How to Access Medicare Preventive Services

Of all the Medicare “alphabet” services, Medicare Part “B” probably receives the least attention.  Since seniors pay a premium under basic Medicare for Medicare “B” by way of deduction from their monthly Social Security benefit, they may do well to explore what benefits they may not be using.   The premium for 2008 is indexed to income and ranges from a low of $96.40 per month for    seniors with incomes below $82,000 per year or $164,000 per couple to a high of $238.40 per month for seniors with incomes above $205,000 for an individual or $410,000 per couple.  Medicare “B” concerns physician and outpatient services.  However, one frequently ignored area of coverage is Medicare preventive services.   Preventative services are intended to help covered seniors to avoid chronic illnesses from the beginning.  A deductible or co-pay may need to be satisfied for some services, but the preventive care program addresses many of the major causes of chronic illness in America today.  Possible covered procedures include cholesterol and diabetes screening, immunizations, bone mass measurements and others.

Here are some of the preventive services available.  For further details, seniors should consult  their family physician or call (800) MEDICARE or visit the Medicare web site at http://www.medicare.gov/health/overview.asp.   These are the basic Medicare benefits.  Individuals may have Medigap or Medicare Advantage coverages that increase or improve the benefit.  

· The “Welcome to Medicare” Physical Examination Those persons whose Medicare coverage began on or after January 1, 2005, are entitled to a physical examination if received within the first 6 months of qualifying for Medicare “B” which should include a review of their overall health, education and counseling about Medicare preventive services, information regarding shots, and recommended referrals for care.   

While the exam under standard Medicare is not totally free  (there is a 20% co-pay after the annual Medicare “B” deductible has been satisfied), the overview seems valuable as a tool to assess present and future medical needs.   Only about 2% of eligible seniors actually sign up to receive this physical according to reported statistics.

  • Cardiovascular testing.  Coverage for this screening is relatively new.  Cholesterol, lipid (fat), and triglyceride testing may be fully covered if the patient qualifies.  He should consult with his physician.
  • Breast cancer mammography screening and tests for cervical, vaginal, colorectal, and prostate cancers.   These may all be covered up to the Medicaid approved amount with a 20% co-pay from the patient.  As with the previously mentioned tests, patients should check eligibility and benefits first to be certain.
  • Shots – Flu, Pneumococcal (pneumonia), and Hepatitis B shots are all available under the program.  There is no cost to Medicare patients for flu shots or the one-time pneumococcal shot.  There is a co-pay of 20% for Hepatitis B and the shot is only for those at risk.
  • Diabetes screening (fasting plasma glucose test), Diabetes Glucose Monitors, test strips and lancets.  All persons on Medicare with diabetes qualify.  The coverage for the fasting glucose test is relatively new.  The patient pays 20% of the Medicare approved amount.
  • Bone mass measurements (osteoporosis diagnostic tests).  Patients pay 20% of the Medicare approved amount after the deductible.
  • Glaucoma testing.  This is available for Medicare patients at risk for glaucoma at the same payment as for many other tests listed above at 20% of the Medicare approved amount.

For those persons who are computer savvy and want to know more, the government instituted a secure on-line service called www.MyMedicare.gov that   allows Medicare recipients to check the status of claims submitted, replace lost or missing Medicare cards,  research entitlement for specific benefits and enroll for benefits and to research through the government web site.   The beauty of www.MyMedicare.gov  is that the information is individualized.  Once you register on line, you can learn information regarding your own account, not just general information on Medicare.  For seniors who do not access the Internet, a helpful family member or friend can help. 

About the Author Janet Colliton

Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.

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