Health care reform generously expanded coverage of recommended preventive screenings by removing deductibles and co-payments for several services. Getting that Medicare coverage begins with a free annual appointment, known as a wellness visit, from a doctor who participates in Medicare.
During the first year you are enrolled in Medicare, doctors can order a few preventive screenings Medicare won’t pay for in subsequent years. And, that once-in-a-lifetime opportunity is only available during the first 12 months you have Part B.
New Coverage Has Been Added
Even after health care reform was already law, Medicare added to the list of covered services. Now there’s extra help to stop smoking, decide whether depression is a problem, and deal with over dependence on alcohol.
There’s actually a long list of recommended preventive health care, so here’s the short list on how to tell the amount of coverage that’s available.
Preventive Services Are Available with No Co-pays or Deductibles
Certain preventive services are available without having to meet the annual Part B deductible. And, you won’t have to cover 20 percent of the doctor’s fee for these:
• Abdominal aortic aneurysm screening
• Bone mass measurement
• Breast cancer screening (mammogram)
• Flu shot
• Hepatitis B shot
• Medical nutrition therapy services if you are diabetic or have kidney disease
• Pap tests and pelvic exams that include a clinical breast exam
• Pneumococcal shot.
Services that Are Available with Only a Co-pay
Other types of preventive services are mostly covered by Medicare, but you may have a co-pay for services, such as:
• Cardiovascular screening tests are free, but there’s a 20-percent co-pay for the doctor appointment
• Colon cancer screening colonoscopy and flexible signoidoscopy are free. However, if something questionable like a polyp is removed, you may have a 20-percent co-pay for the doctor and another co-pay if it’s done in a hospital outpatient setting.
• Diabetes screening tests are free, but there’s a 20-percent doctor co-pay
• HIV screening tests are free, but there’s a 20-percent co-pay for the doctor.
Services that Have a Co-pay and a Deductible
Once you’ve met the Part B annual deductible, other services are available with a co-pay, such as:
• Diabetes self-management training with a 20-percent co-pay
• Glaucoma tests with a 20-percent co-pay
• Prostate cancer screenings (PSA tests) are free with a 20-percent co-pay for the doctor.
Remember that even though you do pay part of the cost for some of the services, they are recommended by an expert panel of doctors as helping to prevent dangerous conditions from developing.
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. For more information visit www.MediGapAdvisors.com.