Q: I know that there are some procedures that Medicare and other insurance companies cover in full, but what are they and how can I find that information?
A: This question is pretty broad, so I am going to address what I think you are asking. I will review (briefly) what are called preventive services. Centers for Medicare & Medicaid Services (CMS) publishes a 26-page book on this topic and I don't have that much space. I will try to cover it briefly. There are also some recently added preventive services and I will review those in more depth.
At the first of the year we often make resolutions to get things done that we didn't do last year or haven't done before and many of these are perfect resolutions.
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A Yearly Wellness Exam: Each year, Medicare covers in full a wellness visit with your primary care physician. This includes a review of medical and family history, a list of current providers and prescriptions; height, weight, blood pressure and other routine measurements; a screening for appropriate preventive services and list of risk factors and treatment options for you.
This wellness exam is not a physical. It involves a discussion with your physician about your history, current situation and potential problems in the future.
A Cardiovascular Screening: This screening covers a check (test) of your cholesterol triglyceride and lipid levels. This is covered every 5 years.
Fact Box
As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms are different, the prices are different, the products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
These questions and answers are meant as a guide to help you understand the complex questions you are now thinking about. Each individual's specific situation may create a different solution. You shouldn't necessarily do what your friends, family and neighbors do.
A Breast Cancer Screening: Mammograms are covered once every 12 months with Medicare.
Cervical and Vaginal Cancer Screening: These screenings of a Pap test and pelvic exam are covered once every 24 months for all women and once every 12 months for those at high risk.
Colorectal Cancer Screening: This screening is divided into a number of different procedures. A fecal occult blood test is covered once every 12 months. Flexible sigmoidoscopy is covered once every 48 months (4 years) or 120 months after a previous colonoscopy. Screening colonoscopy is covered once every 120 months (5 years) or 48 months after a previous flexible sigmoidoscopy. Barium enema once every 48 months (high-risk, 24 months).
Prostate Cancer Screening: A digital rectal exam is covered once every 12 months and a PSA test is covered once every 12 months. The PSA test is covered in full under original Medicare. The digital rectal exam falls under the usual Part B deductible and 80/20 split for cost.
Immunizations: Flu shot is covered in full once a flu season. Pneumococcal shot is covered in full once a lifetime for most individuals. Hepatitis B is covered in full for those individuals who are at medium or high risk for this disease.
Bone mass measurements: This measurement is covered in full once every 24 months for those at risk due to osteoporosis.
Diabetes screening: This blood test involves a fasting blood glucose test and is covered up to twice a year.
Medical nutrition therapy for those with diabetes, renal disease or a kidney transplant with the last 3 years: This covers up to 3 hours of one-on-one counseling services the first year and two hours each year after that to help you manage your diet and nutrition issues.
Tobacco use cessation counseling: This covers up to eight face-to-face visits with a qualified doctor or practitioner during 12 months. This applies to those individuals who have not been diagnosed with an illness cause by tobacco use.
HIV screening: Medicare covers this test once every 12 months or up to three times during a pregnancy for pregnant women.
THREE NEW
PREVENTATIVE SCREENINGS
Depression Screening: Covers an annual discussion with your primary care physician to review Depression and likelihood of depression
Screening and Counseling for Alcohol Misuse: Covers an annual discussion with primary care provider and if you screen positive, Medicare will cover up to four face-to-face behavior counseling interventions annually.
Cardio Vascular Disease (CVD) Risk Reduction Visit: This covers a blood pressure check, encouraging the use of aspirin and behavioral counseling to promote a healthy diet.
These are all screenings that Medicare covers in full. That means there is no deductible or cost share for these services with original Medicare. (This usually means that your Medicare Advantage Plan will also cover these procedures in full.)
Watch for those screenings that are approved once every 12 months, 48 months or the like. If you had your screening in July, you can't do your next screening until July. Don't schedule it for June or earlier, as it won't be covered under these criteria of once every 12 months.
There are also many, many preventative screenings and tests that Medicare covers by the usual $140 annual deductible and then 20 percent cost share applies. This list includes those services that we know helps keep individuals healthy and well as long as possible.
If you want additional information you can call 1-800-MEDICARE, read your Medicare & You Handbook or go online to www.medicare.gov. All of these resources and more are available to you every day.
This is a new year and why not resolve to make it a healthy year by having those screenings and tests that apply to your medical situation. After all we want to have you around in 2013 too.
Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing, and has worked in Chautauqua County with seniors for more than 18 years. She is HIICAP (Health Insurance Information, Counseling & Assistance Program) counselor-trained by Office for the Aging. She does not sell insurance or represent any insurance company. She is an unbiased source of insurance and education to help seniors choose the best option for them.
You may submit questions to be answered in later columns to Janell Sluga at Senior Life Matters, 737 Falconer St., Jamestown, NY 14701, or call 716-720-9797, or by email at janells@lutheran-jamestown.org. Please remember that not all questions can be answered in this format, but as many as can be, will be.