Medicare Now Covers Preventive Services

In a monumental shift to national health care insurance policy, The Affordable Care Act (ACA) started now covering preventive services (as opposed to solely treatment services). As of January 1, 2011, many preventive services are now covered under Medicare (and incentives given to states to be covered under Medicaid) if you get them from a doctor or other health care provider who accepts assignment.

 The services that qualify are listed below:

• Yearly wellness exam. If you are new to Medicare, your “Welcome to Medicare” physical exam is now covered without cost sharing during your first 12 months of Part B coverage (Initial Preventive Physical Examination or IPPE). This exam is a one-time review of your health as well as education and counseling about preventive services and other care.  If you’ve had Part B for longer than 12 months, you can get a yearly wellness visit (Annual Wellness Visit or AWV) to develop or update a personalized prevention plan based on your current health and risk factors.
• Tobacco use cessation counseling. This benefit is now considered a covered preventive service, whether or not you have been diagnosed with an illness caused or complicated by tobacco use.  While the counseling is a covered service, the co-insurance and deductible will apply if you have already been diagnosed with a tobacco related illness.
• Screening. No more Medicare Part B deductible or copayment for these screenings if certain coverage criteria apply:
• Bone mass measurement
• Cervical cancer screening, including Pap smear tests and pelvic exams
• Cholesterol and other cardiovascular screenings
• Colorectal cancer screening (except for barium enemas)
• Diabetes screening
• Flu shot, pneumonia shot, and the hepatitis B shot
• HIV screening for people at increased risk or who ask for the test
• Mammograms
• Medical nutrition therapy to help people manage diabetes or kidney disease
• Prostate cancer screening (except digital rectal examinations).                                                      

In addition, the Centers for Medicare Services has adopted or will be adopting all of the USPSTF A and B recommendations in order to be completely covered. For instance, The Centers for Medicare and Medicaid Services (CMS) has proposed to pay for "high intensity" obesity counseling for obese Medicare beneficiaries. In an effort to stem the tide of the growing obesity epidemic, CMS is proposing to pay covered seniors to undergo behavior modification and weight-loss counseling by a primary care practitioner, according to a proposed decision memo posted August 31 on the CMS web site. The counseling would involve one office visit every week for a month; one office visit every other week for months two to six; and one office visit for every remaining month through one year, provided that the patient has lost at least 6.6 lbs in the first six months. The counseling would have to take place in a primary care setting, such as a family physician's office, in order to be eligible for reimbursement from Medicare.

Take home message: With the advent of the Affordable Care Act, preventive medicine physicians are uniquely positioned specialists to be able to advise you and recommend appropriate preventive services that are uniquely tailored to your needs and risk factors.