Medicare Preventative Services Available Under Healthcare Reform

Experts have long maintained that they key to a healthy and independent life is prevention.

Here in the United States, preventative services will play a key role in our nation’s health as our population continues to age. By 2030, roughly 71 million Americans will be 65 or older. Many of these seniors will have to deal with at least one chronic illness like heart disease, cancer or arthritis in their lifetime – all conditions that are easily detected and preventable if proper care is maintained.

Thanks to the Affordable Care Act, many preventative services are now fully covered under Medicare. Yet millions of Americans are failing to take advantage of tests and screenings that could improve their health and reduce the cost of potential illness.

In a recent survey published by the John A. Hartford Foundation, only seven percent of seniors are actually getting the key preventative services they need as they age. Neglecting routine check-ups and screenings can yield dangerous results. The New England Journal of Medicine estimates that 100,000 seniors are hospitalized every year just for adverse drug interactions alone.

There have been a number of changes to the Medicare system under healthcare reform to help make preventative care more accessible and affordable for seniors. Many of these services are covered under traditional Medicare, known as Medicare Part B, but may also be accessed through other programs like the Medicare Advantage Plan.

One-Time Wellness Visit

If you are new to Medicare, you are allowed a one-time wellness visit with your doctor free of charge. The wellness visit is not a traditional physical, but rather a chance to sit down with your doctor and review your medical history and discuss prescriptions, immunizations and other preventative care services you may need.

Based on your risk factors for certain diseases, your doctor may recommend tests or screenings and provide counseling for preventative services at your disposal. The one-time wellness visit is completely covered and must be done within the first year you sign up for Medicare.

Yearly Wellness Visits

One of the main changes to Medicare under the Affordable Care Act has been the addition of free wellness visits. These annual visits include a review of your medical history and your prescription history, as well as other routine check-ups and screenings.

The Centers for Medicare and Medicaid Services state that in the first five months of 2012, 1.1 million seniors used the free wellness visit now available under Medicare.

Free Screenings

In addition to annual wellness checkups, there are a number of screenings that are now fully covered under Medicare for many common chronic illnesses.

• All those enrolled in Medicare are eligible for a free cardiovascular screening including cholesterol tests every five years.
• Women 40 or older can receive free mammograms every year under new Medicare provisions. All women are also eligible for cervical and vaginal screenings including pap smears once every 24 months or once every year if you receive an abnormal result.
• Men are eligible for colorectal cancer screenings. This includes a yearly fecal occult blood test, a colonoscopy every ten years, and a flexible sigmoidoscopy every four years. Patients that require a barium enema will have a co-pay of up to 20 percent of the Medicare approved amount.
• Immunizations for the flu, pneumonia and hepatitis B are fully covered for everyone enrolled in Medicare.
• Each year one in three adults over the age of 65 will fall. Falls can lead to severe injuries like broken bones and can even cause death. Medicare now fully covers bone mass measurement tests once every two years for those at risk for osteoporosis to help patients maintain strong bones to reduce the damage done from a fall.
• Diabetes screening including the fasting blood glucose test is covered up to twice a year for those at risk for the illness.
• If you are diagnosed with diabetes or kidney disease, you can receive up to three hours of one-on-one nutritional counseling for the first year after your diagnosis and for two hours each year after. A doctor must write you a referral prescription to receive treatment.
• Smoking is one of the main causes of many chronic illnesses. To help seniors kick the habit, Medicare now offers up to eight counseling sessions each year for those that have been diagnosed with an illness caused by tobacco use.

Additional Screenings

While a multitude of preventative services are fully covered under the new health reform law, there are several screenings that do require a co-pay of up to 20 percent of the Medicare approved cost for each test. These services include prostate exams for men over 50, diabetes equipment, glaucoma testing and HIV testing for pregnant women.

In total, CMS estimates that nearly 14.3 million seniors have used at least one preventative service this year at no cost.

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Cited Sources

Baker, Sam. "CMS: 14 Million Seniors Have Received Preventive Benefits under Obama's Health Law in 2012." TheHill.com. The Hill, 11 June 2012. Web. 11 June 2012. <CMS: 14 million seniors have received preventive benefits under Obama's health law in 2012>.

"Falls Among Older Adults: An Overview." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 29 Feb. 2012. Web. 12 June 2012. <http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html>.

Galewitz, Phil. "Seniors Missing Out On Some New Medicare Benefits." Seniors Missing Out On Some New Medicare Benefits" Capsules. Kaiser Health News, 11 June 2012. Web. 11 June 2012. <http://capsules.kaiserhealthnews.org/index.php/2012/06/seniors-missing-out-on-some-new-medicare-benefits/>.

"Medicare Preventive Services." Healthcare.gov. U.S. Department of Health & Human Services. Web. 11 June 2012. <http://www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html>.

O'Reilly, Kevin B. "Only 7% of Seniors Get Key Preventive Services." Amednews.com. American Medical News, 7 May 2012. Web. 11 June 2012. <http://www.ama-assn.org/amednews/2012/05/07/hlsa0507.htm>.

"Seniors and the Affordable Care Act." Fact Sheets. U.S. Department of Health & Human Services. Web. 11 June 2012. <http://www.healthcare.gov/news/factsheets/2011/08/seniors.html>.

"Welcome to Medicare Preventive Visit." Welcome to Medicare Preventive Visit. U.S. Department of Health & Human Services. Web. 11 June 2012. <http://www.medicare.gov/navigation/manage-your-health/preventive-services/medicare-physical-exam.aspx?AspxAutoDetectCookieSupport=1>.

Your Guide to Medicare's Preventative Services. Publication no. 10110. Centers for Medicare & Medicaid Services, May 2011. Web. 11 June 2012.