The new year is barely a month old, but it's not too soon for Medicare users to begin taking advantage of the new, free preventive health screenings and tests provided under the health reform law. Many of the procedures do not require a co-pay and are not subject to any insurance deductibles. Ideally, they should be part of an on-going wellness plan that you and your physician develop.
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Under the new rules, a free yearly wellness exam is available from doctors who participate in Medicare. This visit, in turn, can be used to build a year-long wellness plan with your primary physician. Most Medicare beneficiaries have some form of supplemental coverage beyond basic Medicare. They should check with their insurers for other wellness provisions provided under their policies.
The newly covered wellness exam supplements a one-time "welcome to Medicare" exam that is now also free to people who get it within their first 12 months of being covered by Medicare. This welcome exam had been subject to a 20 percent co-payment but since the first of the year, it's been totally free.
Based on how Medicare beneficiaries have responded to wellness programs in the past, it's likely that the new roster of free benefits will not be heavily used. The benefits are not being broadly publicized, and even many physicians are not fully informed about the new measures.
"In 2008, we did an analysis showing that only about 3 percent" of new beneficiaries used the welcome to Medicare exam, says Dan Mendelson, head of Avalere Health, a policy and research advisory company in Washington, D.C. "In 2008, there was legislation that waived the deductible and doubled the eligibility period, and still only about 3 percent [of beneficiaries] used it."
Mendelson says it's too early for there to be hard data on use of the free wellness benefits, but the early feedback from health insurers is that they are not seeing higher use. A spokeswoman for the Medicare Rights Organization said program counselors were not getting many consumer inquiries about the new benefits, and that the most logical explanation was that they just weren't aware of them.
"It would be a real eye-opener just to tell people what's available," Mendelson said. "For example, if you asked 100 people whether smoking cessation services are provided [as a free benefit], I bet all of them would say 'no.' But they are covered."
The health reform law was enacted as the Patient Protection and Affordable Care Act, and is referred to formally today as the Affordable Care Act (ACA). Opponents, of course, have many other names for it, including Obamacare and other names that usually include a derivative of "job killing" in their title. It mandated expanded preventive health services for all Americans, including Medicare beneficiaries.
The pool of free preventive services is overseen by the U.S. Preventive Services Task Force, an independent panel of medical experts that evaluates treatments and tests and assigns them grade levels that reflect their effectiveness.
Doctors and other care providers are advised to offer measures that have received either an "A" or "B" grade, and the free services are selected from these procedures. Not all highly graded preventive measures are included right now among the free procedures mandated by the ACA.
Medicare has details on the preventive measures it covers. Some were available before the ACA was enacted.
Here are the Medicare preventive and wellness items that are free:
•Abdominal aortic aneurysm screening
•Bone mass measurement
•Hepatitis B shots
•Breast cancer screening (mammograms)
•Medical nutrition therapy services (for those with diabetes or kidney disease)
•Pap tests and pelvic exams (includes clinical breast exam; once every 24 months or once every 12 months for at-risk women)
•One-time "welcome to medicare" physical exam
•Yearly "wellness" exam (for people with Part B Medicare longer than 12 months)
•Smoking cessation (counseling to stop smoking; for those not previously diagnosed with an illness caused or complicated by tobacco use)
Here are available preventive services that still include some cost to Medicare beneficiaries:
•Cardiovascular screenings (the test is free, but there's a 20 percent co-pay for the doctor's visit)
•Colon cancer screening (colorectal) (flexible signoidoscopy and colonoscopy are free, but some other related tests and provisions may involve co-pay for doctor's services)
•Diabetes screenings (the tests are free, but there is a 20 percent doctor's co-pay)
•Diabetes self-management training (there is a 20 percent co-pay, plus the Part B deductible applies)
•Glaucoma tests (there is a 20 percent co-pay, plus the Part B deductible applies)
•HIV screening (the test is free, but there's a 20 percent co-pay for the doctor's visit)
•Prostate cancer screenings (the PSA test is free, but there's a 20 percent co-pay plus the Part B deductible for the doctor's visit)
For a general set of wellness tips, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services, provides a general set of wellness tips for women and men above the age of 50.