Seniors are slowly taking advantage of the greatly expanded menu of free preventive health screenings and tests provided under Obamacare. Many of the procedures do not require a co-pay and are not subject to any insurance deductibles. Ideally, they should be part of an ongoing wellness plan that you and your physician develop.
Under the rules, for example, a free yearly wellness exam is available from doctors who participate in Medicare. This visit, in turn, can be used to build a year-long wellness plan with your primary physician. Most Medicare beneficiaries have some form of supplemental coverage beyond basic Medicare. They should check with their insurers for other wellness provisions provided under their policies.
The wellness exam supplements a one-time "welcome to Medicare" exam that is free to people who get it within their first 12 months of Medicare coverage. This welcome exam has no co-pay and is totally free.
Based on how Medicare beneficiaries have responded to wellness programs in the past, it's a shame that this roster of free benefits is not being more heavily used. The benefits are not being broadly publicized, and even physicians' offices may not be fully informed about the measures.
"Government and private studies show that fewer than 10 percent of beneficiaries are using the welcome to Medicare exam," says Dan Mendelson, head of Avalere Health, a policy and research advisory company in Washington, D.C. "Even though they are free, it's hard to get seniors out to use these important preventive services."
"It would be a real eye-opener just to tell people what's available," Mendelson said. "For example, if you asked 100 people whether smoking cessation services are provided [as a free benefit], I bet all of them would say no. But they are covered."
The health reform law was enacted as the Patient Protection and Affordable Care Act, and is referred to formally today as the Affordable Care Act (ACA). It mandated expanded preventive health services for all Americans, including Medicare beneficiaries.
The pool of free preventive services is overseen by the U.S. Preventive Services Task Force, an independent panel of medical experts that evaluates treatments and tests and assigns them grade levels that reflect their effectiveness.
Doctors and other care providers are advised to offer measures that have received either an "A" or "B" grade, and the free services are selected from these procedures.
Medicare has details on the preventive measures it covers. Here are the Medicare preventive and wellness items that are free:
-- Abdominal aortic aneurysm screening
-- Bone mass measurement
-- Flu shots
-- Hepatitis B shots
-- Breast cancer screening (mammograms)
-- Medical nutrition therapy services (for those with diabetes or kidney disease)
-- Pap tests and pelvic exams (includes clinical breast exam; once every 24 months or once every 12 months for at-risk women)
-- One-time "welcome to Medicare" physical exam
-- Yearly "wellness" exam (for people with Part B Medicare longer than 12 months)
-- Pneumococcal shot
-- Smoking cessation (counseling to stop smoking; for those not previously diagnosed with an illness caused or complicated by tobacco use)
Here are available preventive services that still include some cost to Medicare beneficiaries:
-- Cardiovascular screenings (the test is free, but there's a 20 percent co-pay for the doctor's visit)
-- Colon cancer screening (colorectal) (flexible signoidoscopy and colonoscopy are free, but some other related tests and provisions may involve co-pay for doctor's services)
-- Diabetes screenings (the tests are free, but there is a 20 percent doctor's co-pay)
-- Diabetes self-management training (there is a 20 percent co-pay, plus the Part B deductible applies)
-- Glaucoma tests (there is a 20 percent co-pay, plus the Part B deductible applies)
-- HIV screening (the test is free, but there's a 20 percent co-pay for the doctor's visit)
-- Prostate cancer screenings (the PSA test is free, but there's a 20 percent co-pay plus the Part B deductible for the doctor's visit)
For a general set of wellness tips, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services, provides a general set of wellness tips for women and men above the age of 50.
- Health Care Policy