CMS NEWS RELEASE
By David Sayen
You may have heard something lately about “preventive health care.” What does that mean?
At its most basic, preventive health care 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. And Medicare also covers a variety of screenings and tests to help detect preventable and chronic diseases early, when they’re in their most treatable stages.
One of the ways in which the Affordable Care Act strengthened Medicare was by eliminating co-pays for many of Medicare’s preventive health services. The idea was to encourage people with Medicare to get more preventive screenings and counseling to help them lead healthier, longer lives.
For example, you no longer face any out-of-pocket expenses 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.
During the exam, your doctor will record your medical history and check your height, weight, and blood pressure. He or she will also calculate your body mass index, give you a simple vision test, and advise you on preventing disease and staying healthy.
In addition, the Affordable Care Act provides a free annual wellness exam to people with Medicare.
When you get this exam, your doctor will go over your medical and family history and develop or update a personalized prevention plan for you. Your doctor also will check for any cognitive impairment and risk factors for depression, and review your functional ability and level of safety.
Medicare also covers shots for flu, pneumococcal disease (which can cause pneumonia and meningitis), and Hepatitis B. Flu, pneumococcal infections, and Hepatitis B can be life-threatening for older people, and we recommend that people over age 65 get flu and pneumococcal shots. Most people only need the pneumococcal vaccine once in their lifetime.
And remember: Medicare beneficiaries can get these shots with no co-pays.
Beneficiaries 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. This type of cancer is usually found in people age 50 and older and the risk of getting it increases with age.
Medicare covers screening tests to help find pre-cancerous polyps, which are growths in the colon, so they can be removed before they turn cancerous. Medicare will pay for a fecal occult blood test, a flexible sigmoidoscopy, a screening colonoscopy, or a barium enema.
Medicare beneficiaries pay nothing for fecal occult blood tests. And they pay nothing for the flexible sigmoidoscopy and the screening colonoscopy, if their doctor accepts the Medicare-approved payment amount. (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 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 Medicare-recognized practitioner.
Medicare also helps pay for tests for glaucoma, HIV and osteoporosis (brittleness that places people 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.
That’s a classic win-win.
David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, 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).