Understanding Medicare Preventive Benefits

The Affordable Care Act increased the number of preventative services Medicare offers and eliminated cost sharing on many of them. If your doctor accepts assignment under Medicare, which means that he or she accepts the Medicare payment as the full payment for services, there is no longer cost sharing for many preventative benefits. Here is a brief summary of the preventive benefits that are now available. For additional information, call 1-800-MEDICARE or see www.medicare.gov.

Abdominal Aortic Aneurysm Screening

  • Medicare beneficiaries with certain risk factors may qualify for these screenings. You must get the referral for the ultrasound during your Welcome to Medicare physical, and receive the ultrasound within the first 12 months that you have Part B. You pay nothing for the screening if your doctor accepts assignment.

Bone Mass Measurements

  • Medicare covers bone mass measurements to determine whether you are at risk for a fracture (broken bone). The procedure is covered every 24 months, or every 12 months if you are at high risk.

Cardiovascular Screening

  • Every five years, Medicare will cover screening tests to check cholesterol and other blood fat (lipid) levels. High levels of cholesterol can increase your risk for heart disease and stroke. You may have to pay the 20% of Medicare approved amount for the doctor’s visit.

Colorectal Screening
Medicare covers screening tests to help find pre-cancerous polyps (growths in the colon).

  • Fecal Occult Blood Test - Once every 12 months and you pay nothing.
  • Flexible Sigmoidoscopy - Once every 48 months and you pay 20% of the Medicare-approved amount after the yearly Part B deductible - or 25% if done as outpatient in a hospital. If a polyp is found, you may have to pay 20% of the Medicare approved amount of the doctor’s services, or a copay if it is done as an outpatient procedure.
  • Screening Colonoscopy Once every 24 months (if you're at high risk) Once every 10 years, but not within 48 months of a screening sigmoidoscopy (if you're not at high risk). You do not pay for the screening colonoscopy. However, if a polyp is found, you may have to pay 20% of the Medicare approved amount of the doctor’s services, or a copay if it is done as an outpatient procedure.
  • Barium Enema - Covered every 24 months if you are at high risk for colorectal cancer and every 48 months if you aren't at high risk. You pay 20% of the Medicare-approved amount after the yearly Part B deductible - or a copay if it is an outpatient procedure.

Diabetes

  • Screening (Fasting Plasma Glucose Test): Up to two screenings each year depending on risk factors. No cost to beneficiary.
  • Diabetes Glucose Monitors, Test Strips, Lancets and Self-Management Training: 20% co-pay for Medicare approved fee after the Part B deductible.

Glaucoma

  • Individuals at risk are eligible for glaucoma screening every 12 months, but must pay a 20% co-pay of the Medicare approved fee after the Part B deductible.

HIV Screening

  • Medicare covers a screening test for HIV once every 12 months, or up to 3 times in a year for pregnant women. You will have to pay 20% of the rate for the doctor’s visit, but you do not have to pay for the test itself.

Mammograms

  • Medicare will cover screening mammograms every 12 months. >/p> Pap Test and Pelvic Exam
  • Medicare covers these procedures once every 24 months (or every 12 months for certain high risk individuals).

Physical Exam

  • Medicare offers a free “Welcome to Medicare” physical exam within twelve months of enrollment. You are also entitled to a yearly wellness visit.

Shots

  • Influenza Vaccine (flu shot) - Available once a year in fall or winter for no charge.
  • Pneumoccal Vaccine - Usually needed only once in a lifetime and there is no charge.
  • Hepatitis B Vaccine - Usually a series of 3 shots and is covered for certain high risk persons with a co-pay of 20% of the Medicare approved fee.

Smoking Cessation

  • Medicare will cover up to 8 smoking cessation visits within a year.

Medicare now covers screenings for depression, obesity and alcohol misuse.
Depression

  • Medicare now covers one depression screening per year, for which you pay nothing.

Alcohol Misuse

  • Medicare covers an alcohol misuse screening, for which you pay nothing. It may also cover up to 4 counseling sessions per year if you screen positive.

Obesity Counseling

  • Medicare will cover weight loss counseling sessions for individuals with BMIs over 30.
Healthy Living
  • Cost to the beneficiary is priceless. Maintaining a healthy lifestyle can do more to reduce your medical costs and maintain your standard of living than anything else.
  • According to the AoA: Many Americans fail to make the connection between undertaking healthy behaviors today and the impact of these choices later in life. Studies by the National Institute of Aging indicate that healthy eating, physical activity, mental stimulation, not smoking, active social engagement, moderate use of alcohol, maintaining a safe environment, social support, and regular health care are important in maintaining health and independence. Promoting the healthy lifestyles of older people is vital in helping them to maintain health and functional independence and lead healthy and independent lives.
  • For more information on AoA’s program to promote healthy aging see www.aoa.gov. Look under the Elders and Families tab for the page titled “Promoting Healthy Lifestyles."

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