You may have heard lately about “preventive health care.” What does it mean?
At its most basic, preventive health care means living a healthy lifestyle. Eating a balanced diet. Exercising regularly. Maintaining a healthy weight. And quit smoking.
Like anyone else, people with Medicare can benefit from healthy living habits: Medicare covers a wide variety of shots to help you stay healthy. It also covers numerous tests to help detect diseases early, when they are 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. It also includes education and counseling about preventive services, including certain screenings, flu and pneumococcal shots and referrals for other care, if needed.
If you have 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, your 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. As part of this visit, your provider will ask you to fill out a questionnaire called a “Health Risk Assessment.” 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 coinsurance, and the Part B deductible may apply if:
• Your doctor or other health care 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 can also 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 to detect 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 done 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 quit 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 are 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 Hawai‘i, California, Nevada, Arizona 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).