Remember Dodge’em? You sat in a bumper car trying to bump other cars and avoid being bumped by them. With Medicare, you can use that same principle to “bump or avoid” disease – for no charge. It’s called preventative care.
Medicare preventative services include medical tests and screenings that are designed to detect indications of diseases while, if they are caught early enough, they may be able to be delayed or cured. The Affordable Care Act (as of January 1, 2011) made most of these services free when provided through Medicare. Of course, if Congress succeeds in killing or changing Affordable Care, this may not be true.
What services are available?
A long list of Medicare preventative services is available under Medicare. Here is a sampling:
- Alcohol abuse counseling (once a year)
- Mammogram (once a year)
- Colonoscopy (Every 24 months if high risk; otherwise, every 120 months; co-pay required if polyps are removed)
- Diabetes screening (can be two screenings per year)
- Flu shot (one per flu season)
- Stop-smoking counseling (eight visits in a 12-month period)
What are the ‘buts”?
If you are in Original Medicare and have Part B, you need to get these Medicare preventative services through a provider that accepts “assignment,” meaning he or she has agreed to accept Medicare-approved amounts as full payment. Otherwise, you may be responsible for a co-pay – or more.
If you are in a Medicare Advantage plan, the provider must be in your network. If he or she is not in your network, charges may apply.
Some plans, like HMOs, may require that a primary-care physician may need to make a referral. Most Original Medicare and Medicare Advantage plans allow you to initiate these services on your own.
Wellness vs. physical
You are eligible for a free wellness visit once a year as part of preventative care. During this visit, the provider will take your vital signs and talk about your health. This is NOT a physical. If you make an appointment for a wellness visit, do not say the word “physical.” There are charges for a physical, which is more in-depth than a wellness visit.
If you are new to Medicare, you can also schedule a Welcome to Medicare visit, which includes a review of your medical history, taking your vitals and education about preventative services available. This can occur any time during the first 12 months of your Part B enrollment. This is also not a physical.
Preventative vs. Diagnostic
Medicate preventative services can only be considered preventative is there are no prior symptoms of a disease. Diagnostic services address the symptoms of a condition or disease that you already have. There is usually a co-pay for diagnostic services.
You are exercising, eating healthier, sleeping more. All of these things encourage you to stay healthy. Why not add Medicare preventative services to the list? Don’t wait until it is too late and you enter the diagnostic stage. Chances are, you’ll pass the tests with flying colors. This will bring you peace of mind. If there is a symptom of some disease, you have the opportunity to treat and/or cure it.
Here’s to a healthy and happy 2018.
Visit our Medicare Resource Center at www.medicareonvideo.com.
Next: What Medicare doesn’t cover.