Guide to Medicare’s Preventive Health Benefits SHIBA Statewide Health Insurance Benefits Advisors A free, unbiased service of the: 1November 2013

SHIBA mission SHIBA provides free, unbiased information about health care coverage and access to help improve the lives of all Washington state residents. We cultivate community commitment through partnership, service and volunteering. 2November 2013

How can I start? Do physical activities Educate yourself Avoid tobacco Get a preventive exam Keep a healthy weight 3November 2013

Medicare’s preventive benefits (are you at risk?)  Talk to your doctor or medical provider  Your doctor may identify a health risk from your free screening  If so, there may be a charge for the follow-up diagnostic test 4November 2013

Why get the free screening?  If you seek medical care AFTER you have a problem or become sick:  Damage has already occurred  Treatment can be very costly  Your quality of life suffers 5November 2013

Preventive services  Prevention is covered under Medicare Part B  Most preventive services are free – however some charge a coinsurance  Check with your provider to make sure they accept Medicare “Taking action early to prevent disease, minimize complications, and contain costs” -- Wellsource, Inc. 6November 2013

Risk factors for health  Individual/family medical history  Lifestyle behaviors & choices  Age  Gender  Multiple risk stacking 7November 2013

Types of preventive services  Health screening/exams  Counseling  Education  Immunizations Diagnostic tests may be ordered by the medical provider if you’re at risk, but these tests may have an out-of-pocket cost. 8November 2013

After you’re eligible for Part B  Get your Welcome to Medicare Preventive visit during your first 12 months of Part B coverage  What occurs during this visit – your doctor:  Reviews your medical and family history  Assesses any risk factors you may have  Identifies risk factors that may make it necessary to get follow-up tests that have out-of-pocket costs 9 Welcome to Medicare Preventive visit No cost if medical provider accepts Medicare November 2013

10 After you’re eligible for Part B  The yearly Wellness visit takes place after your first 12 months of Part B eligibility (not as comprehensive)  Medicare covers this visit once every 12 months  Anyone with Medicare is eligible  You pay nothing for the visit, unless you get additional tests or services that aren’t covered Wellness visit No cost if medical provider accepts Medicare November 2013

Abdominal Aortic Aneurysm Screening (AAA)  Covered one time by a doctor referral as a result of your “Welcome to Medicare” visit  You must have a family history of AAA OR  Be a male age 65 to 75 who’s smoked at least 100 cigarettes in your lifetime; and  You’ve never had an AAA ultrasound screening paid for by Medicare No cost if medical provider accepts Medicare 11November 2013

Alcohol misuse counseling  This covers:  One screening per year  Positive screens can receive 4 face-to-face counseling sessions per year (in a primary care setting)  Eligible people include adults and pregnant women who use alcohol 12 No cost if medical provider accepts Medicare November 2013

Bone mass measurements  Test covered once every 24 months (more often if medically necessary)  To qualify you must be at risk for osteoporosis & meet 1 of the 5 criteria: 1.Female being treated for estrogen-deficiency; OR an x-ray reveals back bone abnormalities; OR 2.You get steroid treatments; OR 3.You have hyperparathyroidism; OR 4.You take a osteoporosis drug No cost if medical provider accepts Medicare 13November 2013

Cardiovascular screenings Tests are covered every 5 years and include:  Total cholesterol test  Cholesterol test for high density lipoproteins (HDLs)  Triglyceride test  Lipid panel tests 14 No cost if medical provider accepts Medicare November 2013

Colon cancer screenings (colorectal) How often you can get these tests:  Fecal Occult Blood Test: Once every 12 months  Flexible Sigmoidoscopy (FS): Every 24 months or 120 months for low-risk people  Colonoscopy screening: Every120 months  Every 24 months for high-risk people or 48 months after FS test There are costs for these tests – check with your provider 15November 2013

Depression screening  Covers one screening a year  Must be done in a primary care setting that can provide follow-up treatment and referrals No cost if medical provider accepts Medicare 16November 2013

Diabetes screenings  Screenings are covered if you have these risk factors:  High blood pressure  History of abnormal cholesterol and triglyceride levels  Obesity  History of high-blood sugar  And you are two or more of the following:  Over age 65  Overweight  Family history of diabetes  Had diabetes during pregnancy No cost if medical provider accepts Medicare 17November 2013

Diabetes self-management training  You must be at risk for diabetes implications  You must have a written order from a medical provider  You pay 20% of Medicare-approved amount after you meet Part B deductible 18November 2013

Flu, Hepatitis B and Pneumonia shots  Flu shots: One per flu season starting in the fall  Hepatitis B shots: For people with medium or high risk; comes in a series of three for complete protection  Pneumonia shots: You can have any time of year, most people only need one in a lifetime  High risk people can get a pneumonia booster every 5 years 19 No cost if medical provider accepts Medicare November 2013

Glaucoma tests 20 No cost if medical provider accepts Medicare  Medicare covers a Glaucoma screen by a doctor once every 12 months, including :  Dilated eye exam with an eye pressure measurement  A direct opthalmascope exam  Eligible people include:  You’re at high risk for diabetes  You’re African American over age 50  You’re Hispanic and age 65 or older  Costs:  You pay 20% of Medicare-approved amount after you meet the yearly Part B deductible November 2013

Medical nutrition therapy  Covers people with:  Diabetes  Kidney disease  Kidney transplant within the last 3 years  Therapy must be prescribed by a doctor  Benefits of initial lifestyle & nutrition assessment:  Nutrition counseling  Lifestyle management information (diet)  Diet management follow-up visits 21 No cost if medical provider accepts Medicare November 2013

Cervical & vaginal cancer screenings  High-risk women:  Covers 1 Pap test & Pelvic exam/year  Low-risk women:  Covers 1 exam every 2 years for cervical cancer (breast exam included) If medical provider accepts Medicare, there’s no cost for pap lab test & specimen collection, or pelvic & breast exams 22November 2013

Prostate cancer screenings  Covers men over age 50 for a:  Digital rectal exam & Prostate Specific Antigen (PSA) once every 12 months  Costs:  For PSA, no cost  For digital rectal exam, you must meet the Part B deductible, and you’ll have to pay a deductible and coinsurance 23November 2013

24 Obesity screening & counseling  Medicare covers if your body mass index is 30 or more  Talk to your provider for more details November 2013

HIV screenings  Covers an HIV test once every 12 months or up to 3 times during a pregnancy  People with Medicare may request the test. You must be:  Pregnant  At increased risk for the infection  No cost for the test, but you must pay 20% of the Medicare-approved amount for the doctor visit 25November 2013

Smoking cessation  To qualify, you must use tobacco and be on Medicare  Covers 8 face-to-face sessions to help you stop smoking during a 12-month period  A qualified doctor or other Medicare-recognized provider must provide the sessions  You pay nothing for the counseling sessions 26November 2013

SHIBA volunteer opportunities  Love to learn and help people  Like problem-solving  Don’t mind paperwork or computer work  Are organized  Can attend regular training You might be interested in becoming a volunteer if you: 27November 2013

Want more information? Publications:  Your Guide to Medicare Preventive Services, CMS Pub #10110  Staying Healthy, CMS Pub #11100  Understanding Your Health Insurance Options, SHP November 2013

Medicare preventive benefits tracking To track your benefits, use the My Medicare Preventive Benefits Checklist – get a copy at:  Web:  Call: MEDICARE ( )  TTY users call: November 2013

30 Need help with other insurance questions? The Office of the Insurance Commissioner can also help you with questions, information, and complaints about all types of insurance, such as: Call our Insurance Consumer Hotline Check out our Consumer Toolkit at Homeowner Auto Life Annuities Health And more! November 2013