National Coverage Determinations*
Posted on March 1, 2016
Health New England Medicare Advantage makes mid-year benefit changes only when Medicare changes its coverage rules. As a Medicare health plan, our Medicare Advantage must cover all services covered by Original Medicare.
When Medicare changes its coverage rules, Medicare issues a National Coverage Determination (NCD) explaining whether Medicare will pay for an item or service. The list below contains all recent changes from the past year to Health New England’s Medicare Advantage health care benefits:
- Screening for Cervical Cancer with Human Papillomavirus (HPV) Testing
Effective July 9, 2015, Medicare has determined that the evidence is sufficient to add Human Papillomavirus (HPV) testing once every five years as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap smear test. CMS will cover screening for cervical cancer with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations. - Screening for the Human Immunodeficiency Virus (HIV) Infection
Effective April 13, 2015, Medicare will cover annual voluntary HIV screening for all beneficiaries age 15 to 65, and for beneficiaries younger than 15 and older than 65 who are at increased risk for HIV infection. Medicare will cover a maximum of 3 voluntary screenings for pregnant beneficiaries under certain conditions. - Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)
Effective February 5, 2015, Medicare covers lung cancer screening with low dose computed tomography (LDCT) if all eligibility requirements listed in the National Coverage Determination (NCD) are met. - Discontinued Coverage of Vacuum Erection Systems (VES) Prosthetic Devices in Accordance with the Achieving a Better Life Experience Act of 2014
Effective July 1, 2015, Section 203 of the Achieving a Better Life Experience (ABLE) Act of 2014 implements changes to treat VES prosthetic devices and related accessories as statutorily non-covered in the same manner that erectile dysfunction drugs are treated in Part D.
All NCDs are effective on the date the decision memorandum is released (the date it is posted to the National Coverage Analysis page of the Medicare Coverage Center website at https://www.cms.gov/medicare-coverage-database).
If the newly covered service is covered outside of the contract, the covered service may be obtained from any Medicare provider, including out-of-network providers.
To request printed copies or if you have any questions, please call Member Services at (413) 787-0010 or toll-free at (877) 443-3314. For TTY/TDD, call (800) 439-2370. Member Services hours are 8:00 a.m. – 8:00 p.m., Monday – Friday (Oct. 1 – Feb. 14: 8:00 a.m. – 8:00 p.m., seven days a week).
*Health New England Medicare Advantage is an HMO Plan with a Medicare contract. Enrollment in Health New England Medicare Advantage depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copays and restrictions may apply. Benefits, premiums and/or copays/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.
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