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Medicare News

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

Click for details on Welcome to Medicare exam

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.

 

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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.

Learn what the exam includes and how you can take advantage of this benefit. (Medicare site for consumers)

New Free Annual Physical 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.

Abdominal Aortic Aneurysm Screening

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.

Bone Mass Measurement

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.

Cardiovascular Screenings

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.

Colon Cancer Screening (Colorectal)

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.

Diabetes Screenings

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.

Diabetes Self-Management Training

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.

Flu Shots

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.

Glaucoma Tests

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.

Hepatitis B Shots

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.

HIV Screening

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.

Breast Cancer Screening (Mammograms)

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.

Medical Nutrition Therapy Services

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.

Pap Tests and Pelvic Exams (includes clinical breast exam)

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.

Physical Exam

Starting January 1, 2011, Medicare will cover two types of physical exams—one when you’re new to Medicare and one each year after that.

One-time “Welcome to Medicare” physical exam

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”

Yearly “Wellness” exam

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.

Pneumococcal Shot

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.

Prostate Cancer Screenings

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.

Smoking Cessation (counseling to stop smoking)

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.   

Medicare Covered Test/Screening/Service

Date You Got This Test/Screening/Service

Next Test/Screening Service Due

Abdominal Aortic Aneurysm Screening

 

 

Bone Mass Measurement         

 

 

Cardiovascular Screening

 

 

Colorectal Cancer Screening

 

 

Fecal Occult Blood Test

 

 

Flexible Sigmoidoscopy

 

 

Colonoscopy

 

 

Barium Enema     

 

 

Diabetes Screening

 

 

Diabetes Self-management Training

 

 

Flu Shot

 

 

Glaucoma Test

 

 

Hepatitis B Shot

 

 

HIV Screening

 

 

Mammogram

 

 

Medical Nutrition Therapy Services

 

 

Pap Test and Pelvic Exam  (includes breast exam)

 

 

“Welcome to Medicare”

 

 

Physical Exam: Yearly “Wellness” exam

 

 

Pneumococcal Shot

 

 

Prostate Cancer Screening

 

 

Smoking Cessation Counseling

 

 

 

>> About Medicare's Preventive Services at HealthCare.gov.

>> About Medicare's Preventive Services at Medicare.gov

 

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