Maximizing Medicare Preventive Services for Seniors

Medicare is an invaluable health program that covers seniors in the United States. While its primary focus is on providing essential medical services, it also offers various preventative services that help seniors maintain their health and well-being. This blog post will focus on how seniors can maximize Medicare preventive services. By taking advantage of these services, older adults can proactively manage their health and minimize potential health issues.

Three Important Key Points:

1. Medicare offers a comprehensive range of preventive services to help seniors maintain their health and well-being.
2. Seniors can take advantage of various screenings, counseling sessions, and vaccinations covered by Medicare to detect and prevent potential health issues.
3. Understanding Medicare's preventive services and utilizing them appropriately can lead to better health outcomes and improved quality of life for older adults.

Three Important Takeaways:

1. Medicare provides essential preventive services, including screenings for cancer, heart disease, and infectious diseases, as well as counseling for behavioral health and lifestyle modifications.
2. Regular utilization of Medicare preventive services can help seniors detect health issues early, leading to timely intervention and improved treatment outcomes.
3. By staying informed about Medicare's preventive benefits and actively participating in preventive care, seniors can take proactive steps to maintain their health and well-being as they age.

---

 

Abdominal Aortic Aneurysm

An abdominal aortic aneurysm (AAA) is a severe condition that affects the aorta, the main artery that carries oxygenated blood from the heart to the rest of the body. Medicare covers one ultrasound screening for abdominal aortic aneurysm if you're at risk (referral needed). You're at risk if you have a family history or are a man 65-75 who has smoked 100+ cigarettes in his life. If the healthcare provider accepts a Medicare assignment, there is no cost.

Alcohol Misuse Screenings and Counseling

Alcohol misuse harms health and well-being. Medicare offers screening and counseling for seniors with up to 4 brief sessions per year. Services promote healthy habits and overall well-being.

Bone Mass Measurement

Healthy bones are crucial as we age. Medicare covers bone density testing for 65 and older to assess osteoporosis risk. This test can be done once every 24 months or more frequently if medically necessary. Regular bone mass measurements can help seniors prevent fractures, detect early signs of bone loss, and improve their bone health.

Cardiovascular Behavioral Therapy

Cardiovascular behavioral therapy helps seniors modify their lifestyle behaviors to reduce heart disease and stroke risk. It covers topics like diet, exercise, stress management, and smoking cessation. Medicare covers one visit per year for this therapy.

Cardiovascular Disease Screenings

Medicare covers screenings for cardiovascular diseases every 5 years, including high cholesterol, high blood pressure, heart disease, carotid artery disease, and peripheral artery disease.

Cervical & Vaginal Cancer Screenings

Preventive screenings for cervical and vaginal cancers are crucial for early detection. Medicare covers Pap tests, pelvic exams, and clinical breast exams to screen for cervical, vaginal, and breast cancers. The screening tests are covered once every 24 months in most cases, except for those who have a high risk of cervical or vaginal cancer, or those who are of child-bearing age and had an abnormal Pap test in the past 36 months. Medicare also covers HPV tests (as part of a Pap test) once every 5 years for those aged 30-65 without HPV symptoms. You pay nothing if your doctor accepts Medicare assignment.

Colorectal Cancer Screenings

Medicare covers several colorectal cancer screenings:

- Barium enema: every 48 months if you're over 45

- Screening colonoscopies: every 120 months (or every 24 months if you're high risk) or 48 months after a previous flexible sigmoidoscopy

- Flexible sigmoidoscopies: every 48 months if you're over 45

- Fecal occult blood tests: once every 12 months if you're over 45

- Multi-target stool DNA & blood-based biomarker tests: once every 3 years if you're 45-85 and at average risk

Tests are free if your doctor accepts Medicare assignment.

Counseling to Prevent Tobacco Use & Tobacco-Caused Diseases

Smoking is a leading cause of preventable diseases and premature death. Medicare covers up to 8 face-to-face counseling sessions in a 12-month period for tobacco use cessation. There is no cost for these sessions if your doctor or other qualified health practitioner accepts Medicare assignment.

Covid-19 Vaccines

COVID-19 vaccines are FDA-approved and free. They help build immunity to the virus. Bring your Medicare card to get vaccinated. If you have a Medicare Advantage Plan, use the card provided by your plan. You won't have to pay for the vaccine if you get it from an in-network provider.

Depression Screening

Depression is a common mental health condition that can significantly impact the quality of life. Medicare screening helps identify symptoms, leading to better treatment and support for seniors.

Diabetes Self-Management Screening

Diabetes is a chronic condition that affects millions of people worldwide. Medicare covers diabetes outpatient self-management training that provides tips on healthy eating, physical activity, blood glucose monitoring, prescription drugs, and reducing risks. To qualify, you need a written order from a healthcare provider and a diabetes diagnosis. You may also qualify for medical nutrition therapy services. You pay 20% of the Medicare-approved amount and the Part B deductible applies.

Flu Shots

Flu season is a high-risk period for seniors, especially those with existing health conditions. Medicare covers the seasonal flu shot at no cost if the provider accepts assignment. The Part B deductible does not apply.

Glaucoma Screenings

Glaucoma is a progressive eye condition that can cause vision loss if left untreated. Medicare covers glaucoma screening once a year for high-risk people. Risk factors include diabetes, family history, African American, over 50, Hispanic, and over 65. The test must be done or supervised by a licensed eye doctor. You pay 20% of the approved amount plus the Part B deductible. Copayments may also be required at hospitals.

Hepatitis B Shots

Those at high or medium risk of hepatitis B will have Medicare cover the cost of shots or vaccines. Some risk factors include hemophilia, End-Stage Renal Disease (ESRD), diabetes, living with a Hepatitis B patient, or working in healthcare. Consult your doctor to see if you're at a high or medium risk of Hepatitis B. Medicare assigns these shots to qualified healthcare providers, so seniors don't have to pay for them. By receiving these shots, seniors can reduce complications and protect themselves against hepatitis B.

Hepatitis B virus infection screenings

Medicare covers Hepatitis B Virus screenings if your doctor orders them. If you're at high risk and haven't received a Hepatitis B shot, yearly screenings are covered. If pregnant, screenings are covered at the first visit, delivery (for at-risk patients), and the first visit for future pregnancies. This screening detects acute or chronic infections. There is no cost if the provider accepts a Medicare assignment.

Hepatitis C Screenings

Hepatitis C is a viral infection that affects the liver. Medicare covers one Hepatitis C screening test if you are at high risk due to drug use. You must have had a blood transfusion before 1992 or were born between 1945 and 1965. Medicare also covers yearly repeat screenings for high-risk patients. The screening test is free if your healthcare provider orders it and accepts Medicare assignment. By identifying and treating hepatitis C, Medicare beneficiaries can prevent liver damage and improve their overall health.

HIV (Human Immunodeficiency Virus) Screenings

Medicare covers HIV screenings once a year if you are between 15-65 years old or at an increased risk of HIV. You can also get this test up to 3 times during pregnancy. No payment is required if your doctor accepts a Medicare assignment. Early detection and treatment are crucial to preventing HIV spread and improving health outcomes.

Lung Cancer Screenings

Lung cancer is the leading cause of cancer death in the United States. Medicare covers lung cancer screenings using low dose computed tomography once per year if you're between 50-77, asymptomatic, a current or former smoker with a history of at least 20 pack years and get an order from your doctor. There's no cost if your doctor accepts a Medicare assignment. You need to schedule an appointment with a healthcare provider before the first screening. These screenings are offered to high-risk individuals, including seniors, and can detect lung cancer early for timely intervention and treatment.

Mammograms

Medicare covers mammograms every 12 months if you're 40 years old or older. Medicare covers baseline mammograms every 12 months if you're 35 to 39. Medicare covers diagnostic mammograms more than once a year if they are medically necessary. The test is free if your doctor accepts the Medicare assignment. A deductible of 20% applies to the Medicare-approved amount. Mammograms reduce breast cancer risk and improve outcomes if detected early. Medicare covers medically necessary breast ultrasounds only if ordered by your doctor.

Medical nutrition therapy services

Those with diabetes or kidney disease, as well as those who have had a kidney transplant within the last 36 months, are covered by Medicare for medical nutrition therapy. Providing nutritional therapy services requires a registered dietitian or nutrition professional with specific qualifications. If you have diabetes, you may also qualify for self-management training. Medical nutrition therapy preventive services are not subject to deductibles or coinsurance.

Medicare Diabetes Prevention

Medicare covers a once-in-a-lifetime health behavior change program to prevent type 2 diabetes. The program includes weekly core sessions in a group setting over a six-month period. If you begin the Medicare Diabetes Prevention Program in 2021 or earlier, you'll receive 12 additional monthly sessions if you meet specific weight loss goals. You can get these services from Medicare Diabetes Prevention Program suppliers. They include traditional healthcare providers and faith-based organizations. Visit Medicare.gov/coverage/ medicare-diabetes-prevention-program to locate a supplier or learn more. Your Medicare Advantage Plan can provide these services.

Obesity behavioral therapy

If you have a body mass index (BMI) of 30 or more, Medicare covers obesity screenings and behavioral counseling to help you lose weight by focusing on diet and exercise. Your primary care doctor or other primary care practitioner can coordinate your personalized prevention plan with your other care if you receive this counseling in a primary care setting (such as his or her office). The service is free if your primary care doctor accepts Medicare assignment.

Pneumococcal shots

Medicare covers pneumococcal shots to prevent certain types of pneumonia. Consult your healthcare provider about this vaccine. If the provider accepts Medicare assignment, these shots are free.

Prostate cancer screenings

Once you turn 50, Medicare covers digital rectal exams and prostate-specific antigen (PSA) tests once every 12 months. For the digital rectal exam, you will need to pay 20% of the Medicare-approved amount, and the Part B deductible applies. If you are in a hospital outpatient setting, you will also need to pay a copayment. However, you will not be charged for the PSA test.

Sexually transmitted infection (STI) screenings & counseling

Medicare covers screenings for chlamydia, gonorrhea, syphilis, and Hepatitis B. You can have these tests once a year or during pregnancy if your healthcare provider orders them. If you're at high risk of STDs, Medicare covers two 20-30-minute counseling sessions with a primary care doctor each year. These services are free if your doctor accepts Medicare assignment.

"Welcome to Medicare” preventative visits

If you're newly eligible for Part B, you can get a "Welcome to Medicare" preventive visit within the first 12 months. This visit includes reviewing your health history and counseling on preventive services, such as screenings and vaccines. If you have a prescription for opioids, you'll also receive an assessment and referral, if needed, for non-opioid treatment options. You won't be charged for the visit if your doctor accepts a Medicare assignment. Additional tests or services may require coinsurance or the Part B deductible.

Yearly “Wellness” visit

If you have had Medicare Part B for over 12 months, you are eligible for an annual "Wellness" visit. During this visit, a personalized plan is developed or updated to prevent diseases or disabilities based on your current health and risk factors. You don't need a "Welcome to Medicare" visit to qualify. You may need to pay a coinsurance and Part B deductible for additional tests or services not covered by Medicare.

In conclusion, Medicare's preventive services play a crucial role in promoting the health and well-being of seniors. By offering a comprehensive array of screenings, counseling sessions, and vaccinations, Medicare empowers older adults to take proactive steps towards maintaining their health and preventing potential health issues. Through regular utilization of these preventive services, seniors can detect health conditions early, receive timely interventions, and ultimately enjoy improved health outcomes and a higher quality of life. It is essential for seniors to stay informed about Medicare's preventive benefits and actively engage in preventive care to safeguard their health as they age.

For more information on Medicare Part B preventive services, please call SeniorHelpAndYou – a Medicare Consulting company at 1-877-835-9806 (TTY 711).

Source: Medicare.gov

by Albert Ferrin, April 20, 2024