May 5, 2017

Medicare's Free Preventive Services

You like FREE stuff, right?

I know, who doesn’t? That’s another great thing about Medicare is they provide lots of stuff for FREE!

From doctors’ visits, to preventive shots, to health screenings and counseling for specific health issues, Medicare has lots of resources to help you stay healthy and manage whatever health issues you’re treating.

And, they’re all available to you at no charge!

Let’s take a look at this comprehensive list, starting with your first step, the “Welcome to Medicare” visit…

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“Welcome to Medicare” Preventive Visit

You’re entitled to this visit the first 12 months that you’re on Medicare Part B.

Keep in mind, this benefit applies specifically to folks on Original Medicare. If you’ve enrolled in a Medicare Advantage (MA) Plan, then technically you’re not enrolled in Original Medicare anymore. Your MA plan replaces Medicare. So for you, this benefit may be slightly different and/or have some restrictions to it.  Just check with your plan or primary doctor to make sure you how to get this (or a similar) visit covered, so you don’t miss out.

Quick Tip:  This visit is available to folks their first 12 months on Part B. Let’s say you work past 65, are still covered under your employer group health plan, then get Part B when you retire. You can still take advantage of this visit, no matter how old you are. This is another reason it’s usually best to opt out of Part B if you’re still covered through an employer plan when you’re first eligible for Medicare.

Ok, now that we’ve figured out who’s eligible, let’s look at what value this visit provides and the steps involved…

Components of the Welcome to Medicare visit

  1. The first 3 steps are mainly to “get to know you. In the first step, your doctor will get to know your health history. He, or she, will ask about:
    • Your medical and surgical history (hospital stays, allergies, past injuries and illnesses, for example)
    • What prescriptions and over-the-counter supplements you’re taking
    • Your family’s medical history, to see what diseases run in your family that you may be a higher risk for
    • Your history of alcohol, tobacco, and illicit drug use, and
    • Your diet and level of physical activity
  2. Next, your doctor will see if you are at risk for depression or any other mood disorders. They will use current screening tests or if you’ve struggled with this area in the past.
  3. Your doctor will then evaluate your level of safety, both at home and in general. They’ll evaluate your hearing, risk of falling, safety at home, and even you’re ability to perform your Activities of Daily Living.
  4. This fourth step is the actual exam. Your doctor will take your basic vitals: height, weight, and blood pressure. You’ll also get a basic vision test. However, no lab work or blood work is covered as part of this visit.
  5. You have the option to discuss end-of-life planning, if you wish. Your doctor can give information on how to set up an “advance directive”.  An advance directive allows you to choose what would happen to you in the case that an illness or injury in the future would prevent you from making your own health care decisions.
  6. Based on the information your doctor collected in first 5 steps in the visit, they will provide you with appropriate education and counseling for your situation.  They can also refer you to other healthcare providers where appropriate.
  7. You’ll receive a written plan for how to receive the other free preventive screenings and services I’ll mention later in this article.

So, as you can see this is a free benefit you really don’t want to miss out on. It gives you a game plan on how to manage your health now that you’re on Medicare.

If you want to know the fancy, official name for this visit, it’s called the Initial Preventive Physical Examination (IPPE). You can just use this tidbit to impress your friends or folks at your doctor’s office.

To make the most of this visit, just make sure you bring as much information as you can about:

  • Your medical records
  • Your family history
  • Medications you’re taking

Each year after this initial “Welcome to Medicare” visit, make sure you get your…

Annual Wellness visit

You’re eligible for your first Annual Wellness visit (AWV) when it’s been at least 11 full months since you’ve had your Welcome to Medicare visit. Or, if you never took advantage of your Welcome to Medicare visit, you can have your initial AWV once you’ve been on Part B for 12 months or more.

There is a lot of overlap between the Welcome to Medicare visit and this AWV. They’re both focused on preventing disease by getting recommended preventive services and screenings to find health issues that need your attention. The one main difference I see is that the AWV is much more focused on managing your health risks.

Components of the Annual Wellness visit:

  1. This visit starts off with a Health Risk Assessment (HRA). This HRA is administered during the first AWV and updated during each AWV after. It collects information like:
    • Your assessment of your own health
    • Any psycho-social or behavioral risks you have
    • Your ability to perform the Activities of Daily Living, and
    • Your ability to manage important aspects of your life like shopping, managing medications, or finances.
  2. Your doctor will then get a list of all health care providers who you use for any medical care.
  3. Similar to component #1 of the Welcome to Medicare visit, your doctor will document your medical and family history.
  4. Similar to component #2 of the Welcome to Medicare visit, your doctor will evaluate you for any signs of depression or mood disorders.
  5. Similar to component #3 of the Welcome to Medicare visit, your doctor will evaluate your level of safety
  6. Similar to component #4 of the Welcome to Medicare visit, your doctor will take your vitals.
  7. Your doctor will then evaluate any cognitive impairment you might have. They’ll look for signs when they directly interact with you.  They can also information from your loved ones and others close to you.
  8. The last components of the AWV have to do with creating a game plan to manage your health moving forward. Your doctor will first put together a longer term checklist for what screenings you need over the next 5-10 years. This schedule is based on your personal health and risk factors.
  9. Next, your doctor will evaluate your particular health risks and recommend any treatment options.
  10. Lastly, your doctor will give you personalized health advice and refer you to any education or counseling services they think could help.

So, I’ve mentioned some different preventive services and screenings but haven’t really mentioned what free ones are available. Let’s look at those now…

Taking advantage of your FREE preventive services is tip #28 one of my 31 ways to save money on Medicare. Interested in learning about 30 others? Get your copy of my FREE e-book "31 Ways To Save Money on Medicare"

FREE Medicare Part B Preventive Services

Keep in mind, this is not a complete list of your preventative services covered by Medicare. This is simply a list of those services that are FREE.

  • Abdominal aortic aneurysm screening – You’re entitled to one free ultrasound screening in your life if you’re considered at risk. Those considered at risk either:
    • Have a family history of these types of aneurysms, or
    • You’re male, age 65 - 75, and have smoked 100 cigarettes or more in your life
  • Alcohol misuse screening - You’re entitled to one free screening per year if you use alcohol, but aren’t medically considered alcohol-dependent.
  • Alcohol misuse counseling – You’re entitled to four face-to-face counseling sessions per year if your doctor determines during the screening that you’re abusing alcohol. You have to get this counseling in a primary care setting by a qualified healthcare provider.
  • Bone mass (density) measurement – You’re entitled to one measurement test at least every 24 months if you’re at risk for osteoporosis, and have any of the following other medical conditions:
    • Are an estrogen-deficient woman whose doctor says she’s at risk
    • Have with vertebral abnormalities shown in an x-ray
    • Are getting steroid treatments
    • Have hyperparathyroidism
    • Are already taking an osteoporosis drug
  • Breast cancer screening (mammograms) – You’re entitled to one mammogram every 12 months if you’re a woman 40 and older.
  • Cardiovascular disease (behavioral therapy) – Everyone is entitled to one visit each year with your doctor to discuss ways to lower your risk of heart disease by doing things like:
    • Taking aspirin
    • Monitoring blood pressure
    • Following a healthy diet
  • Cardiovascular disease screening – You’re entitled to one doctor-ordered bloodwork screening every five years to check for high levels of cholesterol, lipids, and triglycerides.
  • Cervical and vaginal cancer screenings – All women on Medicare are entitled to a Pap test and pelvic exam every 24 months. You can get tested every 12 months if you’re considered high risk. Any woman who meets any of the following conditions is considered high risk:
    • Had an abnormal Pap test in the past
    • Had cervical or vaginal cancer in the past
    • Have a history of sexually transmitted diseases
    • Begun having sex prior to age 16
    • Had five or more sexual partners
    • Your mother took a hormonal drug called Diethylstilbestrol (DES) when she was pregnant with you
  • Colorectal cancer screenings – You’re entitled to screenings if you’re age 50 or older. There are several different tests used to find pre-cancerous polyps. Each test has its own frequency for how often it's covered:
    • Multi-target stool DNA test – covered every 3 years for folks
      • age 50 to 85
      • show no signs or symptoms of colorectal disease
      • are at average risk for developing colorectal cancer, and
      • have no family history of this type of cancer
    • Screening fecal occult blood test – covered once every 12 months
    • Screening flexible sigmoidoscopy – covered once every 48 months either after the last sigmoidoscopy, last screening barium enema (not a free test), or 120 months after the last colonoscopy
    • Screening colonoscopy – covered once every 120 months for those not high risk, every 24 months for those who are high risk, or 48 months after a previous flexible sigmoidoscopy
  • Depression screening – You’re entitled to one screening per year.
  • Diabetes screening – You’re entitled to two diabetes screenings per year if your doctor determines you are high risk.
  • Hepatitis C screening test – You’re entitled to one lifetime screening (or yearly annual screenings if you’re determined high risk) ordered by your doctor if you can meet one or more of these conditions:
    • Currently use, or have a history of using, illicit injection drugs
    • Had a blood transfusion before 1992
    • Born between 1945 – 1965
  • HIV screening – You’re entitled to this test every 12 months if you’re between 15 – 65, older than 65 or younger than 15 and considered high-risk, or simply ask for the test.
  • Lung cancer screening – You’re entitled to one screening with Low Dose Computed Tomography (LDCT) every 12 months if you meet all of the following conditions:
    • Between ages 55 – 77
    • Either currently smoke, or have quit within the last 15 years
    • Smoked an average of a pack per day for 30 years, minimum
    • Get a written order from a qualified doctor
    • Don’t currently have symptoms of lung cancer
    • Get tested at a radiology imaging center that meets Medicare standards
  • Medical nutrition therapy services - You’re entitled to a minimum of 3 hours of one-on-one counseling the first year, and 2 hours each year after.  You must get this counseling with a Medicare-approved dietitian or nutrition professional. You can possibly get more hours with your doctor’s permission. To qualify, you must:
    • be diabetic
    • have kidney disease without requiring dialysis, or
    • have had a kidney transplant in the last 3 years.
  • Obesity screening and counseling – You’re entitled to 15 minute face-to-face individual behavioral therapy sessions, or 30 minute face-to-face group behavioral therapy sessions if you have a body mass index (BMI) of 30 or higher.
  • Prostate cancer screening – You’re entitled to one Prostate Specific Antigen (PSA) test every 12 months if you’re a male age 50 or older.
  • Sexually transmitted infection (STI) screening and counseling - You’re entitled to one STI screening for chlamydia, gonorrhea, syphilis, and Hepatitis B every 12 months. You’re covered if you’re considered high risk, or if you’re a pregnant woman. You’re also entitled to two individual 20 – 30 minute, face-to-face, behavioral counseling sessions if you’re at an increased risk for STIs.
  • Shots – You’re entitled to the following preventive shots:
    • Flu shot – once each flu season
    • Hepatitis B shot – up to 3 shots for those whose doctor determines they’re medium-to-high risk
    • Pneumococcal shot – once per lifetime for most people; some folks can get a different shot 11 months after the first one
  • Smoking/tobacco use cessation counseling – If you’re a tobacco user then you’re entitled to 8 face-to-face counseling visits with a qualified doctor or practitioner every 12 months.

Conclusion

Medicare is a wonderful program that provides lots of options to help you prevent disease, or manage those health issues you currently have.  You can see in this article there are lots and lots of ways to get help without paying a dime out of pocket.

Make sure you take advantage of these services so you can stay healthy for years to come!

About the author 

Chris Russo

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