Preventive Services Available from Medicare


Ever heard the expression, “An ounce of prevention is worth a pound of cure” With some rare exceptions, the medical profession has found that generally, it is far cheaper to prevent an illness than to cure it. Also, if an illness is present, it is usually easier to cure it in its early stages than later, when it gets worse. This is particularly true of cancer and some other diseases such as abdominal aortic aneurysms (a bulge in the main blood vessel of the body.)

Medicare agrees, and the Centers for Medicare and Medicaid Services (CMS), which runs Medicare, has specified a list of preventive services available to all Medicare beneficiaries. These services are available whether you are enrolled in Original Medicare or Medicare Advantage. For most, there is no copayment or co-insurance. They are:

  • An annual wellness visit;
  • Obesity counseling;
  • Alcohol miscues screening;
  • High intensity behavioral counseling;
  • Depression screening;
  • Behavioral therapy for cardiovascular risk reduction;
  • Colorectal cancer screening;
  • Prostate cancer screening;
  • Prostate-specific antigen (PSA) testing for prostate cancer;
  • Abdominal aortic aneurysm screening;
  • Diabetes screening; and,
  • Cardiovascular disease screening.

A brief explanation of each service follows:

A wellness visit is Medicare’s version of the old “annual check-up.” It is designed to spot any problems, some of which may have no symptoms, so that they can be caught and treated early.

Obesity screening is aimed at the fact that many American are overweight or obese. There are effective behavior modification techniques, diets, and drugs that your doctor can prescribe to help you lose weight. This service reveals whether or not they are needed in your case.

Alcohol misuse screening looks at your consumption of alcohol and assesses any problems that may be present. If your physician determines that you are abusing alcohol, Medicare will pay for counseling and other treatment to bring your alcohol-related behavior back within the guidelines.

High intensity behavioral counseling is aimed at rapidly modifying behavior that increases the risk for sexually transmitted disease (STDs.) It is often combined with screening for STDs.

Depression screening uses paper-and-pencil diagnostic instruments and the provider’s own clinical judgment in determine whether or not you are depressed and either prescribing treatment or referring you for treatment. If further treatment is needed, Medicare pays for it under most circumstances.

Behavioral therapy for cardiovascular risk reduction is applies when any cardiac risk factors or found. It is aimed at removing any behavioral barriers to adopting a healthier lifestyle and preventing the progression of heart disorders.

Colorectal cancer screening uses manual examinations and diagnostic tests to detect colon cancer, which is highly curable if caught early.

Prostate-specific antigen (PSA) testing is a laboratory blood test that determines the level of an antigen associated with prostate cancer in your blood. A high level indicates that further testing is needed.

Prostate cancer screening consists of manual exams and diagnostic tests, if indicated, to detect prostate cancer. Current research indicates that most men with prostate cancer can be treated by “watchful waiting”, but there is a subset that requires aggressive treatment. This screening can determine if the disease is present and what kind of treatment is appropriate.

Abdominal aortic aneurysm screening looks for bulges in the portion of the aorta, one of the main blood vessels of the body, that lies within the abdomen between the bottom of the rib cage and the hips. A large bulge in this area is dangerous and may require surgical correction. Medicare covers this service is your provider has reason to think that you are at risk based on family history, or you are a male aged 65-75 and have smoked more than 100 cigarettes in your lifetime. The exam consists of an abdominal ultrasound, in which sound waves are used to detect the bulge. This is painless and non-invasive.

Diabetes screening checks your blood sugar level. A high fasting blood sugar level indicates diabetes or pre-diabetes. Losing weight can often resolve pre-diabetes if it is caught early enough.

Cardiovascular disease screening checks for the presence of signs of disease affecting the heart and blood vessels. Many cardiac problems can be avoided if they are detected and treated early. This includes screening for high triglycerides, high blood fats, and high cholesterol. This free service is provided only once every five years, but if your doctor determines that more frequent tests are necessary, Medicare will cover them.

In general, Medicare covers these services “free”, with no deductibles or co-payments, because the United States Preventive Services Task Force has recommended them on the basis of their potential to reduce morbidity and mortality, and thereby save Medicare money. With the exception of the wellness visit, each of them requires that your provider deem them indicated in your case. Even if you do not meet the criteria for the free preventive service, the same services can be provided under Medicare, if indicated, with the usual co-payments and deductibles.

Since these services are free, and can provide you with both peace of mind and chance to detect potentially deadly diseases in the early states, why not call your Medicare provider and arrange to get them today?

To see more details on the preventive services available to you, go to www.MyMedicare.gov, click on “My Health” and then on “Preventive Services.” Each service has a link that explains exactly what it is and gives other details.

Most of these services can be given right in your primary care provider’s office. A few may require a visit to a lab or hospital. It depends on how your doctor’s office is equipped.

Again, the services are free and may help you avoid expensive and distressing illness.

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