Many consumers will need a scorecard to keep up with the rapid changes occurring in Medicare this year, and the latest revisions offer mixed news for 35 million Americans enrolled in the giant federal medical plan.
On one hand, the government is expanding coverage this year for some people with serious health problems, such as cancer and diabetes, and renewing efforts to reach low-income individuals who need help paying Medicare premiums. It is also promising to remove some hurdles that were making it difficult for people with Alzheimer's disease to access medical care. But other changes will make it more difficult for Medicare enrollees to switch back and forth between the traditional Medicare program and HMOs.
The coverage changes are being led by Tom Scully, director of the Centers for Medicare and Medicaid Services, who has announced a drive "to make the latest effective technology available" to Medicare recipients. If successful, the effort will assure that people enrolled in Medicare, many of whom live on modest fixed budgets, will have available the same state-of-the-art equipment and treatments found in the best private health insurance plans.
One key change is that Medicare will begin paying for major, sophisticated diagnostic tools for the detection of breast cancer, which strikes 90,000 Medicare beneficiaries a year. The program will cover Positron Emission Tomography, or PET, a scanning system that shows cross-sectional images of biological activity in tumors or lesions. It can detect the disease when X-rays appear to be normal. The technology gives patients and doctors "potentially lifesaving information not provided by traditional imaging," said Health and Human Services Secretary Tommy G. Thompson.
Medicare also will cover the cost of "image guidance," which uses ultrasound to determine where to insert a needle for a biopsy of the breast. The ultrasound technique is a less-invasive alternative to surgical biopsy, in which a piece of tissue is surgically removed. Another change is that Medicare, which normally excludes coverage for routine foot care, will now pay for two foot exams a year for diabetics. The coverage will be available to people who have peripheral neuropathy, a nerve condition limiting the ability to feel the pains that might signal a foot injury. Many diabetics have undetected foot injuries that sometimes lead to amputations.
