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Seniors Need to Take Advantage of Medicare
Preventive Programs
Caregivers, family need to spread the word on
available services
By Tucker Sutherland, editor
July 15, 2005 – New programs were added to Medicare
in January of this year to increase the “preventive services” offered to
senior citizens by the healthcare program. The rationale being that
preventing disease in beneficiaries will save the cost of expensive
treatment programs later, and, or course, help older Americans live
healthier, happier lives. The problem, however, is a common one – how to
be sure senior citizens “get the word.”
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Beginning in 2005, all newly enrolled Medicare
beneficiaries are covered for an initial physical examination, including
cardiovascular screening blood tests. Those at risk are covered for a
diabetes screening test aimed at early detection and treatment of this
life-threatening condition.
> Welcome to Medicare Physical. The
initial preventive physical will consist of a comprehensive examination
that will allow the physician to diagnose problems early when treatment
is more effective. In addition the physician and office staff will
provide education, counseling and referral to other preventive services
covered by Medicare.
> Cardiovascular Screening Tests. Medicare
covers cardiovascular screening blood tests, including tests for total
cholesterol, high density lipoprotein, and triglycerides. Beneficiaries
will be allowed to be screened every five years in keeping with
recommendations from the Unites States Preventive Services Task Force.
There will be no deductible or co-pay for these tests.
Cardiovascular disease is the number one killer in
the United States. Every year, some 950,000 persons die from this
condition with 84 percent of those deaths occurring in people aged 65
and older. In 2001, more than 6 million Americans were admitted to the
hospital with a diagnosis of cardiovascular disease, of which 64.5
percent were 65 or older.
> Diabetes Screening Tests. Diabetes
ranks as the sixth leading cause of death, and was responsible for more
than 71,000 deaths in 2001. In addition, 562,000 Americans were
admitted to the hospital with a diagnosis of diabetes, or whom 36.6
percent were 65 and older. These tests include a fasting plasma glucose
test and post-glucose challenges. Beneficiaries eligible for this
screen will not have to meet a deductible or co-pay for the test.
Medicare allows for diabetes screening tests up to twice year.
These benefits are in accordance with guidelines
from the United States Preventive Services Task Force. These benefits
are in line with and complement several administrative initiatives such
as Healthy People 2010, Steps to a Healthier US, Secretary’s Diabetes
Detection Initiative, and Healthy Communities.
Background: Each year, hundreds of thousands of
Americans die prematurely as a result of diseases that often are
preventable, such as heart disease, cancer, and diabetes. Evidence
suggests that catching a disease in its early stages brings better
prognosis for the patient. The course of many of these chronic diseases
can be dramatically slowed with proper behavioral modifications and
lifestyle changes. This points to the need for the early detection that
screening provides.
The number of Americans with these diseases is
staggering. Heart disease and stroke—the principal components of
cardiovascular disease—are the first and third leading causes of death
for both men and women in the United States, accounting for nearly 40%
of all deaths.
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In addition, according to CDC, one in five adults age 65 and over has
diabetes. A third of people with diabetes don’t know they have it. The
costs of these diseases to both individuals and to society are
staggering.
The economic impact of cardiovascular disease on
the U.S. health care system continues to grow as the population ages.
The cost of heart disease and stroke in the United States is projected
to be $368 billion in 2004, including health care expenditures and lost
productivity from death and disability.
Approximately 129 million U.S. adults are
overweight or obese which costs between $69 billion to $117 billion per
year. Smaller amounts might be spent preventing these conditions. There
is accumulating evidence that much of the morbidity and mortality
associated with these chronic diseases may be preventable. These new
benefits can be used to screen Medicare beneficiaries for many illnesses
and conditions that, if caught early, can be treated and managed, and
can result in far fewer serious health consequences.
Other Preventive Benefits
When Medicare was established in 1965, it only
provided services for the diagnosis and treatment of illness or injury.
Preventive services were not covered. As the value of preventive
services has become better understood, Congress has amended the Medicare
law in an effort to expand coverage of preventive benefits.
Both the Balanced Budget Act of 1997 (BBA) and the
Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of
2000 (BIPA) significantly added to the preventive benefits covered by
Medicare. These benefits include:
> Mammography screening: BBA provided
coverage for an annual screening mammogram for all women Medicare
beneficiaries age 40 and over, and one baseline mammogram for women age
35-39. There is no Part B deductible for screening mammography. BIPA
moved payment for screening mammography to the physician fee schedule
and also specified payment for two new forms of mammography that use
digital technology
> Screening Pap Smears and Pelvic Exams:
BBA provided coverage for a screening Pap smear and pelvic exam
(including a clinical breast exam) every 3 years, or annual coverage for
women of childbearing age who have had an abnormal Pap smear during the
preceding 3 years, or women at high risk for cervical or vaginal
cancer. There is no Part B deductible for screening pap smears and
pelvic exams. BIPA increased the frequency of coverage for screening
Pap smears and pelvic exams (including a clinical breast exam) from
every 3 years to every 2 years for women at average risk.
> Colorectal Cancer Screening: BBA
provided new coverage for colorectal cancer screening procedures
including (1) annual fecal-occult blood tests for persons age 50 and
over, (2) flexible sigmoidoscopy for persons age 50 and over, every 4
years, (3) colonoscopy for persons at high risk for colorectal cancer,
every 2 years, and (4) other procedures the Secretary finds appropriate.
Barium enemas are also covered, as an alternative to flexible
sigmoidoscopy or colonoscopy. BIPA expanded coverage of screening
colonoscopies to include all beneficiaries, not just those at high risk
for colorectal cancer.
> Prostate Cancer Screening: BBA
provided coverage of annual prostate cancer screening for men over age
50, including (1) digital rectal exams, (2) prostate-specific antigen
(PSA) blood tests, and (3) after 2002, other procedures the Secretary
finds appropriate.
> Glaucoma screening: BIPA provided
coverage of annual glaucoma screening for individuals at high risk for
glaucoma, individuals with a family history of glaucoma, and individuals
with diabetes.
> Medical nutrition therapy services: BIPA
provided coverage of medical nutrition therapy services for
beneficiaries who have diabetes or a renal disease. Covered services
include nutritional diagnostic, therapy and counseling services for the
purpose of disease management, which are furnished by a registered
dietician or nutrition professional, pursuant to a physician’s referral.
> Self-management training for beneficiaries
with diabetes: These services are provided by certified diabetes
educators.
> Standardization of Coverage for Bone Mass
Measurements: BBA provided coverage for bone mass measurement
procedures, including a physicians interpretation of the results, for
estrogen-deficient women at risk for osteoporosis, and persons (1) with
vertebral abnormalities, (2) receiving long-term glucocorticoid steroid
therapy, (3) with primary hyperparathyroidism, and (4) being monitored
for response to an osteoporosis drug.
> Vaccines Outreach Extension: BBA
extended through FY 2002 the existing Influenza and Pneumococcal
Vaccination Campaign conducted by HCFA in conjunction with CDC and the
National Coalition for Adult Immunization. Medicare covers influenza,
pneumococcal, and hepatitis B vaccinations, including payment for the
vaccine plus payment for a physician’s administration of the vaccine.
> Study on Preventive and Enhanced Benefits:
BBA required an analysis of short and long term costs and benefits of
expanding or modifying preventive or other services covered by Medicare,
to be conducted by the National Academy of Sciences in conjunction with
the U.S. Preventive Services Task Force. The study was completed in
December 1999.
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