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Make the most of Medicare's preventive benefits

Created date

February 27th, 2009
When you get sick or have an accident, you know it s time to use Medicare or other health insurance. But what about when you aren t sick or injured? If you have Medicare Part B, you have coverage for more than 15 preventive services services that help you stay one step ahead of serious illness and chronic conditions like diabetes, heart disease, and cancer. Are you taking advantage of preventive services to benefit you? Find problems early Preventive services help to find health issues early, when treatment works best. These services include exams, lab tests, screenings, shots, and monitoring. "Preventive services are very effective in finding health problems in the beginning stages. Get screened early so a potential health problem doesn t get worse," says Shaveta Kotwal, M.D. Getting started People new to Medicare are entitled to a one-time "Welcome to Medicare" physical exam. It reviews their health and recommends the preventive services needed. However, this exam is covered only if it is done within the first 12 months of having Medicare Part B, so people should schedule it as soon as coverage starts. Talk to your doctor about preventive services even if you aren t eligible for the "Welcome to Medicare" exam. "We talk to older adults and get an idea about their health and family history. As people age and life expectancy increases, prevention becomes increasingly important," says Kotwal. The right care for you Preventive health care is good for everyone, but not all people need all services. For example, Medicare covers glaucoma tests once every 12 months, but only for people at high risk. Glaucoma is an eye disease that causes people to lose their sight. If you have diabetes, Medicare may cover diabetes self-management training or medical nutrition therapy. "These services teach you how to monitor your condition and about nutrition and diet. The goal is to prevent you from getting complications later on," says Myla Carpenter, M.D., physician and medical director at Charlestown, an Erickson-built and -managed community in Catonsville, Md. If you are diagnosed with an illness caused or complicated by tobacco use, or you take a medicine that is affected by tobacco, Medicare will cover counseling to help you stop smoking. Medicare covers vaccines as well. "The flu shot and pneumococcal shot are very important. Usually, you need the pneumococcal shot just once after the age of 65, but people who are at increased risk may have it once every five years," says Carpenter. Cancer prevention Medicare covers several screenings for different types of cancer. "Be sure to discuss your risk factors with your physician to see which cancer screening tests would be appropriate for you," says Carpenter. Prostate cancer is the second leading cause of cancer death in men, but it can be found early with a rectal exam and by testing the amount of PSA (Prostate Specific Antigen) in your blood. Medicare covers both of these tests once every 12 months. A mammogram can help prevent breast cancer by detecting it before you or your doctor may be able to feel it. "Once a year, Medicare covers a mammogram for women," says Kotwal. Medicare also covers a Pap test and pelvic exam once every 24 months for women to check for cervical and vaginal cancers. If you are at high risk for cervical cancer, Medicare will cover a Pap test and pelvic exam more frequently once every 12 months. Colorectal cancer screening is also covered by Medicare. The frequency is based on your health history and the type of test you have: fecal occult blood test, flexible sigmoidoscopy, colonoscopy, or barium enema. Proactive about preventive care As you use preventive services, be sure to keep track of the date as well as the date of your next service. If you are concerned about the costs, talk to your doctor. "We can find out how much a preventive service will cost up front and how much Medicare will cover," says Kotwal. If you haven t already started, plan for your health in 2009. "Have a discussion with your physician to see what preventive services are best suited for you, given your health," says Carpenter. "It s always better to prevent an illness, rather than treat it."

How much is it?

Medicare covers much but not all of your preventive care costs

' Cervical and breast cancers screening: There s no cost to you for the Pap lab test, but you pay 20% for Pap test collection, pelvic exam, and breast exam. The Part B deductible does not apply. ' Flu shot and pneumococcal shot: No cost to you if your doctor accepts Medicare assignment. ' Prostate cancer screening: There s no cost to you for the PSA test, but you pay 20% for the doctor s visit, and the Part B deductible applies. ' "Welcome to Medicare" exam: You pay 20%, and the Part B deductible does not apply.