MEDICARE PREVENTIVE CARE SERVICES 3 July 2008
Posted by Service Officer on July 3rd, 2008
Even though it is commonly said that an ounce of prevention is worth a pound of cure, Medicare has not traditionally covered preventive care. However, coverage for many preventive care services has been added in the past few years. Doctors may not realize that Medicare now covers these services, so it is important to ask your doctor about them. As long as you meet basic eligibility standards, you have the right to receive these services no matter which Medicare health plan you are enrolled in. Your costs for these services may be different if you are in a Medicare private health plan (HMO or PPO). However, private plans cannot charge you anything for the flu or pneumonia vaccine. In addition, private plans cannot require that you get a referral in order to get a screening mammogram or a flu shot. Be sure to follow the Medicare guidelines for receiving preventive care services in order to ensure that Medicare will cover them since some are covered only once every few years and others are only covered if you meet specific criteria. The following coverage guidelines are only for preventive screenings. Medicare may cover these tests more frequently if they are needed to diagnose or treat an illness or condition.
• Diabetes screening: 100% of the Medicare-approved amount (no Part B deductible). Every 12 months if you meet the profile for getting diabetes.
• Diabetes services and supplies: 80% of the Medicare-approved amount (after Part B deductible). Up to 10 hours of self-management training for your first year, and two hours every year if you have diabetes and your doctor says that you need diabetes self-management training and education and specified diabetic supplies.
• Medical Nutritional Therapy: 80% of the Medicare-approved amount (after Part B deductible). Three hours for the first year and two hours every year thereafter, although it will cover more hours if your doctor says you need them.
• Glaucoma screening:80% of the Medicare-approved amount (after Part B deductible). Annual (every 12 months) if you are at high-risk for glaucoma.
• Blood testing for cardiovascular diseases: 100% of the Medicare-approved amount (no Part B deductible). Once every five years.
• Bone mass measurement: 80% of the Medicare-approved amount (after Part B deductible). Every two years (24 months), If your doctor believes you are at risk for osteoporosis and orders the test.
• Screening mammograms: 80% of the Medicare-approved amount (no Part B deductible). One Baseline mammogram for women 35 to 39 years of age and every 12 months for women 40 years and older.
• Pap smears, pelvic exams and clinical breast exams: 100% for Pap lab test (no Part B deductible). Every two years (24 months)
• 80% of the Medicare-approved amount for Pap test collection, pelvic exam and clinical breast exam (no Part B deductible).
• Colon cancer screening: 100% for fecal occult blood test; 80% of the Medicare-approved amount for flexible sigmoidoscopy, colonoscopy and barium enema. Once a year for Fecal occult, once every four years for flexible sigmoidoscopy, once every 24 months if you are at high-risk (once every 10 years if not) for colorectal cancer
• Prostate cancer screening: 100% for PSA test; 80% of the Medicare-approved amount for digital rectal exam (after Part B deductible). Prostate screening once a year for men age 50 and older
• Flu shot: 100% of the Medicare-approved amount (no Part B deductible). Once every flu season if you are less able to fight infections; 50 or over; have chronic disorder; 6 or more months pregnant; or reside in a long term care facility.
• Pneumonia vaccine: 100% of the Medicare-approved amount (no Part B deductible). Once in your lifetime.
• Hepatitis B vaccine: 80% of the Medicare-approved amount (after Part B deductible). As needed.
• One routine physical exam : 80% of the Medicare-approved amount (after Part B deductible). One-time during the first six months after you enroll in Medicare Part B regardless of your age.
[Source: Medicare Rights Center Jun 08 ++]
