With the introduction of the Affordable Care Act in 2010; Medicare now covers a broad range of services to prevent, detect and manage disease so that complications can be avoided. This shift to preventative healthcare is seen as a way to reduce the future expenditures for chronic disease and illness and further protect the Medicare trust fund.
There are over 20 preventive tests and services that Medicare covers that are excluded from any deductible, copayment or coinsurance. That means $0 out of pocket for you when you utilize these services correctly.
Over the past few years I have had a few clients who were unsuspectingly charged for services that they believed were covered under the preventive medicine guidelines.
Here are a few of the ‘pitfalls’ that some of my clients have experienced when having these services performed:
· If you have a Medicare Advantage Plan, you must use an in-network provider to perform these services. Otherwise, you will have out of pocket expenses.
· You must know the risk factors and frequency that Medicare has established for these tests. Some of the preventive services are only allowed for certain at-risk groups, and many tests are not covered for free on an annual basis.
· Colonoscopy screenings can easily become outpatient surgeries without you ever knowing -which are subject to coinsurance and copayments. If during your screening surgery, removing polyps becomes necessary, you could be responsible for copayments and coinsurance related to an outpatient surgery.
· Annual Medicare ‘Wellness’ visits with your doctor ARE DIFFERENT than a routine annual physical. Be certain that your doctor office is aware that you are specifically scheduling your annual Medicare Wellness visit.
· Medicare beneficiaries are covered for one annual flu shot. Those going to clinics or pharmacies are sometimes paying a flat fee to receive a flu shot outside of a doctor’s office. Be sure that the off-site clinics participates in Medicare and will file the claim to your insurance for you. If they don’t, you may want to look around for another site that makes things easier, and cheaper, for you.
· Medicare now allows and pays for the new 2-D digital mammography, in conjunction with the traditional 3-D Mammogram; effective January 1, 2015.
· Screening for glaucoma is available once every 12 months for at-risk groups. However, unlike Medicare coverage for the screening and treatment of cataracts; surgery to treat glaucoma is not a Medicare covered service. This means that Medicare will not cover the cost of glaucoma surgery at all.
There is a lot on information online or in annual Medicare guides mailed to beneficiaries that list all of the preventive services that Medicare covers. One online source I used is: https://www.medicare.gov/Pubs/pdf/11100.pdf
Medicare recognizes the crucial role that health care providers play in providing and educating Medicare beneficiaries about potentially life-saving preventive services and screenings. While Medicare now pays for more preventive benefits, many Medicare beneficiaries do not fully realize that using preventive services and screenings can help them live longer, healthier lives. As an insurance agent in the Medicare healthcare industry, I like to be sure that my clients understand the importance of disease prevention, early detection, and lifestyle modifications that support a healthier life.