Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States. Although chronic diseases are among the most common and costly heatlh problems, they are also some of the preventable. Over the years Medicare has continued to expand the range of preventive services for which it pays nd now provides coverage for the folowing preventive services and screenings
Prevention can help you stay healthy, live longer and prevent illnesses. You must be enrolled in Medicare Part B in order for Medicare to cover the following services:
Cardiovascular Disease Screening
-Cardiovascular Screening Blood Tests - This includes blood tests to check cholesterol, lipid or triglyceride levels, and other tests for the early detection of cardiovascular disease. You pay nothing for the lab test. For all other tests, you will pay 20% of the Medicare-approved amount after the yearly Part B deductible has been met.
Cancer Screenings
-Screening Mammograms - Breast cancer is the second leading cause of cancer death in women in the United States. Medicare covers screening mammograms once every 12 months for all women with Medicare age 40 and older. You can also get one baseline mammogram between ages 35 and 39. Medicare also covers digital technologies for screening mammograms to check for breast cancer. You pay 20% of the Medicare-approved amount with no Part B deductible.
-Pap Test and Pelvic Examination - As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer. A Pap test and pelvic exam are covered by Medicare for all women with Medicare once every 24 months. Once every 12 months if you are at high risk for cervical or vaginal cancer, or if you are of childbearing age and have had an abnormal pap test in the past 36 months. You pay nothing for the Pap lab test. For all other tests you pay 20% of the Medicare-approved amount with no Part B deductible.
-Colorectal Cancer Screening - 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. Treatment works best when colorectal cancer is found early.
How often is it covered?
- Fecal Occult Blood Test - Once every 12 months
- Flexible Sigmoidoscopy - Once every 48 months
- Screening Colonoscopy - Once every 24 months (if you’re at high risk), Once every 10 years, but not within 48 months of a screening sigmoidoscopy (if you’re not at high risk).
- Barium Enema - This test is covered every 24 months if you are at high risk for colorectal cancer and every 48 months if you aren’t at high risk.
Coverage is for all people with Medicare age 50 and older, except there is no minimum age for having a screening colonoscopy. You pay nothing for the fecal occult blood test. For all other tests, you pay 20% of the Medicare-approved amount after the yearly Part B deductible.
If the flexible sigmoidoscopy or colonoscopy is done in a hospital outpatient department, you pay 25% of the Medicare-approved amount after the yearly Part B deductible.
-Prostate Cancer Screening - Covers all men with Medicare age 50 and older. Coverage begins the day after your 50th birthday. A digital rectal examination is covered once every 12 months as is the Prostate Specific Antigen (PSA) Test. You generally pay 20% of the Medicare approved amount for the digital rectal exam after the yearly Part B deductible. You pay nothing for the PSA test.
Diabetes Screening, and Self-Management Training
-Diabetes Services - For all people with Medicare, Medicare covers screenings to check for diabetes. For people with diabetes, Medicare covers certain supplies and self-management training to find and treat diabetes.
Diabetes screening tests includes fasting glucose test. You pay nothing for the lab tests. For all other tests and services, you pay 20% of the Medicare-approved amount after the yearly Part B deductible.
Diabetes Self-Management Training is also available for certain people with Medicare who are at risk for complications from diabetes. Your doctor must request this service. You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
Medical Nutrition Therapy
-Nutrition and diet play an important role in helping people with certain diseases manage their health. For people with diabetes or renal diseases, proper diet and nutrition can help prevent and reduce complications from their conditions. Medicare covers medical nutrition therapy services for people with diabetes or renal diseases to help them manage their conditions.
Initial Preventive Physical Exam (“Welcome to Medicare” Physical Exam)
-"Welcome to Medicare" - Is a one time only examination and must be performed within the first six months that you have Medicare Part B. The exam will include height and weight measurement, blood pressure check, an electrocardiogram (EKG), education and counseling, and referral for other preventive services. The "Welcome to Medicare” physical exam is a great way to get up-to-date information on important screenings and shots. It allows you the chance to talk with your doctor about your family history and how to stay healthy. It will be offered to all people whose Medicare Part B begins on or after January 1, 2005. You pay 20% of the Medicare approved amount after the yearly Part B deductible.
Bone Mass Measurements
-Bone Mass Measurements - Once every 24 months for certain people at risk for losing bone mass. You pay 20% of the Medicare-approved amount after the yearly Part B deductible. Your risk for osteoporosis increases if you…
- are age 50 or older
- are a woman
- have a family history of broken bones
- have a personal history of broken bones
- are White or Asian
- are small-boned
- have low body weight (less than about 127 pounds)
- smoke or drink a lot
- have a low-calcium diet
Adult Immunizations
-Shots (Flu, Pneumococcal, Hepatitis B)-
Glaucoma Screening
-Glaucoma - The best way for people at high risk for glaucoma to protect themselves is to have regular eye exams. Medicare covers an exam once every 12 months.
For people with Medicare at high risk for glaucoma:
You pay 20% of the Medicare approved amount after the yearly Part B deductible.
Your risk for glaucoma increases if you…
- have diabetes
- have a family history of glaucoma
- are African American and age 50 or older
- and/or are Hispanic American age 65 or over
Smoking and Tobacco-Use Cessation Counseling Services
-Smoking and tobacco use is the most preventable cause of disease and death in the U.S. People who continue to smoke after the age of 65 have a higher overall risk of disease and death than those who quit. Smoking contributes to and can exacerbate heart disease, cancer, stroke, lung disease, hypertension, diabetes, osteoporosis, macular degeneration, and cataracts. It can also interfere with the effectiveness of medications that many older adults take, including insulin.
Medicare covers 2 types of counseling:
- Intermediate cessation counseling is 3 to 10 minutes per session; and
- Intensive cessation counseling is greater than 10 minutes per session.
Medicare will cover 2 quit attempts per year. Each quit attempt may include a maximum of 4 intermediate or intensive counseling sessions, with the total annual benefit covering up to 8 sessions in a 12-month period. The health care provider and patient have the flexibility to choose between intermediate and intensive counseling.
To be eligible to receive this benefit, you must have a condition that is affected by smoking or tobacco use.
In addition, Medicare Part D will also cover smoking cessation treatments prescribed by a physician beginning in January 2006. However, over-the-counter treatments, such as nicotine patches or gum, will not be covered.
While the number of Medicare-covered preventive services is higher than ever, many Medicare beneficiaries are not taking advantage of the full range of services. Some of the reasons for this are:
- Not knowing these services are covered by Medicare;
- Not understanding the importance of prevention, early detection and treatment;
- Being afraid to talk with your physician or not knowing how or what questions to ask;
- Fearing the pain that may occur during the preventive service procedure; or
- Fearing the results of the preventive service procedure.
There may also be physical and social barriers that prevent you from obtaining preventive services.
Regardless of the reason for you not using a preventive service, your physician, or healthcare provider, can help you address this problem. They can help you by doing the following:
- Talk with you about your risk for disease and the value of prevention, early detection
- Perform or refer you to the appropriate preventive services
- Provide follow-up care on all screening results, even negative ones
- Provide information about lifestyle changes that support a healthy lifestyle
You can learn more about Medicare’s preventive services by looking at www.medicare.gov on the web, or by calling 1-800-MEDICARE (1-800-633-4227). TYY users should call 1-877-486-2048.
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