Medicare expands preventive-care coverage

By: Tammie Smith | Richmond Times-Dispatch
Published: January 17, 2011

A: Medicare enrollees with Part B. The exam must be done within the first 12 months of enrolling in Medicare.

That exam is still available for new enrollees. Also, starting this year, people in original Medicare will be able to get many preventive-care screenings and counseling without having to make Part B co-pays or meet deductibles. It's one of the provisions of federal health-care reform.

The rule is different for people in privately run Medicare Advantage plans.

"Medicare Advantage plans are not required to offer that exact benefit," said Joe Baker, president of the Medicare Rights Center, a national nonprofit organization with offices in Washington and New York.

"However, they are required to offer an actuarially equivalent benefit," Baker said.

According to the Kaiser Family Foundation, there were about 46.5 million Medicare enrollees in 2010, of which about 11 million, or 24 percent, were in Medicare Advantage plans.

In Virginia in 2010, there were 155,855 enrollees in Medicare Advantage plans, about 14 percent of the approximately 1.1 million Medicare beneficiaries in the state.

The preventive services covered by the new rule are based on recommendations of the U.S. Preventive Services Task Force, an advisory panel that considers scientific evidence.

Screenings include:

•An annual wellness visit to update medical history, measure height, weight, blood pressure and body mass index, and screen for cognitive issues.

•Mammograms, once every 12 months.

•Blood tests to screen for cholesterol, lipid and triglyceride levels once every five years.

•Bone mass measurements once every 24 months or more frequently if medically necessary.

•Diabetes screening once every 12 months if you have a family history or are at risk, or twice a year if you have been diagnosed with pre-diabetes.

•Colon cancer screening: fecal occult blood test, colonoscopy and flexible sigmoidoscopy.

•Vaccinations: Pneumonia shot; annual flu shots; hepatitis B shot for people at medium to high risk.

•Smoking cessation: Counseling to stop smoking for people who don't have a smoking-related illnesses. Covers two quitting attempts per year, with four counseling sessions per quit attempt.

•Cervical cancer screening: Pap smear and pelvic exam.

•Prostate cancer screening: Prostate specific antigen (PSA) test.

•Medical nutritional therapy, with a doctor's referral, to help people manage diabetes or kidney disease.

Keep in mind that you may have to pay co-insurance for the office visit if you get other services at the same visit. Also, there are other limits on frequency.

Another Medicare deadline is nearing. People in a Medicare Advantage plan they don't like have until Feb. 14 to switch to original Medicare and pick a Part D prescription plan. People cannot switch to another Medicare Advantage plan, only to original Medicare.

Baker, at the Medicare Rights Center, said people need to consider changes very carefully.

"If you are having a problem, try to solve that problem before you re-enroll back into original Medicare," he said.

People also need to line up Medigap coverage, Baker said, and he advised those who switch to do so through the 1-800-Medicare (1-800-633-4227) hotline.

tlsmith@timesdispatch.com

(804) 649-6572