Medicaid Surgery Costs

Each year, about 300,000 Americans undergo arthoscopic knee surgery to ease the pain of arthritis, but government researchers are now saying the operation is worthless for arthritis sufferers and may even be harmful in some cases.

Arthoscopic knee surgery is an attempt to clean out debris or repair damaged cartilage in the knee. In the study, some patients received the real operation, while others received a sham operation. Neither group knew whether or not their operations had really been performed.

The researchers monitored the patients’ progress over the next two years. They discovered that those who had received the fake surgery could climb stairs and walk slightly faster on average than those who had received the real operation.

The surgery generally costs about $5,000 and accounts for a total of $1.5 billion each year nationwide. The results of this study may prompt some insurers to refuse to pay for it. Other options for treating osteoarthritis of the knee include pain relievers, cortisone shots, hot packs, exercise, and knee-replacement surgery.elderly

Osteoarthritis affects about 12% of senior citizens.

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Guidance for When Drugs Are Covered by Medicare

The Centers for Medicare and Medicaid Services (CMS) has issued guidance on when Medicare pays for prescription drugs. This should help Medicare Intermediaries to determine whether a drug or biological that is furnished incident to a physician’s service is subject to the Medicare program exclusion for drugs that are usually self-administered by the patient. In general, drugs that are administered by beneficiaries more than 50% of the time will be excluded from coverage by Medicare.

Absent evidence to the contrary, drugs delivered intravenously or through intramuscular injection should be considered to be not usually self-administered. However, the opposite is generally true for drugs administered through subcutaneous injection.

For the full text of the guidance, go online:

Common Medicare Questions and Answers About HHS

Can someone who has never worked receive Social Security or Medicare based on his or her spouse’s employment?

A U.S. citizen’s spouse who has never worked can obtain both Social Security and Medicare benefits. These benefits are derived from the spouse’s work record. But these rights differ for U.S. citizens and non-citizens.

Do I have to live in the U.S. for five years and be a U.S. citizen to qualify for Medicare? When I qualify for Medicare, how much will it cost me?

It is not necessary to be a citizen of the U.S. in order to purchase Medicare. All that is required is that you be 65 or older and have lived in the U.S. for five consecutive years. If you OR your spouse have worked (combine the number of years for each of you) for more than seven years you may be eligible for Medicare at a reduced cost. Otherwise, it will cost $309 for Medicare Part A and $43.80 for Medicare Part B each month.

I am an American citizen. Next year I will be 65 years old. I also have accumulated 40 working quarters. My wife is over 65 and immigrated here in September l997. She has not worked in the states. When she has lived here for five years, will she be able to get Medicare so we won’t have to pay for it ourselves?

Yes. Because she is married to someone who has Medicare, she can get Medicare based on your contributions. If she were not married, she would need to buy-in. When she is eligible for Medicare, she can apply at the Social Security office or by calling 1-800-772-1213.