Medicare coverage for Thyroid Disease is a necessity for a large number of Americans. Thyroid diseases are mostly conditions affecting the level of producing thyroid hormones.
Of those individuals, about 60% are unaware they have it. Unfortunately, thyroid problems are more common among women than men. Less than 13% of women develop a thyroid disorder.
Medicare coverage for thyroid disease depends on the medical necessity of treatment or services. Thyroid disorders can cause other serious health complications, such as heart disease when left without treatment.
Medicare Coverage for Thyroid Disease
Original Medicare covers thyroid testing as a diagnostic service due to the range of symptoms relating to thyroid dysfunction. Thyroid disease is known to cause many other health disorders.
Conditions include diabetes, atrial fibrillation, hypertension (high blood pressure) and hyperlipidemia. An estimate of 20 million Americans has some type of thyroid disease, according to the American Thyroid Association.
The benefits of screening for thyroid disease has been a controversial topic over the years. The U.S. Preventive Services Task Force was unable to determine whether screening of thyroid disease in adults was beneficial or not.
However, The American Thyroid Association and the American Association of Clinical Endocrinologists highly recommend screenings for hypothyroidism in patients 60 years or older.
Screening for Thyroid Disease
Health care providers may order a test for a certain condition when a patient shows no symptoms or signs of the condition; this process is known as screening.
If a suspicion of thyroid dysfunction is obvious or present, a doctor may order TSH testing. Medicare already covers this service as it’s a diagnostic process, not a screening.
A screening program must meet certain requirements to be successful. Specifically, the results must improve an individual’s chances for cure, lessen disability, or reduce pain development. Otherwise, patients should have less expensive treatment as a result of the screening.
However, studies show TSH screening for thyroid disease doesn’t meet screening conditions. The benefits were no greater when patients began treatment at the time of screening than those starting after the disease is present.
Thyroid Disease Types
The thyroid gland helps regulate the body’s metabolism, regulated by the thyroid-stimulating hormone (TSH). Different diseases and disorders may affect how the thyroid functions or the structure of the gland itself.
Hypothyroidism is the result of a lack of production of thyroid hormones. Individuals with this condition may experience several signs or symptoms; while others may not have any.
Signs of hypothyroidism are dry skin, fatigue, feeling “foggy” or having poor concentration, slow reflexes, loss of hair, digestive issues (constipation) and weight gain. Other symptoms include feeling cold, fluid retention, aching muscles, and joints, slow speech, and depression. In some cases, women have had abnormally long cycles or excessive menstrual bleeding.
Although, not as common hyperthyroidism is the opposite. This condition is an overactive gland, excessively producing thyroid hormones.
In such cases, patients may have a higher metabolism. Signs may include tremors, nervousness, increased heart rate, anxiety, and excessive sweating. Individuals may notice a heat intolerance, more bowel movements than usual, unintentional weight loss and even difficulty concentrating.
Many individuals with hyperthyroidism notice an enlargement of their thyroid gland.
How Much Does Medicare Pay for Thyroid Tests
Thyroid disease may cause altered blood cholesterol and lipid levels, and bone density levels. However, routine screenings include tests for these levels under Part B coverage.
Outpatient facilities require beneficiaries to pay a copayment for services. Therapy services from a stand-alone facility require 20% of the amount approved by Medicare for services. The Part B deductible will apply in both situations.
All beneficiaries should have these procedures as part of a general preventive care program, no matter the possible relation to thyroid disease. Although, treatments depend on the cause of disease, level of severity and the amount of hormone production.
Any Part A deductible and coinsurance costs are the beneficiary’s responsibility when receiving inpatient services such as radiation therapy, or surgery.
For example, Laurel has hyperthyroidism. After meeting with her doctor, she must schedule an inpatient service to destroy part of her thyroid gland. Using radioactive iodine to prevent the over-production of thyroid hormones. Part A covers the costs of her inpatient services.
Medicare Coverage for Thyroid Disease Medications
However, Laurel must take anti-thyroid drugs to replace the hormones that her thyroid gland no longer makes. Once she leaves the hospital, her Medicare Part D prescription drug plan may cover the entire costs of her medications. She makes sure to use a pharmacy her policy prefers to avoid any out-of-pocket expenses.
Cancer doesn’t discriminate; yes, we’re talking about thyroid cancer. The progression and type of cancer will determine treatment options. Cases may require radiation and chemotherapy prior to and following surgery.
Part A provides coverage for chemotherapy for patients with cancer. Although, patients must be staying at an inpatient facility. Part B covers chemotherapy for outpatient and doctor’s office services.
Beneficiaries must pay the copayment for chemotherapy under Part B in an outpatient hospital facility.
Although, chemotherapy from a freestanding facility or doctor’s office requires beneficiaries to pay 20% of the amount approved by Medicare for services. Patients should review their plan’s drug formulary to ensure coverage for medications.
Thyroid Tests Medicare Covers
Doctors or health care providers may order a variety of tests such as the TSH test to determine the status of a patient’s condition. The acronym TSH is for thyroid-stimulating hormone. The TSH test tells doctors how much of the thyroid hormone is in an individual’s blood.
Depending on where a beneficiary lives, Medicare may provide coverage for many tests, services, and supplies. When a health care provider or physician orders a test, it must be medically necessary for treating the patient’s condition.
If Medicare disagrees on the need for a test, they may deny coverage for that service.
Earlier, it was said that thyroid dysfunction causes other health conditions when left without treatment. However, Medicare covers thyroid testing and relating tests/services/treatments when a beneficiary’s physician certifies it’s medically necessary.
Although, there may be some tests that Parts A and B won’t pay for. Beneficiaries may look online to determine coverage for a test, service or item. If it’s not on the list, patients should contact their health care provider.
They can explain the need for certain services, tests or supplies; this includes if Medicare offers coverage or not.
Medicare Advantage Coverage
Coverage and benefits for thyroid disease and testing are, at minimum, equal to what Medicare Parts A and B provide. Although, most Advantage plans offer additional coverage – including prescription drug benefits.
Doctors or health care providers may recommend services Medicare doesn’t cover. For some, providers may recommend services more frequently than Parts A and B will pay for. Advantage plans can help provide extra benefits.
Use a Medicare agent to determine an Advantage plan costs. Benefits and the amounts a plan charges varies among plans. Calling a plan directly can help determine how must a test or service will cost.
How Medigap Can Help Lower Expenses
Beneficiaries with a Medicare Supplement have extra coverage on services. So, instead of paying 20% of tests and services, most beneficiaries just pay a monthly premium. Although, some beneficiaries have a deductible that applies before the supplement covers.
Those with a Medicare Supplement will save money out of pocket when they use a doctor or hospital services. To discover the best policy for you contact us at the number above.
If calling isn’t an option, fill out our online rate contact form and you can get started today!