There are steps you can take to lower your risk of disease and illness. Medicare provides coverage for these preventive services to help you stay healthy. These valuable benefits may be the key to long lasting good health.
Talk with your doctor about your risk of developing these health problems and your need for these preventive services. Medicare Part B covers the following types of preventive health services:
Bone Mass Measurements
Medicare covers procedures that identify bone mass, detect bone loss, or determine bone quality. People who qualify for these procedures include:
- Estrogen-deficient women at risk for osteoporosis
- Persons with vertebral abnormalities
- Persons receiving long-term glucocorticoid steroid therapy
- Persons with primary hyperparathyroidism
- Persons being monitored to assess their response to, or efficacy of, an approved osteoporosis drug
NOTE: Medicare does not automatically cover a screening bone mass measurement procedure. There must be a medical need for the procedure determined by your doctor in order for Medicare to consider payment for the procedure.
Cardiovascular Screening
Beginning January 1, 2005, Medicare covers cardiovascular screenings that check your cholesterol and other blood fat (lipid) levels. High levels of cholesterol can increase your risk for heart disease and stroke. These screening tests will tell if you have high cholesterol. You might be able to make lifestyle changes (like changing your diet) to lower your cholesterol and stay healthy.
For the cardiovascular screening blood tests, you do not have to meet the deductible or have any co-pays, so you will not incur any cost.
Colorectal Cancer Screening
Medicare now covers screening tests for the early detection of colorectal cancer. These tests help find precancerous growths so they can be removed and prevent cancer. They also help find colorectal cancer early, when treatment is most effective. If you are 50 or older, or are at high risk for colorectal cancer, one or more of the following tests is covered: Fecal Occult Blood Test, Flexible Sigmoidoscopy, Screening Colonoscopy, and/or Barium Enema. How often Medicare pays for these tests depends on the test you and your doctor decide is best and your level of risk for this cancer.
*The law defines individuals in the following situations as being at high-risk of developing colorectal cancer:
- Family history
- Prior experience of cancer or precursor neoplastic polyps
- History of chronic digestive disease condition (including: inflammatory bowel disease, Crohn's disease, or ulcerative colitis)
- Presence of any appropriate gene markers for colorectal cancer
- Other predisposing factors
Diabetes Information
Diabetic Test Strips
Effective July 1, 1998, Medicare began covering diabetic test strips and the blood glucose monitoring device for all individuals with diabetes regardless or whether or not they are insulin-treated. Formerly, these items were covered only for those individuals who were insulin-dependent.
Diabetes Outpatient Self-Management Training
Effective July 1, 1998, Medicare began covering diabetes outpatient self-management and training services. The covered benefit includes: education about self-monitoring of blood glucose; diet and exercise; an insulin treatment plan developed specifically for the patient who is insulin dependent; and motivation for patients to use the skills of self-management.
Only a Medicare “certified provider” can render diabetes outpatient self-management training. Please ask your provider if he/she is certified to provide this benefit. You may also contact our Customer Service Department to ask if your provider is certified. Your provider must indicate under a comprehensive plan of care that your condition requires self-management training. If you receive diabetes outpatient self-management training by a provider who is not certified, you will be responsible to pay for all the charges for the services you receive.
Diabetes Screening
Beginning January 1, 2005, Medicare will pay for diabetes screening tests for the purpose of early detection of diabetes for a person at risk for diabetes. The frequency of tests will be determined, but will not be covered more often than twice in the 12 month period following the date of your most recent diabetes screening test. You will not be responsible for a deductible or co-pay since these are clinical laboratory tests.
Glaucoma Screening
Medicare will cover glaucoma screening. Starting January 1, 2002 glaucoma screening is covered for Medicare beneficiaries who are at high risk for glaucoma, including people with diabetes or a family history of glaucoma. Medicare beneficiaries are eligible for the service every 12 months. The screening must be done or supervised by an eye doctor who is legally allowed to do this service in the beneficiary's state. Ask your doctor if you need this screening.
Screening Mammography
Women 40 years of age and older who are eligible for Medicare, can have a breast cancer screening every year. Medicare will also cover one screening mammogram for Medicare eligible women between the ages of 35 to 40. In addition, Medicare's annual deductible will not apply toward the screening mammogram service.
NOTE: A mammogram may be covered more frequently if your doctor determines that there is a medical need for the service. In this case, your mammogram would be considered a diagnostic service, not a screening. Medicare will cover the service based on the medical reason(s) supplied by your doctor.
Screening Pap Smears and Pelvic Exams
A screening Pap smear and pelvic exam is covered once every 24 months for Medicare eligible women. Coverage of this service now includes a clinical breast exam as well. Also, Medicare's annual deductible will not apply toward the screening Pap smear and pelvic exam service.
If you are a Medicare eligible woman at high risk for cervical or vaginal cancer, Medicare will cover an annual screening Pap smear and pelvic exam. If you are a Medicare eligible woman of childbearing age and have had a Pap smear during the preceding 24 months, which indicated the presence of cervical or vaginal cancer or other abnormality, Medicare will cover an annual screening Pap smear and pelvic exam.
NOTE: A Pap smear may be covered more frequently if your doctor determines that there is a medical need for the service. In this case, your Pap smear would be considered a diagnostic service, not a screening. Medicare will cover the service based on the medical reason(s) supplied by your doctor.
Prostate Cancer Screening
These tests help find prostate cancer. Medicare covers a digital rectal exam and Prostate Specific Antigen (PSA) test once every 12 months for all men with Medicare over age 50.
Vaccines
Hepatitis B
Medicare Part B covers the Hepatitis B vaccination and its administration when ordered by a doctor of medicine or osteopathy for Medicare patients who are at high or intermediate risk of contracting Hepatitis B. The Medicare Part B deductible and coinsurance apply.
Influenza
Medicare covers a flu shot every year! No doctor's order is required. The charge for a flu shot is covered at 100% when the provider accepts Medicare's payment assignment. Accepting assignment means that the provider of the service has agreed to accept Medicare's approved payment amount as payment in full.
Pneumococcal Pneumonia
Effective July 1, 2000 a doctor's order is no longer needed for a pneumococcal pneumonia vaccination. The vaccination will be covered at 100% as long as the provider accepts Medicare's assignment. Accepting assignment means that the provider of the service has agreed to accept Medicare's approved payment amount as payment in full.
'Welcome to Medicare' Physical Exam
Medicare will begin to help pay for a “Welcome to Medicare” initial preventive physical examination within the first six months that you have Part B. The exam will include a thorough review of your health, education and counseling about the preventive services you need, like certain screenings and shots, and referrals for other care if you need it. This initial preventive physical exam benefit does not include payment for clinical laboratory tests.
In order to be covered, the initial preventive physical exam must be performed no later than 6 months after the date your coverage first begins under Part B. It applies to those whose coverage for Part B begins on or after January 1, 2005.
You pay 20% of the Medicare-approved amount after you meet the yearly Part B deductible ($110 for 2005). Since this may be your first Medicare-covered service, you may meet your entire Part B deductible at this visit.
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