By David Sayen
U.S. Centers for Medicare & Medicaid Services
You may have heard something lately about “preventive health care.” What does that mean, exactly?
At its most basic level, preventive health care means living a healthy lifestyle. Eat a balanced diet. Exercise regularly. Maintain a healthy weight. And stop smoking.
People with Medicare can benefit from these healthy living habits as much as anyone. But Medicare also covers a wide variety of screenings and tests to help detect preventable and chronic diseases early, when they’re at their most treatable and curable stages.
The federal health reform law made significant improvements to Medicare’s preventive health benefits by eliminating cost-sharing requirements for many of them. The idea was to encourage people with Medicare to get more preventive screenings and counseling to help them lead healthier and longer lives.
For example, there are no longer 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 give you advice on preventing disease and staying healthy.
In addition, the health reform law makes it possible for people with Medicate to get a free annual wellness exam.
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.
During the first two months of this year, more than 150,000 people with Medicare got a wellness exam.
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 all people over age 65 get flu and pneumococcal shots. Most people only need the pneumococcal vaccine once in their lifetime.
And remember: these shots are free for Medicare beneficiaries.
Beneficiaries also can get screened for cardiovascular disease and for several 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.
Diabetes is a big problem in this country and Medicare covers screening for people at risk for the disease. For people who have diabetes, Medicare covers certain supplies and educational training to help them manage it.
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 help pay for tests for glaucoma, HIV, and osteoporosis (brittleness that places people at risk for broken bones).
The truth is that Medicare beneficiaries don’t use these preventive health services as much as they should. But getting screened can help them stay healthy and live longer – and save the government billions in healthcare costs.
It’s a classic win-win.
David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories. You can get answers to your Medicare questions by visiting www.Medicare.gov or calling 1-800-MEDICARE (1-800-633-4227).