Published on January 25, 2011

Medicare Patients Have New Preventive Benefits

Millions of Americans, including those on Medicare, have new health benefits that they may not have heard about yet.

The Patient Protection and Affordable Care Act included a long list of covered preventive services, including screenings for breast cancer, diabetes, prostate and colorectal cancers. And, the preventive services must be are provided without a copayment or co-insurance charge.

For now, people with employee health insurance or private health insurance will only be eligible for the additional benefits if their plan was established since Sept. 23.

For Medicare and Medicaid recipients, the coverage for preventive services began automatically on Jan. 1.

One of the concerns is that Americans are not receiving the preventive care and screenings they need.  By offering the services at no costs to the patient, it is believed that lives can be saved and the cost of care can be reduced if serious health issues like diabetes, heart disease and cancer are diagnosed sooner.

"It has taken time to get the information out to the public and to get doctors up to speed on their responsibilities and what is required in order to bill for these services,'' explained Michelle VanderWeele, physician billing manager, Genesis Health Group. "There are a lot of Medicare patients out there who don't understand some of the new benefits they have.''

One of new benefits is that every Medicare recipient is entitled to an annual physical examination. New Medicare patients also receive an initial "wellness" exam.

"In the past, physicians haven't been well-informed about what additional areas need to be to be included in those physical exams in order for them to be covered by Medicare,'' VanderWeele added. "With the final release of guidelines published from Medicare, we have gotten some guidelines out to offices about what has to be included."

Here is a partial list of the tests and preventive screenings now available without copayments or deductibles:

• Pneumonia, influenza, hepatitis B, herpes zoster (shingles) vaccinations
• Screening mammography
• Screening pap smear and screening pelvic examination
• Digital rectal examination for prostate cancer
• Colorectal cancer screening
• Diabetes screening
• Diabetes outpatient self-management training
• Bone mass measurement
• Glaucoma screening
• Cardiovascular screening blood test
• Ultrasound screening for abdominal aortic aneurysm
• HIV testing
• Obesity screening and counseling
• Blood pressure screening
• Cholesterol screening for adults of certain ages
• Tobacco cessation
• Standard childhood vaccinations

Another major change for Medicare recipients was relief for those who slipped into the "donut hole" because of their medications. Medicare recipients who fall into the "donut hole" will receive a one-time rebate check of $250 in 2011.

Patients on Medicare will also receive a  50% discount on covered brand-name drugs they need while in the donut hole, and will start to pay less and less for generic drugs.

VanderWeele suggests that Medicare patients visit www.Medicare.gov or contact Medicare by phone at 1-800-MEDICARE for more information on their preventive care available to them. They can also discuss their preventive needs with their primary care physician.
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