What Are Medicare’s Preventive Care Benefits?

April 27, 2016

by: The My Medicare Matters Team

Last month we discussed “knowing your numbers” – being aware of your blood pressure, blood sugar, weight and cholesterol levels so that you could be better informed at your medical appointments.

The first place that these numbers become important to you (in terms of Medicare) is when you access two of the most important preventive benefits: the Welcome To Medicare Physical and the Annual Wellness Visit. At these visits, you and your doctor will discuss what types of disease screenings and other services will help you stay healthy as you age.

Although these visits are two of the biggest advantages of Medicare, very few beneficiaries use them. In fact, one survey showed that within a sample group of beneficiaries, fewer than 4% took advantage of the Welcome to Medicare physical. Similarly, the recently added obesity screening and weight-loss counseling has been used by less than 1% of Medicare beneficiaries (despite a 30% obesity rate among seniors).

So, what exactly do these wellness visits entail, and what types of tests and screenings should you take advantage of? Read on for the key facts you need to know.

1. What exactly is a Medicare wellness exam?

The Welcome to Medicare physical is the first wellness exam you can expect when you enroll in Medicare. It’s what sets your baseline for looking at your health changes over time. The yearly Wellness visits follow-up on the information found in that initial exam (they start once you’ve had Part B for longer than 12 months). The purpose of these two types of wellness appointments is to allow your doctor to develop a personalized plan for your care, so you prevent diseases and chronic conditions before they can develop.

At the start of the appointment, you will fill out a questionnaire called a “Health Risk Assessment.” By looking at your family and medical history, a list of your medications, routine measurements and a cognitive screening, your doctor can develop a list of risk factors, and also suggest screenings and treatments that you may want to consider. You are entitled to this Annual Wellness appointment once every 12 months.

2. What are some of the key preventive screenings offered by the wellness exam?

Now let’s examine some of the most important preventive screenings that may be recommended and encouraged by your doctor at your first Medicare Wellness Visit. Many of these are available at no charge, although if the screening reveals abnormalities, then you or your insurance may be charged for a diagnostic follow-up.

  • Obesity screening and counseling: Almost 1 in 3 people with Medicare is estimated to be obese. This screening can help you get treatment to improve your quality of life. If you screen positive for obesity, Medicare will cover counseling for up to 1 year to help you learn ways to reduce your weight and improve your overall health.
  • Mammography Screening: Breast cancer is the second most common cancer in women, and the second leading cause of cancer death in women in the United States. The good news is that breast cancer can usually be treated successfully when found early. Mammograms are covered once every 12 months free of charge.
  • Prostate Screening: Prostate cancer is the most common type of cancer in men in the United States. A rectal exam and a blood test called a Prostate-Specific Antigen (PSA) test can find this cancer. The PSA test is free, and the digital exam has a 20% copay. Both are covered by Medicare once every 12 months.
  • Colon Cancer Screening: This cancer is more common in people over 50, and the risk increases with age. In the United States, it is the fourth most common cancer in men and women. Colon cancer screenings help find growths in the colon (pre-cancerous polyps) so your doctor can remove them before they turn into cancer. There are a wide variety of tests and screenings available for colon cancer; some are covered every 12 months and some are covered every two to three years. All of them are free except the barium enema–although it may be covered in some instances.
  • Bone Density: Bone mass measurements help your doctor determine if you are at risk for a broken bone (fracture). The results will help you and your doctor choose the best way to keep your bones strong. The bone density test can also identify osteoporosis. The measurements are covered once every 24 months for those meeting screening criteria.
  • Cardiovascular Screening: Cardiovascular diseases affect your heart or your blood vessels. High blood pressure (also known as hypertension), stroke and heart failure are all types of cardiovascular diseases. So is coronary heart disease, which includes heart attack and chest pain. Once a year, your doctor will screen you to see if you are at risk for heart disease (covered for free). If you’re at risk, they will administer a blood test (covered once every 5 years).
  • Pap Tests and Pelvic Exams: Cervical and vaginal cancers are cancers of the womb and birth canal. To check for these, your doctor will do a pelvic exam and look inside your cervix. They will also take some cells from your cervix for a Pap test. These screenings are covered with no copay once every two years (and once a year if you are high risk).
  • Diabetes screenings: Diabetes is the seventh leading cause of death in the United States. Millions of people have diabetes and do not know it. If you have diabetes and your doctor finds it early, they may be able to prevent the serious health problems caused by diabetes. For those with risk factors (high blood pressure, history of abnormal cholesterol and triglyceride levels, history of high blood sugar) diabetes screenings are covered up to twice a year for free.
  • Alcohol misuse screening and counseling: Alcohol abuse is a growing problem. Currently, 1 in 6 people in the United States has a drinking problem. This screening can help prevent you from becoming dependent on alcohol in the future. The screening is covered once a year, and Medicare beneficiaries who screen positive are entitled to four free counseling sessions.
  • Depression screening: Among people over the age of 65, 1 in 6 suffers from depression. Many people who suffer from depression are not diagnosed or treated, which can also lead to additional health problems. Screenings are covered for free once a year.

For additional information, please check out our complete guide to Medicare’s preventive services. Around 70% of Americans die from chronic diseases and conditions each year–many of which are preventable. Focusing on preventing diseases before they occur allows people of all ages (including you!) to live healthier and happier lives.