Medicare Preventive Services
1.“ Welcome to Medicare ”
Don’t let the name fool you; this isn’t just a friendly message from the government.
Well, of course, it is. But it’s also a free one-time preventive visit that you can take advantage of within 12 months of enrolling in the Medicare Part B Program.
During the appointment, you can expect advice from your doctor about your overall health and disease prevention.
More importantly, however, you should receive a checklist letting you know what other Medicare Preventative Services you should avail.
Moreover, this is why your “Welcome to Medicare” visit should be the first item on your Medicare Preventive Services Checklist for 2019.
Be sure to bring the following to your appointment:
- Your medical records. If you’re seeing a new doctor, try to forward the files from your old doctor to the new one.
- Your family health history. This information will help your doctor determine if you are at risk for any illnesses or diseases.
- A list of your prescriptions and any over-the-counter drugs you take.
2.Yearly “Wellness” Visit
The next Medicare Preventive Service that everyone under Medicare Part B should take advantage of is the Annual “Wellness” Visit.
After you’ve been on Part B for at least 12 months, you can visit your doctor to develop (or update) a personalized prevention plan.
You will also take a “Wellness Exam” that will screen you for various things.
Now don’t break out into a cold sweat, this isn’t your typical school exam. It’s used interchangeably with “Annual Wellness Visit,” so don’t be nervous!
Also, in case you’re wondering, you needn’t have gone to the “Welcome to Medicare” preventive visit first.
However, if you did not do it, then you should bring the items mentioned in the previous section to your “Wellness” appointment.
If you DID do the “Welcome to Medicare” visit though, you’d have to wait one year to schedule your “Wellness” visit.
Medicare Preventive Services For Women
3.Medicare Well Woman Exam
Oh no, more exams!
Luckily this one can be done at the same time as the Annual Wellness Exam. It’s almost the same too, except you can also receive a pap smear and a pelvic and breast exam.
4.Cervical and Vaginal Cancer Screening
Speaking of pap smear and pelvic and breast exams, these are also covered for all women under Medicare to check for cervical and vaginal cancers.
You are covered under Medicare for one free screening test every 2 years or annually if you’re at high risk.
High-risk factors for these cancers include:
- You have a history of STIs (including HIV).
- You’ve suffered from cervical or vaginal cancers in the past.
- You had atypical pap test results.
- You had five or more sexual partners.
- You had sex before the age of 16.
- Your mother took DES (Diethylstilbestrol) while she was pregnant with you.
For women, breast cancer is the most common non-skin-related cancer. It’s also the leading cause of cancer death in the US.
Thankfully, however, it can be detected early. Mammogram screenings and other technologies are fantastic for this.
Free mammograms are available under Medicare: one free mammogram for women between age 35-39, and one free mammogram per year for women 40 and older.
Of course, you’re probably wondering if you’re at risk. Unfortunately, every woman is at risk to varying degrees.
Risk factors for breast cancer include the following:
- Close family members with breast cancer.
- You experienced a previous instance of breast cancer.
- You never had a baby, or if you did, had it after age 30.
Medicare Preventive Shots
Many of us grew up hearing from our parents, “remember to get your shots.” Perhaps because these shots prevent infections that usually affect older people (especially those over 65) the most.
So, unsurprisingly, Medicare provides coverage for the following essential shots: Flu, pneumococcal infections, and Hepatitis B.
- The flu shot is covered once per flu season.
- Pneumococcal shot for most people is administered only once in a lifetime. A second shot should also be scheduled after the first one. Talk to your doctor first to find out if you need these shots.
- Hepatitis B shots are allowed for patients declared by doctors to be particularly susceptible to Hepatitis B. These patients often include those with Diabetes, ESRD, Hemophilia, and other conditions that increase the risk of getting Hepatitis B.
Medicare Preventive Services For Cancer
7.Colorectal Cancer Screening
Also known as a colonoscopy, this will help to detect pre-cancerous polyps in the colon. These are growths that lead to Colorectal Cancer.
Finding these growths at the early stages and removing them is the key to treating cancer.
So who’s covered for colonoscopies then?
Here’s the bottom line:
Colonoscopies are covered for everyone with Medicare ages 50 and up. However, you don’t necessarily have to be 50 years old to be covered for a colonoscopy. It depends if you have certain medical conditions.
The frequency of coverage, on the other hand, is quite varied depending on different situations and goes outside the scope of this post.
Costs can also vary depending on the type of colonoscopy as well as the severity of the results.
For instance, if polyps are discovered and removed, you might have to pay 20% of the Medicare-approved total for the doctor’s services.
8.Lung Cancer Screening
Lung cancer mainly affects smokers but can happen to nonsmokers as well. However, only current or former (within the past 15 years) smokers from ages 55-77 can qualify for covered lung cancer screenings under Medicare.
Alternatively, people with a minimum tobacco smoking history of 30 “pack years” (an average of one pack per day) can qualify too.
If you qualify, you’ll be covered for one free lung cancer screening every year.
No matter your smoking history, you must also get a written order of approval from the qualified physician who will do the screenings.
Because here’s the truth about lung cancer screenings:
They are not for everyone. Lung cancer screenings come with risks at varying degrees, depending on the type of testing.
You’ll want to discuss the pros and cons of this screening during an appointment with your doctor.
9.Prostate Cancer Screening
There are two kinds of prostate cancer screenings covered under Medicare: digital rectal examination and PSA test. Both can be availed of once each year by men over the age of 50.
However, unlike many other Medicare preventive services, you might have to share some of the costs.
If you have Original Medicare, and after paying the annual Part B deductible, you’ll pay 20% of the total Medicare-approved amount. This cost does not apply to the PSA test, however.
To determine if you’re at risk for prostate cancer, you should speak to your doctor.
Medicare Preventive Services For Diseases
10.Cardiovascular Disease Screening
Cardiovascular disease (CVD) is an umbrella term for diseases affecting the heart and blood vessels.
The term is often used interchangeably with heart disease.
This makes sense when you consider the fact that 610,000 deaths of men and women every year (1/4 of all deaths) in the United States are the result of heart disease alone!
CVD also includes coronary artery diseases (the cause of heart attacks), stroke, heart failure, and the list goes on.
Therefore, it’s in the best interest of the federal government and taxpayers to cover everyone for cardiovascular disease screening. Which is why this is one of the few screenings that everyone qualifies for under Medicare.
Each person under Medicare can avail one covered screening per year.
Diabetes is a life-altering condition. It occurs when the body doesn’t produce enough insulin or has a reduced response to it.
Checking blood sugar levels often is a part of life for people with diabetes.
Under Medicare, there’s coverage for both screenings as well as self-management training.
Diabetes screening, aka the fasting blood glucose test, is covered for Medicare recipients who are at risk of diabetes and who get a referral from their doctor.
You may be eligible for up to 2 diabetes screenings every year, depending on your screening results.
Self-management training is also essential for people with diabetes. As we said, it’s a life-altering condition that requires adjustments as well as reassurance.
However, as a person with diabetes, you’ll still be able to achieve success and live a long and happy life.
To be covered for the self-management training, you’ll need a written order from a doctor. If covered under Original Medicare, you’ll also have to pay the Part B deductible as well as 20% of the Medicare-approved total.
There are many risk factors for diabetes that goes outside the scope of this post, but it’s well worth it for everyone to read up on the condition as it can happen to anyone.
12.Medical Nutrition Therapy
In addition to the self-management training, Diabetics can also receive medical nutrition therapy (MNT).
Nutrition professionals, specialists, and registered dietician nutritionists (RDNs) provide MNT. Its role is typically to reduce the risk of complications in several pre-existing conditions (like type 2 diabetes).
MNT is also provided to certain people who have renal disease (people with kidney disease but aren’t on dialysis) or have had a kidney transplant within the last 3 years (with a doctor’s referral note).
Assuming that you qualify for MNT, you’ll receive 3 free hours of one on one counseling in the first year.
The following years after that, you’ll receive 2 hours of counseling per year.
However, the number of hours can be bumped up higher if your treatment worsens and you get a doctor’s referral.
Obesity is an epidemic in America. However, did you know that obesity is actually classified as a disease?
It used to be a matter of debate, but not so much anymore. Most prestigious organizations, including the Mayo Clinic and the American Medical Association, classified obesity as a disease years ago already.
Since obesity often leads to further health problems, everyone who’s covered under Medicare and with a body mass index (BMI) over 30 can get screened for it. Having a BMI over 30 is considered obese.
Intensive behavioral therapy is available, as well. After all, habits are among the hardest things to change about ourselves. Medicare is luckily here to help obese people do just that.
For more information about this Medicare Preventive Service, including counseling, you should consult with your primary practitioner.
Medicare Preventive Services For STIs
There are many different kinds of STIs. Medicare covers screenings for the main ones: Hepatitis B, Chlamydia, syphilis, and gonorrhea.
If you’re pregnant or were previously determined to be at increased risk of STIs, then you’ll be covered for these Medicare preventative services.
Tests are covered once every 12 months or at specific periods during pregnancy.
Coverage also includes up to two 20-30 minute face-to-face sessions of intense behavioral counseling each year for individuals at high risk for STIs.
However, it’s important to note that these counseling sessions must be conducted in a primary care setting by a primary care doctor or practitioner. Otherwise, Medicare will not cover them.
HIV is one of the most dangerous STIs. Left untreated for 10 years, it will progress into AIDS.
Starting antiretroviral therapy (ART) as soon as you’re diagnosed HIV positive is critical.
HIV screenings are covered for any Medicare recipient who asks.
You can take the test once every year, or up to 3 times if you’re a pregnant woman.
Medicare Preventive Services For Substance Abuse
Alcoholism is a terrible affliction. It comes in many different forms. The two that are considered by Medicare are “alcohol misuse” and “alcohol dependence.”
What do these terms mean in plain English?
Alcohol dependence means the same thing as alcoholism. It means that a person has an uncontrollable urge to drink alcohol.
It can even become a physical dependence if the condition worsens enough.
Alcohol misuse, on the other hand, is when you drink in a way that can be harmful.
Misuse can be considered as the crossover point from occasional hangovers interfering with your work-life balance, to habitual and harmful addiction. Now let’s take a look at Medicare Preventive Services for alcohol misuse…
You can have one screening every year. If your primary care practitioner determines that you’re misusing alcohol, you can choose to go to 4 brief face to face counseling sessions per year.
This counseling must take place in a primary care setting (such as a doctor’s office)
17.Tobacco Use Cessation Counseling
Smoking truly is one of the worst silent killers of our time.
Not only is smoking itself linked to lung cancer, but it has also been shown to lead to other diseases.
According to the U.S. Surgeon General, people who stopped smoking and using other forms of tobacco significantly reduced their risk for certain diseases.
There are also several health benefits (even for older adults) of quitting smoking even if you’ve smoked for years.
In short, any tobacco user can get the help they need under Medicare.
You are covered with up to 8 face to face visits over a 1-year timeframe. The appointments must be presided over by a qualified Medicare-approved doctor.
Other Medicare Preventive Services
18.Abdominal Aortic Aneurysm Screening
Here we have an example of a potential smoking-related illness.
Those at the most risk of abdominal aortic aneurysm are men ages 65-75 who have smoked 100 cigarettes during their life. You’re also at higher risk if they run in your family.
Even for non smokers, the U.S. Preventive Services Task Force (USPSTF) recommends selective screening for men ages 65-75. If you fit in this age range, you’ll want to discuss this with your doctor.
For this screening, you’re only covered once during your lifetime with a referral from your doctor.
19.Bone Mass Measurements
These are necessary due to the disease Osteoporosis. This disease can make your bones brittle and more vulnerable to fracturing and/or breaking.
Your healthcare professional can walk you through several steps to creating a healthy regimen for making your bones stronger.
The first step is getting bone mass measurements. This is free for Medicare patients whose doctors say are at risk of osteoporosis.
One of these conditions must also be determined as a risk factor for osteoporosis
- A woman who is estrogen deficient as declared by the doctor
- Taking osteoporosis drugs
- Vertebral abnormalities showed in X-rays
- Received or planning to take steroids
These measurements can be covered by Medicare every 2 years or more often if medically required.
Yes, depression is considered a medical illness and is covered under Medicare.
This is quite fortunate since estimates show that at least 6.7% of American adults may be suffering from chronic depression. This 16.1 million adults in 2015 reported at least one major depressive episode in the previous year.
All people under Medicare are covered for one depression screening a year. However, like most kind of appointments on this list, it should be done in a primary care setting where you can follow up with your doctor if necessary.
Therapy for depression is also available under original Medicare. Part B coverage will pay 80% for sessions outside the hospital, such as individual and group therapy.
It’s worth mentioning that if you see a non-medical doctor (like a psychologist or clinical social worker), you should make sure that they are Medicare-certified and accept the assignment. This means that they will accept the pre-approved Medicare total amount as payment.
Glaucoma tests come in the form of eye exams.
Glaucoma is the result of pressure building up in the eyes and can often develop suddenly without warning. However, all you need are regular eye examinations to prevent it.
Under Medicare, you’re covered for an exam once every year.
If you have Original Medicare, you’ll pay 20% of the Medicare-approved total.
Now that you know how to prevent Glaucoma, how would you know if you’re even at risk of getting it?
Here are some of the most common risk factors:
- You’re African American over the age of 50
- You have a family tree of people with glaucoma
- you are diabetic
- you’re a Hispanic American over the age of 65
22.Hepatitis C Screening Test
Hepatitis C is the inflammation of the liver. The infection spreads through infected blood.
People who are covered for a Hepatitis C screening includes the following:
- People who injected illegal drugs
- People born from 1945-1965
- People who got a blood transfusion prior to 1992
It’s worth noting that Medicare will only approve your Hepatitis C screening test if it’s ordered by a primary practitioner.
NOW IT’S YOUR TURN
Please get in touch with us. We will assess your medical needs and help you come up with a step by step Medicare preventive services checklist. We will also walk you through the process so that you don’t miss any steps that could lock you out of preventative Medicare coverage.
If you’d like to get started, just fill out our simple contact form, or you can also call us at 480-331-7974. We here at IPA have all the necessary professionals to guide you through all manner of preventive Medicare programs. Let us help you get the insurance policies that are best for you!
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