Want to Keep Your Medicare Costs Down? Get These 5 Screenings
When it comes to keeping health care costs in check, Benjamin Franklin may have been on to something. He is said to have originated the axiom "an ounce of prevention is worth a pound of cure" -- a truth helpful for anyone hoping to keep their out-of-pocket Medicare costs to a minimum.
Take, for instance, a patient with high blood pressure. Annual costs to treat hypertension in adults was $733 per person in 2010, according to a 2013 Agency for Healthcare Research and Quality report. If left untreated, that patient could experience a stroke, which can come with a bill over $20,000. While Medicare would pay a portion of the expenses in both cases, a patient would undoubtedly spend more on a stroke than on medication for high blood pressure.
Fortunately, Medicare makes it simple to identify many small issues before they turn into big problems. Doctors say the following five screenings are health care essentials. Best of all, Medicare will pick up 100 percent of the tab for most of them.
Cardiovascular Disease Screenings
Detect or prevent: Heart disease, heart attack, stroke, vascular dementia
Dr. Robert Vogel, co-author of "The Pritikin Edge: 10 Essential Ingredients for a Long and Delicious Life" and advocate for the cardiac rehab program Pritikin ICR, says it's never too late for seniors to become heart healthy. "Without question, I don't care if you're 40 years old or 80 years old, the opportunity to correct youthful indiscretions is still there," he says.
Correcting past health mistakes involves eating right, avoiding a sedentary lifestyle and potentially losing weight. Vogel recommends seniors first see their doctor for a cardiac risk assessment. The process involves measuring blood pressure, cholesterol and glucose levels as well as answering questions about family history and lifestyle choices.
"Most people don't understand it's not just about death," Vogel says. While seniors may assume a heart attack or stroke will be a life-ending event, many people survive and are left with impaired abilities, loss of independence and ongoing medical bills.
What's more, poor heart health is linked to some cases of dementia. "People who have bad hearts often have bad brains," says Dr. Fred Rubin, professor of medicine at the University of Pittsburgh. The hardening of arteries in the brain can cause vascular dementia, a condition with symptoms similar to Alzheimer's disease.
While treating cardiovascular conditions is expensive, Vogel says proper screening along with lifestyle changes and medication can prevent most cases of heart disease.
Medicare will pay for the following cardiovascular health screenings, free of charge:
-- A screening every five years to test cholesterol, lipid, lipoprotein and triglyceride levels
-- An annual primary care visit to check blood pressure and discuss nutrition and other heart-healthy habits
-- Obesity screenings and counseling from primary care doctors
Colonoscopy or CT Colonography
Detect or prevent: Colorectal cancer
Colon cancer and colorectal cancer are other conditions people may be able to avoid with proper screening. "Unlike the other major cancers, they are almost entirely preventable," says Dr. Perry Pickhardt, professor of radiology at the University of Wisconsin School of Medicine and Public Health. "It really shouldn't be on the top 10 cancer list if people had appropriate screenings."
The most common way to detect these cancers or polyps that may turn into cancer is through a colonoscopy. Medicare will cover the complete cost of a colonoscopy every 120 months or every 24 months for those at high risk. If polyps are removed during the procedure, a patient may have coinsurance or copayment costs.
While colonoscopies are effective, Pickhardt is a fan of what he hopes will someday become the standard screening for colorectal cancers: CT colonographies. Unlike a colonoscopy, a colonography is a noninvasive scan that can be performed without needles, sedation or pain. Plus, it's about a quarter of the cost of a colonoscopy. "It's just as good as a colonoscopy at identifying large polyps," Pickhardt says. "It's the best kept secret in the medical world."
Medicare does not currently cover the cost of a CT colonography as a screening tool, although Pickhardt says the government is reviewing whether to include it as a covered service. In the meantime, seniors will have to shell out around $500 for the test, although the cost may vary by region and facility. That can be a steep price to pay, but it's certainly cheaper than the $50,000 the National Cancer Institute estimates it costs for treatment during the first year of a colorectal cancer diagnosis.
Depression and Alcohol Screenings
Detect or prevent: Liver problems, memory problems, harmful drug interactions
The dollar savings attributable to alcohol and depression screenings are less clear than those linked to cardiovascular and cancer screenings. Still, that shouldn't dissuade seniors and their families from using these services.
"My take on the purpose of screenings isn't to save money," Rubin says. "It's to improve quality of life."
Depression can be a socially isolating condition, and one that has been linked to problems like memory loss. It may also lead to seniors abusing alcohol, which can lead to a number of other problems. Excess drinking can complicate conditions like diabetes, and alcohol can interact negatively with some medications.
Medicare will pay for one alcohol misuse screening and one depression screening per year. Seniors who meet criteria for alcohol misuse can then receive four free face-to-face counseling sessions per year.
"It's pretty straightforward to screen for depression [and alcohol misuse]," Rubin says. "If untreated, it has profound negative effects on a person's life."
Mammograms
Detect or prevent: Breast cancer
One in 28 women will develop breast cancer between ages 60 and 70, according to the National Cancer Institute. For women age 65 or older, the average cost of treatment during the first year after diagnosis is more than $23,000.
While the cost of treatment is substantial, most seniors don't have to pay a dime for a mammogram to screen for cancer. Medicare pays for one mammogram every 12 months for women age 40 or older.
Rubin says there are diminishing returns on the value of mammograms for older women, and he recommends those age 75 or older forego them. At that point, a women's life expectancy may not be long enough to warrant continued testing, he says. For women ages 65 to 74 with a life expectancy of 10 years or less, Rubin suggests they discuss with their doctors whether ongoing mammograms are needed.
Glaucoma Tests
Detect or prevent: Blindness
Glaucoma and macular degeneration are two other screenings Rubin recommends. "[You] have no symptoms until you don't see, but these things can be easily screened," he says.
Medicare typically doesn't cover eye examinations, with the exception of glaucoma tests. The government will pay for one screening every 12 months for people who fall into one of the following high-risk categories:
-- Diabetes patients
-- Those with a family history of glaucoma
-- African-Americans age 50 or older
-- Hispanics age 65 and older
Glaucoma tests are the one service on this list that come at a cost to patients. Those eligible for the screening will need to pay 20 percent of the cost, and the Part B deductible must be met before Medicare will pick up the remaining 80 percent. Some seniors may balk at health screenings, but that could be a mistake. Rubin emphasizes that testing is not so much about saving money or extending lives as it is about making the most of the time people have left.