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.
A one-time screening ultrasound for people at risk.
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.
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.
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
Covered once a flu season in the fall or winter.
Covered once every 12 months for people at high risk for glaucoma.
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
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.
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.
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.
Medicare covers a digital rectal exam and Prostate Specific Antigen
(PSA) test once every 12 months for all men with Medicare over age
Medicare covers smoking cessation counseling as a preventive
serviceand you'll pay nothing for the counseling sessions.