By Greg Dill
You may have heard something lately about "preventive healthcare." What does that mean? At its most basic, preventive healthcare means living a healthy lifestyle. Eat a balanced diet. Exercise regularly. Maintain a healthy weight. And stop smoking.
Like anyone else, people with Medicare can benefit from healthy living habits. But, Medicare covers a wide variety of shots to help you stay healthy. It also covers numerous tests to help detect diseases early, when they're in their most treatable stages.
You pay nothing for most Medicare-covered preventive services if you get them from a doctor or other qualified healthcare provider who "accepts assignment," meaning they accept Medicare as payment in full for their services. For example, you pay nothing out-of-pocket when you get a "Welcome to Medicare" physical exam. This one-time exam is offered during the first 12 months after you've enrolled in Medicare Part B. This visit includes a review of your medical and social history related to your health, and education and counseling about preventive services, including certain screenings, flu and pneumococcal shots, and referrals for other care if needed.
If you've had Part B for longer than 12 months, you can get a yearly wellness exam. You pay nothing for this visit if your doctor accepts assignment. And, the Part B deductible doesn't apply. The wellness exam is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a "Health Risk Assessment" as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit, which can also include:
- A review of your medical and family history
- Developing or updating a list of current providers and prescriptions
- Height, weight, blood pressure and other routine measurements
- Detection of any cognitive impairment
- Personalized health advice
- A list of risk factors and treatment options for you
- A screening schedule (like a checklist) for appropriate preventive services
However, you may have to pay co-insurance, and the Part B deductible may apply if:
- Your doctor or other healthcare provider performs additional tests or services during the same visit
- These additional tests or services aren't covered as Medicare preventive benefits
Medicare also covers shots for flu, pneumococcal disease (which can cause pneumonia) and hepatitis B. Flu, pneumococcal infections and hepatitis B can be life-threatening for older people. Flu and pneumococcal shots are recommended for people over age 65.
People with Medicare also can get screened for cardiovascular disease and different kinds of cancer, including breast, prostate, cervical/vaginal and colorectal cancer. Take colorectal cancer, for example. Medicare covers screening tests to help find precancerous growths or find cancer early, when treatment is most effective. Medicare covers the multi-target stool DNA test, screening fecal occult blood test, screening flexible sigmoidoscopy, screening colonoscopy and screening barium enema. You pay nothing for fecal occult blood tests, flexible sigmoidoscopy and screening colonoscopy if your doctor accepts assignment. (Note: If a polyp or other tissue is removed during a colonoscopy, you may have to pay 20 percent of the Medicare-approved amount for the doctor's services and a co-payment if the procedure was performed in a hospital outpatient setting.)
For people who have or are at risk for diabetes, Medicare covers screenings, certain supplies and self-management training. If you need help to stop smoking, Medicare pays for up to eight face-to-face counseling sessions per year with a doctor or other qualified provider. Medicare also pays for tests for lung cancer, HIV and bone mass (to see if you're at risk for broken bones).
People with Medicare don't use preventive health services as much as they should. But, getting screened can help you stay healthy and live longer — and save the government billions in healthcare costs. It's a classic win-win.
Greg Dill is Medicare's regional administrator for Arizona, California, Nevada, Hawaii and the Pacific Territories. You can get answers to your Medicare questions by visiting www.Medicare.gov or calling 1-800-MEDICARE (1-800-633-4227).