When Medicare began, the purpose was to provide services to treat a specific diagnosis, illness or injury. These treatments included a copay and deductible which were the responsibility of the patient. As health care knowledge and procedures expanded, the Centers for Medicare and Medicaid Services (CMS) began to include a limited number of services covered to prevent illness or to detect illness at an early stage. Preventive services do not have a diagnosis related to illness and would be considered as screening for a specified condition based on health and family history.
Initially these services were procedures or tests. Those most frequently covered include screening mammograms, bone density studies, colorectal cancer screening, prostate screenings and screening lab tests for diabetes or cardiovascular disease. Any screening tests performed are covered under Medicare Part B. If the service is performed by a provider who accepts Medicare assignment, there are no copays or deductibles. While the regulations define prevention as absence of illness, they may also include limitations based on age or gender or frequency of testing.
CMS further expanded preventive coverage to include one “Welcome to Medicare” physical exam. This visit includes a medical history and a complete physical examination. To be paid under Part B, the service must be provided within 12 months of initial Part B enrollment. There is no deductible or copay for this initial exam. After another 12 months has passed, Medicare Part B pays for one Annual Wellness visit each year. This does not have to be a physician visit. Someone employed by the physician can help you update your health status and review the plan to maintain your health. There is no deductible or copay for this service. Your physician may review this plan with you while you are there; however, if you see the physician while you are in the office to be evaluated for a specific condition or recommended treatment, that physician service can be subject to deductible and/or copay.
In recent years, counseling services to assist in attaining an optimal level of health have been added. Again these services, in the absence of illness, do not have copays or deductibles. Examples of these expansions to coverage include:
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• Tobacco use: Vounseling to stop smoking; up to 8 visits a year
• Obesity: Body mass index (BMI) over 30 qualifies for weight loss counseling. Sessions can continue as long as weight loss progresses.
• Alcohol misuse: With positive screen, up to 4 brief face-to-face counseling sessions per year
As new ways are studied to effectively screen for and provide care, additional services continue to be added:
• Hepatitis C: Effective June 2014, persons considered at high risk (history of injectable drug use or blood transfusions) for Hepatitis C can have lab test done once every 12 months. Persons born between 1945 and 1965 not at high risk are entitled to one test.
• Lung Cancer: Effective February 2015, Medicare covers a lung cancer screening counseling and shared decision making visit for persons considered at high risk. For appropriate beneficiaries, annual screening for lung cancer with low dose computed tomography(CT) can be performed.
A complete list of covered benefits can be found in your Medicare and You handbook, updated yearly. You may also get additional information on the CMS website www.medicare.gov.
APPRISE is Pennsylvania’s statewide program of free insurance consultation under the auspices of the Chester County Department of Aging Services and the State Health Insurance Assistance Program. Its website is http://www.chesco.org/477/Apprise---Health-Insurance-Counseling
If you are getting close to Medicare age or have questions about how Medicare works, APPRISE offers free “Medicare 101” sessions throughout the county. You can contact the APPRISE help line at 610-344-5004 or by email at apprisechesco@outlook.com to find the nearest class or to get any other Medicare question answered.
The Chester County Department of Aging, through its APPRISE program of trained Medicare counselors, helps Medicare beneficiaries to understand the health care options specific to their health needs and financial resources. This is one in a series of articles prepared by APPRISE volunteers to help Medicare beneficiaries navigate this complex system.
Initially these services were procedures or tests. Those most frequently covered include screening mammograms, bone density studies, colorectal cancer screening, prostate screenings and screening lab tests for diabetes or cardiovascular disease. Any screening tests performed are covered under Medicare Part B. If the service is performed by a provider who accepts Medicare assignment, there are no copays or deductibles. While the regulations define prevention as absence of illness, they may also include limitations based on age or gender or frequency of testing.
CMS further expanded preventive coverage to include one “Welcome to Medicare” physical exam. This visit includes a medical history and a complete physical examination. To be paid under Part B, the service must be provided within 12 months of initial Part B enrollment. There is no deductible or copay for this initial exam. After another 12 months has passed, Medicare Part B pays for one Annual Wellness visit each year. This does not have to be a physician visit. Someone employed by the physician can help you update your health status and review the plan to maintain your health. There is no deductible or copay for this service. Your physician may review this plan with you while you are there; however, if you see the physician while you are in the office to be evaluated for a specific condition or recommended treatment, that physician service can be subject to deductible and/or copay.
In recent years, counseling services to assist in attaining an optimal level of health have been added. Again these services, in the absence of illness, do not have copays or deductibles. Examples of these expansions to coverage include:
Advertisement
• Tobacco use: Vounseling to stop smoking; up to 8 visits a year
• Obesity: Body mass index (BMI) over 30 qualifies for weight loss counseling. Sessions can continue as long as weight loss progresses.
• Alcohol misuse: With positive screen, up to 4 brief face-to-face counseling sessions per year
As new ways are studied to effectively screen for and provide care, additional services continue to be added:
• Hepatitis C: Effective June 2014, persons considered at high risk (history of injectable drug use or blood transfusions) for Hepatitis C can have lab test done once every 12 months. Persons born between 1945 and 1965 not at high risk are entitled to one test.
• Lung Cancer: Effective February 2015, Medicare covers a lung cancer screening counseling and shared decision making visit for persons considered at high risk. For appropriate beneficiaries, annual screening for lung cancer with low dose computed tomography(CT) can be performed.
A complete list of covered benefits can be found in your Medicare and You handbook, updated yearly. You may also get additional information on the CMS website www.medicare.gov.
APPRISE is Pennsylvania’s statewide program of free insurance consultation under the auspices of the Chester County Department of Aging Services and the State Health Insurance Assistance Program. Its website is http://www.chesco.org/477/Apprise---Health-Insurance-Counseling
If you are getting close to Medicare age or have questions about how Medicare works, APPRISE offers free “Medicare 101” sessions throughout the county. You can contact the APPRISE help line at 610-344-5004 or by email at apprisechesco@outlook.com to find the nearest class or to get any other Medicare question answered.
The Chester County Department of Aging, through its APPRISE program of trained Medicare counselors, helps Medicare beneficiaries to understand the health care options specific to their health needs and financial resources. This is one in a series of articles prepared by APPRISE volunteers to help Medicare beneficiaries navigate this complex system.
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