Not too many years ago, we would take calls from people turning age 65 and investigating Medicare supplement plans. Invariably, the conversation would turn to preventative benefits which have long been available on the individual and group market for people not on Medicare. The voice on the other side would go silent when we informed them that neither Medicare or Medicare supplement insurance plans would cover preventative benefits. It really was a shocker since you couldn’t blink without seeing another article or tv show on the important of preventative benefits to not only remain healthy but bring down the cost of health care in general since catching a big problem before it’s a big problem is pennies on the dollar in today’s world. Luckily, we finally have better news on that front when we get those calls. Let’s take a look at Medicare and preventative benefits.
First, let’s look at traditional Medicare where most of the preventative benefits reside now. Preventative benefits are covered under Part B of Medicare. We’ll get into the current benefits offered but it’s important to mention that you get a preventative benefit covered when first enrolling and then once per year after that which will be covered at 100% by Medicare. Preventative benefits are not covered by the Medicare supplement insurance although Advantage plans may have additional benefits beyond what Medicare dictates as part of its preventative benefit offering. Now, let’s take a look at the actual benefits as they exist today. It’s important to look at your current Medicare and You Handbook under Part B benefits or online to confirm any changes or additions to Preventative benefits. Part B co-insurance, deductibles, etc may apply to certain preventative benefits so make sure to check first to understand your full out of pocket expense if any.
Make sure to check the Medicare site for Preventative services as these can change going forward and this information is based on 10/1/11.
Abdominal Aortic Aneurysm Screenings
A one-time screening ultrasound for people at risk.
Bone Mass Measurements
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.
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.
Colon Cancer Screenings (Colorectal)
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.
Diabetes 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). Based on the results of these tests, you may be eligible for up to two diabetes screenings every year.
Diabetes Self-Management Training
Your doctor or other health care provider must provide a written order.
Medicare covers a one-time screening EKG if you get a referral for it as a result of your one-time “Welcome to Medicare” Preventive Visit.
Covered once a flu season in the fall or winter.
Covered once every 12 months for people at high risk for glaucoma.
Hepatitis B Shots
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. You pay 20% of the Medicare-approved amount, and the Part Bdeductible applies.
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 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.
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.
Pap Tests and Pelvic Exams
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.
Medicare will cover two types of preventive visits–one when you’re new to Medicare and one each year after that.
Most people only need this preventive shot once in their lifetime.
Prostate Cancer Screenings
Medicare covers a digital rectal exam and Prostate Specific Antigen (PSA) test once every 12 months for all men with Medicare over age 50.
Smoking Cessation (counseling to stop smoking)
Medicare covers smoking cessation counseling as a preventive serviceand you’ll pay nothing for the counseling sessions.