Medicare Preventative Care Benefits (2011)

November 11th, 2010

Preventive Services Checklist

Take this checklist to your doctor or other health care provider, and ask which preventive services are right for you. You can also keep track of your preventive services by visiting www.MyMedicare.gov. See page 118.

Medicare -Covered Preventive Service	Details on page	Notes
Abdominal Aortic Aneurysm Screening	30
Bone Mass Measurement	31
Cardiovascular Screenings	31
Colorectal Cancer Screenings	32
Fecal Occult Blood Test	32
Flexible Sigmoidoscopy	32
Colonoscopy	32
Barium Enema	32
Diabetes Screenings	33
Diabetes Self-management Training	33
Flu Shots	36
Glaucoma Tests	36
Hepatitis B Shots	36
HIV Screening	36
Mammogram (screening)	37
Medical Nutrition Therapy Services	37
Pap Test and Pelvic Exam (includes breast exam)	39
Physical Exams	39
One-time “Welcome to Medicare” physical exam	39
Yearly “Wellness” exam	39
Pneumococcal Shot	40
Prostate Cancer Screenings	41
Smoking Cessation (counseling to stop smoking for people with no sign of disease)	42

Abdominal Aortic Aneurysm Screening

A one-time screening ultrasound for people at risk. You must get a referral for it as part of your one-time “Welcome to Medicare” physical exam. See page 39. Starting January 1, 2011, you pay nothing for the screening if the doctor accepts assignment.

Bone Mass Measurement(Bone Density)

Helps to see if you’re at risk for broken bones. This service is covered once every 24 months (more often if medically necessary) for people who have certain medical conditions or meet certain criteria. Starting January 1, 2011, you pay nothing for this test if the doctor accepts assignment.

Cardiovascular Screenings

Blood tests that help detect conditions that may lead to a heart attack or stroke. This service is covered every 5 years to test your cholesterol, lipid, and triglyceride levels. You pay nothing for the tests, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.

Colorectal Cancer Screenings

To help find precancerous growths or find cancer early, when treatment is most effective. One or more of the following tests may be covered. Talk to your doctor.

Fecal Occult Blood Test—Once every 12 months if 50 or

Flexible Sigmoidoscopy—Generally, once every 48 months

Colonoscopy—Generally once every 120 months (high

Barium Enema—Once every 48 months if 50 or older

■■older. You pay nothing for the test, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit. ■■if 50 or older, or 120 months after a previous screening colonoscopy for those not at high risk. Starting January 1, 2011, you pay nothing for this test if the doctor accepts assignment. ■■risk every 24 months) or 48 months after a previous flexible sigmoidoscopy. No minimum age. Starting January 1, 2011, you pay nothing for this test if the doctor accepts assignment. ■■(high risk every 24 months) when used instead of a sigmoidoscopy or colonoscopy. You pay 20% of the Medicare-approved amount for the doctor’s services. In a hospital outpatient setting, you also pay the hospital a copayment.

Diabetes Screenings

Medicare covers these screenings if you have any of the following risk factors: high blood pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar (glucose). Tests may also be covered if you meet other requirements, like being overweight and having a family history of diabetes.

Based on the results of these tests, you may be eligible for up to two diabetes screenings every year. You pay nothing for the test, but you generally have to pay 20% of the Medicare

-approved amount for the doctor’s visit.

Diabetes Self-Management Training

For people with diabetes with a written order from a doctor or other health care provider. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

EKG Screening

Medicare covers a one-time screening EKG if ordered by your doctor as part of your one-time “Welcome to Medicare” physical exam. See page 39. You pay the doctor 20% of the Medicare

-approved amount, and the Part B deductible applies. An EKG is also covered as a diagnostic test. See page 42. If you have the test at a hospital or a hospital-owned clinic, you also pay the hospital a copayment.

Flu Shots	Generally covered once per flu season in the fall or winter. You pay nothing for the flu shot if the doctor or other health care provider accepts assignment for giving the shot. Note: Medicare Part B also covers administration of the H1N1 flu shot. You pay nothing if your doctor accepts assignment for giving the shot.
Foot Exams and Treatment	If you have diabetes-related nerve damage and/or meet certain conditions. You pay the doctor 20% of the Medicare-approved amount, and the Part B deductible applies. In a hospital outpatient setting, you also pay the hospital a copayment.
Glaucoma Tests	Covered once every 12 months for people at high risk for the eye disease glaucoma. You’re at high risk if you have diabetes, a family history of glaucoma, are African-American and 50 or older, or are Hispanic and 65 or older. An eye doctor who is legally allowed by the state must do the tests. You pay the doctor 20% of the Medicare-approved amount, and the Part B deductible applies for the doctor’s visit. In a hospital outpatient setting, you also pay the hospital a copayment.
Hearing and Balance Exams	If your doctor orders these tests to see if you need medical treatment. You pay the doctor 20% of the Medicare-approved amount, and the Part B deductible applies. In a hospital outpatient setting, you also pay the hospital a copayment. Note: Medicare doesn’t cover hearing aids and exams for fitting hearing aids.
Hepatitis B Shots	Covered for people at high or medium risk for Hepatitis B. Your risk for Hepatitis B increases if you have hemophilia, End -Stage Renal Disease (ESRD), or certain conditions that increase your risk for infection. Other factors may increase your risk for Hepatitis B, so check with your doctor. You pay nothing for the shot if the doctor accepts assignment.
HIV Screening	Medicare covers HIV (Human Immunodeficiency Virus) screening for people with Medicare of any age who ask for the test, pregnant women, and people at increased risk for the infection. Medicare covers this test once every 12 months or up to 3 times during a pregnancy. You pay nothing for the test, but you generally have to pay the doctor 20% of the Medicare -approved amount for the doctor’s visit.

Mammograms (screening)	A type of X-ray to check women for breast cancer. Medicare covers screening mammograms once every 12 months for women 40 and older. Medicare covers one baseline mammogram for women between 35–39. Starting January 1, 2011, you pay nothing for the test if the doctor accepts assignment.
Medical Nutrition Therapy Services	Medicare may cover medical nutrition therapy and certain related services if you have diabetes or kidney disease, or you have had a kidney transplant in the last 36 months, and your doctor refers you for the service. Starting January 1, 2011, you pay nothing for these services if the doctor accepts assignment.

Pap Tests and Pelvic Exams (includes clinical breast exam)

Checks for cervical, vaginal, and breast cancers. Medicare covers these screening tests once every 24 months, or once every 12 months for women at high risk, and for women who have Medicare and are of child-bearing age who have had an exam that indicated cancer or other abnormalities in the past 3 years. You pay nothing for the Pap lab test. Starting January 1, 2011, you also pay nothing for Pap test specimen collection, and pelvic and breast exams if the doctor accepts assignment.

Physical Exams

Note: Your first yearly “Wellness” exam can’t take place within 12 months of your “Welcome to Medicare” physical exam.

Medicare covers two types of physical exams—one when you’re new to Medicare and one each year after that.

“Welcome to Medicare” physical exam

■■—A one-time review of your health, education and counseling about preventive services, and referrals for other care if needed. Medicare will cover this exam if you get it within the first 12 months you have Part B. Starting January 1, 2011, you pay nothing for the exam if the doctor accepts assignment. When you make your appointment, let your doctor’s office know that you would like to schedule your “Welcome to Medicare” physical exam. Keep in mind, you don’t need to get the “Welcome to Medicare” physical exam before getting a yearly “Wellness” exam. Yearly “Wellness” exam

■■—If you’ve had Part B for longer than 12 months, starting January 1, 2011, you can get a yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. You pay nothing for this exam if the doctor accepts assignment. This exam is covered once every 12 months.

Pneumococcal Shot

Helps prevent pneumococcal infections (like certain types of pneumonia). Most people only need this shot once in their lifetime. Talk with your doctor. You pay nothing if the doctor or supplier accepts assignment for giving the shot.

Prostate Cancer Screenings

Medicare covers a digital rectal exam and Prostate Specific Antigen (PSA) test once every 12 months for men over 50 (coverage for this test begins the day after your 50th birthday). You pay nothing for the PSA test. You pay the doctor 20% of the Medicare

-approved amount, and the Part B deductible applies for the doctor’s visit. In a hospital outpatient setting, you also pay the hospital a copayment.

Smoking Cessation (counseling to stop smoking) NEW	Includes up to 8 face-to-face visits in a 12-month period if you’re diagnosed with an illness caused or complicated by tobacco use, or you take a medicine that is affected by tobacco. You pay the doctor 20% of the Medicare-approved amount, and the Part B deductible applies. In a hospital outpatient setting, you also pay the hospital a copayment.
	Medicare coverage of smoking cessation counseling is now considered a covered preventive service if you haven’t been diagnosed with an illness caused or complicated by tobacco use. Starting January 1, 2011 you pay nothing for the counseling sessions.