understanding medicares preventive benefits… stay informed…stay healthy brought to you by
TRANSCRIPT
Understanding Medicare’s Preventive Benefits…
Stay informed…Stay healthy
Understanding Medicare’s Preventive Benefits…
Stay informed…Stay healthy
Brought to you by
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Session TopicsSession Topics
• What is Covered– Eligibility– Risk factors– What you pay– Why it is important
• Information Sources
• Question and Answer
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Healthy LifestyleHealthy Lifestyle
• Diet• Exercise• Maintain a Healthy Weight• Healthy Choices (Don't Smoke)• Take advantage of preventive services!
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Most recent additions!Most recent additions!
• Ultrasound screening for abdominal aortic aneurysms– Referred to during “Welcome to Medicare” exam– No deductible
• Smoking cessation coverage
• No deductible for colorectal cancer screening
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Bone Density MeasurementBone Density Measurement
For people at risk for osteoporosis
• Age 50+• Female• Family or Personal History of Broken Bones• White or Asian• Small boned• Low body weight (under 127 lbs.)• Smoke, drink a lot of alcohol• Low calcium diet
Eligibility
Risk Factors
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Bone Density MeasurementBone Density Measurement
Bone Mass Measurement once every two years
You Pay: 20% after Part B Deductible
What it covers
What you pay
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Colorectal Cancer ScreeningColorectal Cancer Screening
For all people with Medicare age 50 and older
• Close relative with colorectal cancer• History of polyps• Diet high in fat, • Smoking, drinking • Overweight • Risk increases with age
Eligibility
Risk Factors
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Colorectal Cancer screeningColorectal Cancer screening
Fecal Occult blood test• Flexible Sigmoidoscopy• Colonoscopy
– No age limit for those at high risk• Barium Enema
• Nothing for Fecal Occult test• 20% for all other tests-no deductible• 25% colonoscopy done in hospital
What it covers
What you pay
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Diabetes ScreeningDiabetes Screening
All people at risk
• High Blood pressure• High Cholesterol• Obesity• History of high blood sugar• At least 2 of the following
– 65+– Overweight– Family history– History of gestational diabetes or delivering a
baby over 9 lbs.
Eligibility
Risk Factors
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Diabetes ScreeningDiabetes Screening
Fasting blood glucose test-up to twice in a 12 month period
• Self Management Training• Medical Nutrition Therapy• Blood Sugar testing supplies• Special Eye Exams• Hemoglobin A1c tests
For people with Diabetes who need them:• Insulin Pumps• Special Foot Care• Therapeutic Shoes
What it covers
What you pay
Additional Covered Services
No co-payment or deductible in Original Medicare
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Screening MammogramsScreening Mammograms
Age 35-39 one baseline once a year starting at age40
Risk Factors:– Family history– First baby after age 30 or never had a baby– HRT for a long time– Overweight
Check for abnormal breast tissue using new digital technology
Eligibility
Risk Factors
What it covers
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Screening MammogramsScreening Mammograms
20% coinsurance –no deductible
• Most commonly diagnosed non-skin cancer in women and leading cause of cancer death for women in U.S.
• Often successfully treated when found early
What you pay
Why Important
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Pap Test and Pelvic ExamPap Test and Pelvic Exam
High Risk for Vaginal Cancer Mother took DES when pregnant with you Childbearing age and had an abnormal Pap test in
past 36 months
• All women on MedicareEligibility
Risk Factors
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Pap Test and Pelvic ExamPap Test and Pelvic Exam
You Pay: Nothing for the Pap Lab Test
– 20% for Pap Test collection, pelvic exam/clinical breast exam-No Part B Deductible
Once every 24 months but, every12 months if…
High Risk for cervical cancer– Abnormal Pap Test– Infected with HPV– Sex before age 16– Many sexual partners– No negative or had any Pap Tests in past 7 years
What you pay
What it covers
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Prostrate Cancer ScreeningProstrate Cancer Screening
All men with Medicare age 50+
• Age• Heredity
• Covers: – Digital Rectal Exam– PSA Blood Test
20% after Part B Deductible for the digital rectal examNothing for the PSA Blood test
Eligibility
Risk Factors
What it covers
What you pay
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Flu ShotFlu Shot
All people with Medicare
Risk Factors:– Can Lead to pneumonia– Dangerous viral illness for people age 50+
One shot each flu season
Nothing
Eligibility
Risk Factors
What it covers
What you pay
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Pneumonia VaccinationPneumonia Vaccination
All people with Medicare
One shot is usually all you will ever need
Nothing
Eligibility
What it covers
What you pay
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Hepatitis BHepatitis B
Hepatitis B shots
Covered for those at medium to high risk for End-Stage renal disease or Hemophilia or conditions that lower resistance to infection
You Pay: 20% after Part B Deductible
Serious disease that can cause liver failure or death
Eligibility & Risk Factors
What you pay
Why it's important
What is covered
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GlaucomaGlaucoma
All Medicare Beneficiaries
• Family history of glaucoma• Diabetes• African Americans age 50+• Hispanic Americans age 65
Screening eye exam every 12 months
20% after Part B Deductible
Eligibility
Risk Factors
What it covers
What you pay
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Cardiovascular Disease ScreeningCardiovascular Disease Screening
All Medicare beneficiaries
Blood tests for early detection of heart disease-Every 5 yrs
– Cholesteral– Trigylcerides– Lipids
No copayment or deductible in Original Medicare
Eligibility
What is covers
What you pay
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Welcome to Medicare PhysicalWelcome to Medicare Physical
One time physical for all beneficiaries who begin with Medicare 1/1/2005 and after and get the exam within the first six months of Part B coverage
Height, weight, blood pressure, EKG, education and counseling and referrals i.e. Ultrasound for abdominal aneurysm
20% after the Part B deductible is met
Eligibility
What it covers
What you pay
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Smoking CessationSmoking Cessation
Covered for those with an illness caused or complicated by tobacco use and or who take medication affected by tobacco use
Cessation counseling up to 8 sessions per year. Drug therapies e.g. nicotine patches
20% after Part B deductible
Significant health benefits for those who quit
Eligibility
What it covers
What you pay
Why it's important
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If you want to know moreIf you want to know more
• Medicare 1-800-633-4227 or www.medicare.gov
• American Cancer Society 1-800-227-2345 or www.cancer.org
• Centers for Disease Control and Prevention www.cdc.gov
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Key ConceptsKey Concepts
• You can take steps to live a longer and healthier life• Take advantage of Medicare preventive services• Information is available
– Internet– Publications– 1-800-MEDICARE