Medicare Preventive Services
Unfortunately, too many Americans delay getting the care they need, or skip it altogether. For example, 65% of American adults report not being up to date on at least one routine cancer screening. And a 2018 study found that among Americans over age 35, only about 8 percent had received all the preventive medicine services recommended.
Why? Reasons include lack of awareness, absence of symptoms, and cost concerns.
But early detection is critical to successfully treating many health conditions, including cancer, heart disease, and even mental health problems.
Don’t wait until you have symptoms to take care of yourself or it could be too late! Medicare offers a range of preventive services designed to detect health issues early, when they are most treatable, and to help seniors maintain their health.
This article explores the value of early detection, the importance of timely screenings, and the benefits of using Medicare’s annual wellness visit. It’s also a great time to talk with an expert to answer any questions you may have about your current Medicare wellness benefits.
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The Value of Early Detection with Medicare Preventive Services
Sometimes people avoid going to the doctor when they don’t feel sick.
They’d rather just assume everything is good, and go the “ignorance is bliss” way of thinking.
This is a terrible idea, with deadly consequences for thousands of people every year.
Studies show that nearly 95% of adults over the age of 60 have at least one chronic condition, and nearly 80% have two or more. Early detection can help manage these conditions much more effectively, prevent future complications, and save lives.
Here are a few additional statistics to consider:
- The 5-year survival rate is approximately 90% for most cancers when detected early.
- Approximately 70% of adults aged 65 and older have hypertension. Early detection and management can prevent complications such as heart disease and stroke.
- Nearly 30% of adults over age 65 have diabetes. Early detection and proper management can prevent severe complications like kidney failure, blindness, and amputations.
- Only 35% of older adults diagnosed with dementia are aware they have the disease, which makes early detection a challenge. Yet the earlier the diagnosis, the better the long-term outcome.
Medicare Preventive Services Impact on Healthcare
Early detection initiatives can reduce hospital admissions, nursing home admissions, and mortality rates among older adults. Properly targeted screenings can help allocate healthcare resources more effectively.
Early detection and treatment of diseases like cancer, diabetes, and heart disease can lead to better health outcomes and lower mortality rates.
Preventive screenings help address normal aging and quality of life by assessing areas like osteoporosis, vision, mobility, and hearing loss before they become major issues. Optimal health in all of these areas is critical for maintaining independence and preventing falls in older adults.
Psychological and Social Benefits
- Regular screenings can provide reassurance to seniors about their health status, and reduce the anxiety someone might have about potential undiagnosed conditions. It’s better to know and take the appropriate action than to not know.
- Preventive screenings include mental health as well as physical health. If any issues are found, your provider can connect you with health counseling to promote healthier lifestyles and better management for any existing conditions.
In summary, preventative screenings for people over 65 are vital for early disease detection, improved health outcomes, personalized care, cost-effectiveness, and psychological benefits.
These screenings help manage the increased risk of various health conditions associated with aging, ultimately contributing to a longer, healthier, and more independent life.
Learn More: How People on Medicare can Protect Themselves Against the Financial Risk of Cancer
Use Your Free Annual Wellness Visit
Medicare Part B covers an Annual Wellness Visit each year for beneficiaries who have had Part B for more than 12 months.
This visit is not a physical exam but a comprehensive review of your health to develop or update a personalized prevention plan. This evaluation includes routine measurements, a health risk assessment, a review of your medical and family history, and personalized health advice. Key Benefits of the Annual Wellness Visit
- No Additional Cost. The Medicare Part B deductible doesn’t apply to your annual wellness visit. So you don’t have to pay anything out of pocket for this visit once per year.
- Personalized Prevention Plan. This visit helps create a personalized plan for you to help prevent disease and disability based on your current health and risk factors.
- Early Detection. The visit includes screenings for cognitive impairments, depression, and other health issues, allowing for treatment to start at the first sign of trouble. The earlier treatment can begin, the better the outcome!
Your annual wellness visit is a great time to speak with your doctor about what tests, screenings, evaluations, and preventive procedures you should be thinking about at your current age.
Covered Screenings
Medicare covers a wide range of preventive services aimed at detecting health issues early and helping seniors maintain overall good health.
Here are some common preventive services covered by Medicare:
Screenings and Exams
- “Welcome to Medicare” Preventive Visit. You are entitled to a one-time visit within the first 12 months of enrolling in Medicare Part B. This visit includes a review of medical and social history, preventive services information, and the taking of basic baseline measurements like height, weight, and blood pressure.
- Breast Cancer Screening (Mammograms). A screening mammogram is provided each year for women over 40.
- Cervical and Vaginal Cancer Screenings. Pap tests and pelvic exams are provided for women every 24 months for low-risk patients, or every 12 months for those at high risk or with a history of abnormal pap tests.
- Prostate Cancer Screenings. Annual digital rectal exams (DRE) and prostate-specific antigen (PSA) tests are provided for men aged 50 and older.
- Colorectal Cancer Screenings. Includes colonoscopies, fecal occult blood tests, and other tests provided at specified intervals based on risk factors to be determined by your doctor.
- Lung Cancer Screening. Annual low-dose computed tomography (LDCT) is provided for individuals aged 50-77 who meet specific criteria, such as a history of heavy smoking.
- Bone Mass Measurements. Provided every 24 months, or more often for individuals at risk of osteoporosis to be determined by their doctor.
- Cardiovascular Disease Screenings. Blood tests for cholesterol, lipid, and triglyceride levels are provided every five years.
- Abdominal Aortic Aneurysm Screenings. Provided once for men aged 65-75 who have smoked, and anyone considered high risk by their doctor.
- Diabetes Screenings. Individuals at risk of diabetes, including those with high blood pressure or obesity as determined by their doctor, can receive up to two free screenings per year.
- Glaucoma Screenings. Annual screenings are provided for individuals at high risk, such as those with diabetes or a family history of glaucoma.
- HIV Screenings. Provided for individuals at increased risk, including those who request the test.
- Hepatitis C Screenings. Provided for individuals at high risk or those born between 1945 and 1965.
Vaccinations
- Flu Vaccine. Annual vaccinations are covered by Medicare Part B.
- Pneumococcal Vaccine. This one-time vaccine is covered by Medicare Part B if determined to be necessary by your doctor.
- Hepatitis B Vaccine. For individuals who have been determined to be at medium to high risk by their doctor, this vaccine is covered by Medicare Part B.
- COVID-19 Vaccine. All recommended vaccines and boosters are covered by Medicare Part B, with updated vaccines provided as they become available.
- Shingles Vaccine. If eligible, it is covered by Medicare Part D and given in two shots over two to six months.
- Tdap Vaccine. Covered for those eligible by Medicare Part D and protects against tetanus, diphtheria, and pertussis.
Counseling and Other Services
- Alcohol Misuse Screenings and Counseling. One screening and up to four counseling sessions per year are provided.
- Tobacco Use Cessation Counseling. Up to eight counseling sessions per year for individuals who use tobacco and are trying to quit are provided.
- Depression Screenings. Annual screenings are provided to identify and address depression.
- Behavioral Therapy for Obesity. Counseling sessions are provided to help manage weight and improve health outcomes.
- Medical Nutrition Therapy. Provided for individuals with diabetes or kidney disease, including dietary counseling and education.
These preventive services are designed to help Medicare beneficiaries maintain their health as they age.
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What Might Not Be Covered
Some healthcare screenings aren’t typically covered under Original Medicare.
For example, a standard physical exam may not be covered unless it includes specific services like a blood pressure check or a screening test.
Additionally, routine vision and hearing exams are generally not covered. Although they might be covered if found to be medically necessary, such as following a glaucoma diagnosis or after sudden hearing loss.
Dental cleanings and dental X-rays are not covered, but some Medicare Advantage plans do offer limited dental coverage. Or, you can purchase a stand-alone dental plan.
Get All Your Screenings!
If you’re feeling great and don’t think you have any health issues at the moment, you might be tempted to skip some screenings.
This may be especially true if you have to pay extra for tests and labs.
Don’t give in to this temptation!
Even if a screening isn’t covered by Original Medicare, there are options to help with the costs:
- Programs like Medi-Share 65+ and Medigap plan allow you to see any specialist for any reason without a referral.
- Medigap plans and Medi-Share 65+ can both help cover your out-of-pocket expenses, such as your Medicare co-pays and deductibles. To enroll, contact a MediGap Advisors Personal Benefits Manager.
- Free clinics can also offer services at low or no cost to those who qualify.
How To Get The Most of Medicare
Medicare focuses on screenings that are medically necessary for the early detection and prevention of serious health issues.
Preventive services, such as the Annual Wellness Visit and various screenings and vaccinations, provide valuable tools for early detection and disease prevention. Schedule your screenings on time and discuss your vaccination needs with your doctor to stay on top of your health.
For more detailed information on coverage and eligibility options, contact a Personal Benefits Manager right away to discuss your specific needs. They’ll help get you on the best track to take full advantage of all your preventative health benefits, for life!
For Further Reading: Things Medicare DOESN’T Cover—And How to Protect Yourself|Medigap Shopping Tips – Don’t Overpay! | 10 Medicare Mistakes to Avoid When Choosing a Plan
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Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage.