Notification of National Medicare Coverage Determinations
What is this notice?
From time to time, the federal agency that runs Medicare announces new information about coverage under the program. The Medicare program requires Essence Healthcare to notify you of these changes on our website and in our member newsletter.
What does this mean to me?
These notifications announce new coverage rules. The new rules do not affect most members.
The changes in this notice are about treatment for advanced prostate cancer and magnetic resonance imaging (MRI) scans for people with pacemakers.
What are the changes?
- The Medicare program now covers annual screening for depression in a primary care setting. This change was effective as of October 14, 2011. (Posted 11/17/2011)
- The Medicare program now covers screening and behavioral counseling in a primary care setting to reduce alcohol misuse. Coverage includes annual screening for all Medicare beneficiaries, including pregnant women. Those who screen positive may be eligible to receive up to four brief face-to-face behavioral counseling interventions. This change was effective as of October 14, 2011. (Posted 11/17/2011)
- The Medicare program now covers one cardiovascular disease risk reduction visit each year, which includes: encouraging aspirin use when appropriate, screening for high blood pressure, and providing intensive behavioral counseling on diet for adults with known risk factors for heart disease. This change was effective as of November 8, 2011. (Posted 11/17/2011)
- The Medicare program now covers screening for certain sexually transmitted infections when the tests are used in accordance with FDA labeling and ordered by a primary care provider. Coverage also includes up to two brief counseling sessions to prevent infections in high-risk sexually active beneficiaries. This change was effective as of November 8, 2011. (Posted 11/17/2011)
- The Medicare program now covers the prostate cancer drug Provenge. The drug is approved for use in patients with certain forms of advanced prostate cancer. (posted 07/17/2011)
- The Medicare program now covers MRIs for patients with implanted permanent pacemakers, if the pacemakers are approved for use in an MRI environment. (posted 07/17/2011)
What should I do if I have questions?
If you have a question about these changes or about how Essence will cover these benefits, please contact us.