Medicare’s New Preventive Services Provide Free
Opportunity for Seniors to Stay Healthy
Affordable Care Act improvements kicked in for 2011 –
Welcome to Medicare now free for senior citizens in original Medicare -
see video
Feb. 10, 2011 - The Affordable Care
Act of 2010 has significantly expanded the "preventive services" offered
to senior citizens in Medicare but most importantly the cost has
virtually been eliminated. It provides an exciting opportunity for older
Americans - particularly those on tight budgets - to take better care of
themselves and to, hopefully, avoid or delay chronic and crippling
diseases.
In 2005, the federal government began
offering coverage for a physical exam to seniors new to original
Medicare and called it the "Welcome to Medicare Physical Exam." It was
hailed as a great advancement for maintaining good health for America's
seniors. But, only about ten percent of seniors coming into Medicare
have taken advantage of it.
It has been unclear when
participation was so low, but certainly a consideration was the cost.
Medicare patients had a 20 percent co-pay for the "Welcome To Medicare"
exam.
With the new health care reform bill
this co-pay is eliminated starting in 2011. New beneficiaries can now
start their dependence on Medicare with a free comprehensive medical
exam.
Even bigger news, however, is the
addition of a new free annual physical for seniors. After a Medicare
client has had Part B for longer than 12 months, he or she can get a
yearly wellness exam to develop or update a prevention plan, based on
the person's current health and risk factors. This exam is totally
covered once every 12 months.
Video
on what senior citizens need to know about the Affordable Care
Act.
“Preventing diseases that can be
prevented, and detecting others at earlier, more treatable stages, are
among the keystones for transforming Medicare,” said Jonathan Blum, CMS
deputy administrator and director of the Center for Medicare.
“By eliminating the beneficiary’s
out-of-pocket costs for most preventive services, we are removing a
barrier to access and paving the way for improved health for seniors and
people with disabilities who rely on Medicare for their health
coverage.”
Tobacco Cessation
Counseling
One significant addition to
preventive services is tobacco use cessation counseling. This benefit is
now considered a covered preventive service, whether or not you have
been diagnosed with an illness caused or complicated by tobacco use.
While still a covered service, the coinsurance and deductible will apply
if you have already been diagnosed with a tobacco related illness.
There will also be no Part B
deductible or copayment for these screenings, if certain criteria apply:
• Bone mass measurement
• Cervical cancer screening,
including Pap smear tests and pelvic exams.
• Cholesterol and other
cardiovascular screenings
• Colorectal cancer screening
(except for barium enemas.)
• Diabetes screening
• Flu shot, pneumonia shot, and
the hepatitis B shot
• HIV screening for people at
increased risk or who ask for the test
• Mammograms
• Medical nutrition therapy to
help people manage diabetes or kidney disease.
• Prostate
cancer screening (except digital rectal examinations.)
Some
Important Details
• For some preventive services,
you will pay nothing. You may have to pay co-insurance (a part of the
cost) for the office visit when you get these services.
• If you’re in a Medicare
Advantage Plan, check with your plan to see if these benefits will also
be free for you.
Medicare's Preventive Care Benefits
Below is a summary of the preventive
services offered by Medicare as of Feb. 11, 2011. For the latest
information, follow this link to the
Medicare Preventive Services web page.
The following information is from the Preventive Services section of
Medicare.gov on Feb. 10, 2011. For the latest information,
click here.
A one-time
screening ultrasound for people at risk. Medicare only covers this
screening if you get a referral for it as a result of your one-time
"Welcome to Medicare" physical exam. Before January 1, 2011, you pay 20%
of the Medicare-approved amount. Starting January 1, 2011, you pay
nothing for the screening if the doctor accepts assignment.
Helps to see if
you are at risk for broken bones. This service is covered once every 24
months (more often if medically necessary) for people who have certain
medical conditions or meet certain criteria. Before January 1, 2011, you
pay 20% of the Medicare-approved amount, and the Part B deductible
applies. Starting January 1, 2011, you pay nothing for this test if the
doctor accepts assignment.
Helps detect
conditions that may lead to a heart attack or stroke. This service is
covered every 5 years to test your cholesterol, lipid, and triglyceride
levels. No cost for the tests, but you generally have to pay 20% of the
Medicare-approved amount for the doctor's visit.
Colorectal cancer
is usually found in people age 50 or older, and the risk of getting it
increases with age. Medicare covers colorectal screening tests to help
find pre-cancerous polyps (growths in the colon) so they can be removed
before they turn into cancer. Treatment works best when colorectal
cancer is found early.
One or more of the
following tests may be covered. Talk to your doctor.
·
Fecal Occult Blood Test—Once every 12 months if 50 or older. You pay
nothing for the test, but you generally have to pay 20% of the
Medicare-approved amount for the doctor’s visit.
·
Flexible Sigmoidoscopy—Generally, once every 48 months if 50 or older,
or 120 months after a previous screening colonoscopy for those not at
high risk. Before January 1, 2011, you pay 20% of the Medicare-approved
amount at your doctor’s office, 25% of the Medicare-approved amount if
you get it in an outpatient hospital setting or an ambulatory surgical
center. Starting January 1, 2011, you pay nothing for this test if the
doctor accepts assignment.
·
Colonoscopy—Generally, you can get this procedure once every 120 months,
or 48 months after a previous flexible sigmoidoscopy. If your doctor
says you’re at high risk, you can get it every 24 months. There’s no
minimum age required for you to get a colonoscopy. If you get the
procedure before January 1, 2011, you’ll pay no Part B deductable, plus
20% of the Medicare-approved amount at your doctor’s office or 25% of
the Medicare-approved amount if you get it in an outpatient hospital
setting or an ambulatory surgical center. If you get the procedure on or
after January 1, 2011, you’ll pay nothing for the procedure if your
doctor accepts
assignment.
·
Barium Enema—Once every 48 months if 50 or older (high risk every 24
months) when used instead of a sigmoidoscopy or colonoscopy. You pay 20%
of the Medicare approved amount for the doctor’s services. In a hospital
outpatient setting, you also pay the hospital a copayment.
Checks for
diabetes. These screenings are covered if you have any of the following
risk factors: high blood pressure (hypertension), history of abnormal
cholesterol and triglyceride levels (dyslipidemia), obesity, or a
history of high blood sugar (glucose). Tests are also covered if you
answer yes to two or more of the following questions:
·Are
you age 65 or older?
·Are
you overweight?
·Do
you have a family history of diabetes (parents, siblings)?
·Do
you have a history of gestational diabetes (diabetes during pregnancy),
or did you deliver a baby weighing more than 9 pounds?
Based on the
results of these tests, you may be eligible for up to two diabetes
screenings every year. No cost for the test, but you generally have to
pay 20% of the Medicare-approved amount for the doctor's visit.
For people with
diabetes. Your doctor or other health care provider must provide a
written order. You pay 20% of the Medicare-approved amount, and the Part
B deductible applies.
Helps prevent
influenza or flu virus. Generally covered once a flu season in the fall
or winter. You need a flu shot for the current virus each year. No cost
to you for the flu shot if the doctor or other health care provider
accepts assignment for giving the shot. Note: Medicare Part B also
covers administration of the H1N1 flu shot. You pay nothing if your
doctor accepts assignment for giving the shot.
Helps find the eye
disease glaucoma. Covered once every 12 months for people at high risk
for glaucoma. You are considered high risk for glaucoma if you have
diabetes, a family history of glaucoma, are African-American and age 50
or older, or are Hispanic and age 65 or older. An eye doctor who is
legally authorized by the state must do the tests. You pay 20% of the
Medicare-approved amount, and the Part B deductible applies for the
doctor’s visit. In a hospital outpatient setting, you also pay the
hospital a copayment.
Helps protect
people from getting Hepatitis B. This is covered for people at high or
medium risk for Hepatitis B. Your risk for Hepatitis B increases if you
have hemophilia, End-Stage Renal Disease (ESRD), or a condition that
increases your risk for infection. Other factors may increase your risk
for Hepatitis B, so check with your doctor. Before January 1, 2011, you
pay 20% of the Medicare-approved amount, and the Part B deductible
applies. Starting January 1, 2011, you pay nothing for the shot if the
doctor accepts assignment.
Medicare covers
HIV screening for people with Medicare who are pregnant and people at
increased risk for the infection, including anyone who asks for the
test. Medicare covers this test once every 12 months or up to 3 times
during a pregnancy. You pay nothing for the test, but you generally have
to pay the doctor 20% of the Medicare approved amount for the doctor’s
visit.
A type of X-ray to
check women for breast cancer before they or their doctor may be able to
find it. Medicare covers screening mammograms once every 12 months for
all women with Medicare age 40 and older. Medicare covers one baseline
mammogram for women between ages 35–39. Before January 1, 2011, you pay
20% of the Medicare-approved amount. Starting January 1, 2011, you pay
nothing for the test if the doctor accepts assignment.
Medicare may cover
medical nutrition therapy and certain related services if you have
diabetes or kidney disease, or you have had a kidney transplant in the
last 36 months, and your doctor refers you for the service. Before
January 1, 2011, you pay 20% of the Medicare-approved amount, and the
Part B deductible applies. Starting January 1, 2011, you pay nothing for
the test if the doctor accepts assignment.
Checks for
cervical, vaginal, and breast cancers. Medicare covers these screening
tests once every 24 months, or once every 12 months for women at high
risk, and for women of child-bearing age who have had an exam that
indicated cancer or other abnormalities in the past 3 years. No cost to
you for the Pap lab test. Before January 1, 2011, you pay 20% of the
Medicare-approved amount for Pap test specimen collection, and pelvic
and breast exams. Starting January 1, 2011, you pay nothing for Pap test
specimen collection, and pelvic and breast exams if the doctor accepts
assignment.
Medicare covers a
one-time
“Welcome to Medicare” physical exam, if you get it within the first
12 months you have Part B. It’s a review of your health, plus education
and counseling about preventive services, and referrals for other care
you may need. Before January 1, 2011, you pay 20% of the
Medicare-approved amount. Starting January 1, 2011, you pay nothing for
the "Welcome to Medicare" exam if the doctor accepts assignment. When
you make your appointment, let your doctor’s office know you’d like to
schedule your “Welcome to Medicare”
If you’ve had Part
B for longer than 12 months, you can get a yearly wellness visit to
develop or update a prevention plan just for you, based on your current
health and risk factors. Medicare does not cover this exam before
January 1, 2011. Starting January 1, 2011, you’ll pay nothing for this
exam if the doctor accepts assignment. This exam is covered once every
12 months.
You don’t need to
get the “Welcome to Medicare” physical exam before getting a yearly
“Wellness” exam, but if you do choose to get the “Welcome to Medicare”
physical exam, you’ll have to wait 12 months before you can get your
first yearly “Wellness” exam.
Helps prevent
pneumococcal infections (like certain types of pneumonia). Most people
only need this preventive shot once in their lifetime. Talk with your
doctor. No cost if the doctor or supplier accepts assignment for giving
the shot.
Helps detect
prostate cancer. Medicare covers a digital rectal exam and Prostate
Specific Antigen (PSA) test once every 12 months for all men with
Medicare over age 50 (coverage for this test begins the day after your
50th birthday). You pay 20% of the Medicare-approved amount, and the
Part B deductible applies for the doctor's visit. You pay nothing for
the PSA test. In a hospital outpatient setting, you also pay the
hospital a copayment.
Includes up to 8
face-to-face visits in a 12-month period if you are diagnosed with an
illness caused or complicated by tobacco use, or you take a medicine
that is affected by tobacco. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies. In a hospital outpatient
setting, you also pay the hospital a copayment.
Note: Medicare
coverage of smoking cessation counseling is now considered a covered
preventive service if you haven’t been diagnosed with an illness caused
or complicated by tobacco use. Starting January 1, 2011, you pay nothing
for the counseling sessions.
Medicare's Preventive Services Checklist
Take this checklist to your doctor or
other health care provider, and ask which preventive services are right
for you.
You can also track your preventive
services on
MyMedicare.gov! Get a two-year calendar of the Medicare-covered
tests and screenings you’re eligible for, and print a personalized “on
the go” report to take to your next doctor’s appointment.
