexible sigmoidoscopy or colonoscopy. This test is covered every 24 months if you are at high risk for colorectal cancer and every 48 months if you aren’t at high risk.
How do I qualify?
A Medicare patient can qualify for a screening colonoscopy if they:
• Are of the recommended screening age (for people of average risk — age 50 or over, though recent studies indicate that African-Americans may need to start screening at age 45).
• Do not have any symptoms.
• Do not have personal history of colon polyps or colon cancer.
A Medicare patient can still qualify for a screening colonoscopy despite having:
• A family history of colon cancer or colon polyps.
Costs: Screening Colonoscopy.
• $0 annual deductible for procedure.
• $0 co-insurance for procedure.
Costs: Diagnostic Colonoscopy
• $0 annual deductible for procedure.
• 20-percent co-insurance must be paid for procedure.
Medicare rules dictate how often you can get a free screening colonoscopy. If you get the test sooner than the time periods listed below, you will likely be fully responsible for the cost.
Fecal Occult Blood Test: Once every 12 months.
Why a Screening Colonoscopy?
Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death in both men and women in the US. The great majority of these cancers and deaths could be prevented with early screening. This is because most colorectal cancers develop from adenomatous polyps. Polyps are noncancerous growths in the colon and rectum. Detecting polyps through screening and removing them can actually prevent cancer from occurring. Furthermore, being screened at the recommended frequency improves the chance that colorectal cancer will be detected at an earlier stage, when it is more likely to be cured by surgery alone, the surgical procedure is less extensive, and the recovery is much faster. (Statistics excerpted from American Cancer society, Colorectal Cancer Facts and Figures 2008-2010.)
A new health insurance website from the Division of Insurance is up with excellent general information for consumers about the health insurance marketplace: http://doraapps.state.co.us/Insurance/Consumer/pages/main.aspx.???????
Within this website, you will find consumer information on many health insurance topics including;
• What types of health insurance are available in Colorado.
• What to look for when shopping for health insurance.
• What factors affect the amount of your health insurance premiums.
• Where to search and view a complete copy of the rate filings pertaining to your insurance carrier.
• Where to go if you can’t get insurance coverage.
• How you can appeal a denied health claim.
• The latest on federal healthcare reform.
AARP Driver Safety Program
Take the four-hour classroom refresher course especially designed for drivers age 50 and over. AARP members $12, non-members $14 Auto discounts in most states, contact your insurance agent for more information.
The course is offered at Durango/La Plata County Fairgrounds, Pine Room, Saturday, Sept. 17, 9 a.m.-1:30 p.m.
To register, call Jim O’Brien at 375-1693.
Our thanks to Soulquilt.org (Hawk Mesa Storm) for the generous donation of 10 tickets to “The Secret Lives of the Divine.”
We also thank the folks at the Four Corners Folk Festival for their donation of 30 tickets to the Labor Day weekend event, a foot-tapping, bootie-shaking good time.
And, last but not least, thank you to Mountain View Homemakers for their generous donation of $500 in support of our home delivered meal program.
Upcoming special events
Animal Control Presentation. Chris Crump has been the Archuleta County Animal Control Supervisor with the sheriff’s office over the past five years. Chris has enjoyed working with animals for the majority of his life, from being a veterinary assistant to?ranch work and?zoo work to running a successful mobile grooming and dog?training business. He has had extensive training provided by Archuleta County in all three levels of the?National Animal Control Association and Equine Investigations training with Code 3 Associates, certified through the University of Missouri and?Colorado State University. Join Chris to learn his role and responsibilities in Archuleta County and hear his “tails.” Monday, Sept. 19, at 12:30 p.m.
Dr. Kurz and Nurse Sandy will provide information on prostate and ovarian cancer, Wednesday, Sept. 21, at 12:30 p.m. Learn the function of the prostate, what cancer of the prostate is, and how to get the information you need to make the right decision for you. Also learn what ovarian cancer is, as well as about cancer basics and the general outlook for women diagnosed with ovarian cancer.
Are you new to Medicare or about to be? If so, this introduction is for you. Trained volunteer SHIP (Medicare) counselors will provide the ins and outs of Medicare and help you navigate through this complicated program. Monday, Sept. 26, 1 p.m. at the Senior Center. Registration is required; please call 264-2167.
Medicare open enrollment
The 2011 General Enrollment for Medicare Prescription Plans (Part D) and Medicare Advantage Plans has changed to Oct. 15-Dec. 7, 2011.
Available Monday, Tuesday, Wednesday and Friday to seniors age 60-plus. Suggested donation is $2 per day. Call for details, 264-2167.
Home meal delivery
These meals are the same meals prepared in our kitchen by the same cooks who prepare those scrumptious senior center meals. Our hot meal home-delivery program remains available to those closer to town four days per week, with frozen meals on Thursdays and weekends. Meals are available to people age 60-plus for a suggested donation of $3 per meal. Give us a call at 264-2167 for further information. Donations are greatly appreciated.
Friday, Sept. 16 — Geezers 9 a.m.; Stitchin’ in the Kitchen 10 a.m.; Gym walk 12:30 p.m.
Monday, Sept. 19 — Animal Control presentation with Chris Crump 12:30 p.m.; Gym Walk 12:30 p.m.; Canasta 1 p.m.
Tuesday, Sept. 20 — Gym walk 12:30 p.m.; Meditation for healing 1 p.m.
Wednesday, Sept. 21 — Prostate and ovarian cancer presentation 12:30; Sky Ute Casino trip (signup required) 1 p.m.
Thursday, Sept. 15 — Administrative day, no services.
Friday, Sept. 16 — Geezers 9 a.m.; Stitchin’ in the Kitchen 10 a.m.; Book Club 10:30 a.m.; Gym walk 12:30 p.m.
Suggested donation for older adults age 60-plus is $3, kids 12 and under and guests $6. Our meal program is partially funded through the Older Americans Act via the San Juan Basin Area Agency on Aging, United Way, Archuleta County, Town of Pagosa Springs and other donations and grants. These funds help support the cost of the meal which is approximately $11.51. Please note our menu is subject to change. The salad bar opens at 11:30 a.m. with lunch served from noon to 12:30 p.m.
Friday, Sept. 16 — French dip, oven browned potatoes, mixed veggies, fresh orange.
Monday, Sept. 19 — Porcupine meatballs with gravy, whipped potatoes, almond peaches, peas and carrots, whole wheat bread, tossed salad.
Tuesday, Sept. 20 — Spinach lasagna, Italian vegetables, tossed salad, strawberry fruit whip with bananas.
Wednesday, Sept. 21 — Hamburger with lettuce, tomato, onion and pickles, roasted sweet potatoes, tossed salad, fresh fruit salad with citrus.
Thursday, Sept. 22 — Closed.
Friday, Sept. 23 — Dijon chicken, brown rice with parsley, green salad, orange beets, orange wedges.