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Guide to Medicares Preventive Health Benefits SHIBA Statewide Health Insurance Benefits Advisors A free, unbiased service of the: 1November 2013

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SHIBA mission SHIBA provides free, unbiased information about health care coverage and access to help improve the lives of all Washington state residents. We cultivate community commitment through partnership, service and volunteering. 2November 2013

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How can I start? Do physical activities Educate yourself Avoid tobacco Get a preventive exam Keep a healthy weight 3November 2013

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Medicares preventive benefits (are you at risk?) Talk to your doctor or medical provider Your doctor may identify a health risk from your free screening If so, there may be a charge for the follow-up diagnostic test 4November 2013

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Why get the free screening? If you seek medical care AFTER you have a problem or become sick: Damage has already occurred Treatment can be very costly Your quality of life suffers 5November 2013

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Preventive services Prevention is covered under Medicare Part B Most preventive services are free however some charge a coinsurance Check with your provider to make sure they accept Medicare Taking action early to prevent disease, minimize complications, and contain costs -- Wellsource, Inc. 6November 2013

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Risk factors for health Individual/family medical history Lifestyle behaviors & choices Age Gender Multiple risk stacking 7November 2013

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Types of preventive services Health screening/exams Counseling Education Immunizations Diagnostic tests may be ordered by the medical provider if youre at risk, but these tests may have an out-of-pocket cost. 8November 2013

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After youre eligible for Part B Get your Welcome to Medicare Preventive visit during your first 12 months of Part B coverage What occurs during this visit your doctor: Reviews your medical and family history Assesses any risk factors you may have Identifies risk factors that may make it necessary to get follow-up tests that have out-of-pocket costs 9 Welcome to Medicare Preventive visit No cost if medical provider accepts Medicare November 2013

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10 After youre eligible for Part B The yearly Wellness visit takes place after your first 12 months of Part B eligibility (not as comprehensive) Medicare covers this visit once every 12 months Anyone with Medicare is eligible You pay nothing for the visit, unless you get additional tests or services that arent covered Wellness visit No cost if medical provider accepts Medicare November 2013

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Abdominal Aortic Aneurysm Screening (AAA) Covered one time by a doctor referral as a result of your Welcome to Medicare visit You must have a family history of AAA OR Be a male age 65 to 75 whos smoked at least 100 cigarettes in your lifetime; and Youve never had an AAA ultrasound screening paid for by Medicare No cost if medical provider accepts Medicare 11November 2013

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Alcohol misuse counseling This covers: One screening per year Positive screens can receive 4 face-to-face counseling sessions per year (in a primary care setting) Eligible people include adults and pregnant women who use alcohol 12 No cost if medical provider accepts Medicare November 2013

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Bone mass measurements Test covered once every 24 months (more often if medically necessary) To qualify you must be at risk for osteoporosis & meet 1 of the 5 criteria: 1.Female being treated for estrogen-deficiency; OR an x-ray reveals back bone abnormalities; OR 2.You get steroid treatments; OR 3.You have hyperparathyroidism; OR 4.You take a osteoporosis drug No cost if medical provider accepts Medicare 13November 2013

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Cardiovascular screenings Tests are covered every 5 years and include: Total cholesterol test Cholesterol test for high density lipoproteins (HDLs) Triglyceride test Lipid panel tests 14 No cost if medical provider accepts Medicare November 2013

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Colon cancer screenings (colorectal) How often you can get these tests: Fecal Occult Blood Test: Once every 12 months Flexible Sigmoidoscopy (FS): Every 24 months or 120 months for low-risk people Colonoscopy screening: Every120 months Every 24 months for high-risk people or 48 months after FS test There are costs for these tests check with your provider 15November 2013

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Depression screening Covers one screening a year Must be done in a primary care setting that can provide follow-up treatment and referrals No cost if medical provider accepts Medicare 16November 2013

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Diabetes screenings Screenings are covered if you have these risk factors: High blood pressure History of abnormal cholesterol and triglyceride levels Obesity History of high-blood sugar And you are two or more of the following: Over age 65 Overweight Family history of diabetes Had diabetes during pregnancy No cost if medical provider accepts Medicare 17November 2013

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Diabetes self-management training You must be at risk for diabetes implications You must have a written order from a medical provider You pay 20% of Medicare-approved amount after you meet Part B deductible 18November 2013

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Flu, Hepatitis B and Pneumonia shots Flu shots: One per flu season starting in the fall Hepatitis B shots: For people with medium or high risk; comes in a series of three for complete protection Pneumonia shots: You can have any time of year, most people only need one in a lifetime High risk people can get a pneumonia booster every 5 years 19 No cost if medical provider accepts Medicare November 2013

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Glaucoma tests 20 No cost if medical provider accepts Medicare Medicare covers a Glaucoma screen by a doctor once every 12 months, including : Dilated eye exam with an eye pressure measurement A direct opthalmascope exam Eligible people include: Youre at high risk for diabetes Youre African American over age 50 Youre Hispanic and age 65 or older Costs: You pay 20% of Medicare-approved amount after you meet the yearly Part B deductible November 2013

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Medical nutrition therapy Covers people with: Diabetes Kidney disease Kidney transplant within the last 3 years Therapy must be prescribed by a doctor Benefits of initial lifestyle & nutrition assessment: Nutrition counseling Lifestyle management information (diet) Diet management follow-up visits 21 No cost if medical provider accepts Medicare November 2013

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Cervical & vaginal cancer screenings High-risk women: Covers 1 Pap test & Pelvic exam/year Low-risk women: Covers 1 exam every 2 years for cervical cancer (breast exam included) If medical provider accepts Medicare, theres no cost for pap lab test & specimen collection, or pelvic & breast exams 22November 2013

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Prostate cancer screenings Covers men over age 50 for a: Digital rectal exam & Prostate Specific Antigen (PSA) once every 12 months Costs: For PSA, no cost For digital rectal exam, you must meet the Part B deductible, and youll have to pay a deductible and coinsurance 23November 2013

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24 Obesity screening & counseling Medicare covers if your body mass index is 30 or more Talk to your provider for more details November 2013

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HIV screenings Covers an HIV test once every 12 months or up to 3 times during a pregnancy People with Medicare may request the test. You must be: Pregnant At increased risk for the infection No cost for the test, but you must pay 20% of the Medicare-approved amount for the doctor visit 25November 2013

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Smoking cessation To qualify, you must use tobacco and be on Medicare Covers 8 face-to-face sessions to help you stop smoking during a 12-month period A qualified doctor or other Medicare-recognized provider must provide the sessions You pay nothing for the counseling sessions 26November 2013

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SHIBA volunteer opportunities Love to learn and help people Like problem-solving Dont mind paperwork or computer work Are organized Can attend regular training You might be interested in becoming a volunteer if you: 27November 2013

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Want more information? Publications: Your Guide to Medicare Preventive Services, CMS Pub #10110 Staying Healthy, CMS Pub #11100 Understanding Your Health Insurance Options, SHP 106 28November 2013

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Medicare preventive benefits tracking To track your benefits, use the My Medicare Preventive Benefits Checklist get a copy at: Web: http://www.medicare.govhttp://www.medicare.gov Call: 1-800-MEDICARE (1-800-633-4227) TTY users call: 1-877-486-2048 29November 2013

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30 Need help with other insurance questions? The Office of the Insurance Commissioner can also help you with questions, information, and complaints about all types of insurance, such as: Call our Insurance Consumer Hotline 1-800-562-6900 Check out our Consumer Toolkit at www.insurance.wa.gov/consumers Homeowner Auto Life Annuities Health And more! November 2013