26, 2011 - Despite tough economic times, there are some things the
government can’t give away. Starting this year, seniors enrolled in
Medicare no longer have to pay for more than a dozen tests and other
services to help prevent or control cancer and other costly and
debilitating diseases. These benefits, which also include an annual
wellness exam, are part of the new federal health-care law.
But big crowds aren’t lining up for free mammograms
or colonoscopies, although early data indicate that the free wellness
checkup is luring patients.
Advocates say details about the new benefits
haven’t reached enough seniors, and Medicare’s information about it
isn’t easily accessible and can be confusing.
"Our hope is that by waiving cost-sharing and
making preventive care more affordable, more beneficiaries will get it,"
said Jonathan Blum, deputy administrator at the Centers for Medicare and
At a senior center in Reston, roughly 35 people
recently attended a "Medicare 101" meeting that provided information
about the free services.
Howard Houghton, director of the Fairfax County
senior health insurance information program, said he warned the seniors
not to delay calling their doctor. "You want to do it sooner than later
because this law might get repealed," he said. "The law might change, so
why take a chance?"
Even doctors have had some trouble figuring out
what tests and exams are free and for which patients. Medicare is now
paying all costs for most services that earned top ratings from the U.S.
Preventive Services Task Force, an advisory group of medical experts.
But if patients receive those services more often than recommended or
don’t have risk factors to qualify for the tests, they can be charged a
co-payment. In some cases, seniors may still have to pay for an office
visit, even if the screening or test they receive is free.
To help clear things up, the American Medical
Association issued a two-page guide for doctors. That’s in addition to
e-mails that Medicare has sent to physicians and their professional
Steven Schwartz, a family physician in Kensington
who also teaches at Georgetown University’s medical school, said his
group practice developed its own checklist of the preventive services
and is contacting Medicare patients who haven’t had a wellness exam.
In 2008, when co-payments were required for many of
the tests and screenings that are now free, only a minority of
traditional Medicare beneficiaries in the District, Maryland and
Virginia received them.
Fewer than 4 percent took advantage of the one-time “Welcome to
Medicare” physical exam.
Fewer than 10 percent were tested that year for diabetes.
Only 36 to 41 percent of women received mammograms.
Only 12 to 15 percent of women got bone density tests.
Fewer than 20 percent of men received prostate cancer screenings.
And even though the flu shot was available for free before 2011, fewer
than half got one.
A list of which preventive services are now free
and other information are included in the "Medicare & You" handbook
(available at www.medicare.gov or at 800-MEDICARE), the user’s manual
sent to all 48 million Medicare beneficiaries. A 48-page Medicare guide
on preventive benefits is also available online at
But Joe Baker, president of the nonprofit Medicare
Rights Center, said seniors usually read the handbook only when they
have questions about a benefit. "If they haven’t heard about it, they're
not going to look for it," he said.
One reason why seniors may not pay attention to the
changes is that they have purchased a supplemental insurance policy or a
Medicare Advantage managed-care plan that already offers some preventive
health services without additional charges.
But cost isn't the only reason that seniors may not
be receiving preventive health services. Some people worry about whether
procedures will be uncomfortable, and many are afraid of hearing bad
"It's human nature to put off things that aren't
pleasant," she said.
Blum thinks that attitude may be changing. In just
the first three months of this year, almost 300,000 seniors nationwide
received the new free wellness exam.
"Based upon what we've seen so far, we are very
optimistic that we will have a greater proportion of beneficiaries who
will take advantage of the preventive benefits," said Blum.