Medicare Benefit

Beginning January 1, 2011, Medicare started covering preventive care services. These services include screenings, exams, labs, counseling, and monitoring. Before 2011, the only way Medicare beneficiaries could get coverage for these services was by enrolling in either a Medicare Advantage plan or a Medigap Plan J.

Because Medicare began covering the items under Original Medicare, Medigap Plan J was discontinued, and Medigap Plan F became the most comprehensive gap plan available thereafter.

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Before Original Medicare added coverage for these services, not many seniors would get preventive care screenings and exams. The percentage of beneficiaries that use this service has increased since 2011. However, it hasn’t increased near the amount it should.

Screenings and Exams Covered by Original Medicare

Medicare Part B is the part of Original Medicare that covers your preventive care services. Each service has its own rules and qualifications for coverage. For instance, to qualify for an abdominal aortic aneurysm screening, you must be at risk for one. One way that Medicare considers you to be at risk is if you have a family history of abdominal aortic aneurysms.

The preventive care services that Medicare Part B covers are listed below:

• Abdominal aortic aneurysm screening
• Alcohol screenings and/or counseling for alcohol misuse
• Bone mass measurements
• Cardiovascular disease screenings
• Cardiovascular disease therapy
• Cervical and vaginal cancer screening
• Colorectal cancer screenings
• Depression screenings
• Diabetes screenings
• Diabetes self-management training
• Glaucoma eye exams
• Hepatitis B Virus (HBV) infection screening
• Hepatitis C screening test
• HIV screening
• Lung cancer screening
• Mammograms for women
• Nutrition therapy services (typically for diabetes or dialysis patients)
• Obesity screenings andweight counseling
• An initial wellness visit
• Prostate cancer screenings
• STD screening & counseling
• Flu shots
• Hepatitis B shots
• Pneumococcal shots
• Counseling to discontinue using tobacco
• Annual Physical or “Wellness” visit

Why You Should Take Advantage of This Benefit

Seniors should be utilizing these preventive benefits for many reasons.These services provideearly detection of diseases that can be life-threatening. By detecting such diseases early on, your doctor will be better able to treat them.

Another reason why seniors should be taking advantage of prevention services is that for the most part, you’re 100% covered! Therefore, if you qualify for a screening, you should be scheduling them as often as recommended.

Potential Costs of Services

Like we just mentioned above, for the most part, these services are 100% covered. However, there are a few circumstances where you might have to pay for a service.For most of the preventive care services Medicare covers, you won’t pay anything unless your doctor doesn’t accept Medicare assignment.

When a doctor accepts Medicare assignment, it means they agree to charge the Medicare approve price for the service. If your doctor doesn’t accept assignment, then you could be responsible for excess charges. Excess charges can’t exceed 15% of the Medicare-approved price.

For example, if the Medicare-approved price for your service is $100 and your doctor doesn’t accept assignment, then they can charge you up to $15 out-of-pocket.
One more way you might have to pay for your service is if your Part B coinsurance and deductible apply.Your coinsurance and deductible apply for these services:

Diabetes self-management training
• Glaucoma tests
• Diagnostic mammograms
• Digital rectal exam for prostate cancer screenings

If your Part B coinsurance and deductible apply, you will need to meet the annual deductible of $185 before Medicare pays anything. If the Medicare-approved price is higher than $185, you will owe 20% of the remaining amount, while Medicare will cover 80%.

With a Medigap Plan F, you could lower or even eliminate these fees altogether.

Get in The Know is a helpful resource for learning more about each preventive care service covered by Medicare. You can also use to track your preventive care services.

These services can save lives; they do every year.Talk to your doctor today to see what screenings they recommend for you.


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