Health reform law effective January 1, 2011 includes added benefit of free preventive care for Medicare recipients.
Those enrolled in Medicare should expect a decrease in their outpatient medical costs this year as the new health reform laws have waived patient cost-sharing for most preventive services covered by Medicare.
Effective for services received on or after January 1, 2011, The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (the “Act”) provides that Medicare recipients will not be required to pay a co-pay, coinsurance or deductible to receive preventive services that are highly recommended by the U.S. Preventive Services Task Force. Such services include the “Welcome to Medicare” medical evaluation visit, screenings for breast cancer, colon cancer, diabetes and heart disease, as well as smoking cessation counseling.
Medicare Part B recipients will also receive a free annual wellness visit, including an update of the patient’s medical history, new prescriptions, if necessary, cognitive screening and the implementation of a 5-10 year screening schedule.
“Preventing diseases that can be prevented, and detecting others at earlier, more treatable stages, are among the keystones for transforming Medicare,” said Jonathan Blum, CMS deputy administrator and director of the Center for Medicare. “By eliminating the beneficiary’s out-of-pocket costs for most preventive services, we are removing a barrier to access and paving the way for improved health for seniors and people with disabilities who rely on Medicare for their health coverage.”
Partial List of Services Covered by Original Medicare Without a
Coinsurance or Deductible Starting in 2011
Service and Frequency
“Welcome to Medicare” Physical Exam
A one-time routine physical examination. This includes an electrocardiogram (EKG); and height, weight and blood pressure measurements. Covered if you receive the exam within 12 months of enrollment in Medicare Part B.
Annual Wellness Visit
A yearly visit in which your doctor will update your medical history and current prescriptions; measure your height, weight, blood pressure and body mass index; create a screening schedule for the next 5 to 10 years and screen for cognitive issues.
Breast Cancer Screenings
Mammogram screening: Once every 12 months for women age 40+; women between ages 35 and 39 can get one baseline mammogram; Breast examination: Once every 24 months; if at risk, once every 12 mos.
Heart Disease Screening
Blood tests to screen for cholesterol, lipid and triglyceride levels: once every five years.
Bone mass measurements: Once every 24 months; more frequently if medically necessary.
Once every 12 months if you have a family history or are at risk for diabetes. Twice a year if you have been diagnosed with pre-diabetes.
Colon Cancer Screenings
Fecal occult blood test: Once every 12 months for people age 50 and older; Colonoscopy: Once every 10 years if you are not at high risk; once every 24 months if you are at high risk; Flexible sigmoidoscopy: Once every 48 months.
Pneumonia shot:** Most people need only one shot in their lifetime; Flu shot**: Once a season; Hepatitis B shot: Only for people at medium to high risk.
Counseling to stop smoking for people without smoking-related illnesses: Covers 2 quitting attempts per year; each attempt includes 4 counseling sessions.
Cervical Cancer Screenings
Pap smear and pelvic examination: Once every 24 months; if at risk, once every 12 months.
Prostate Cancer Screenings
Prostate specific antigen (PSA) test: One every 12 months for men age 50 or older.
Once every 12 months if you are at high risk. Screening must be supervised by a state certified eye doctor.
For more on Medicare’s preventive services from the Medicare Rights Center, click here.