New Preventive Services for People with Medicare: The New Medicare Prescription Drug Coverage
As of January 1, 2005, Medicare expanded coverage for some preventive services. These include a one-time initial physical exam after enrolling in Medicare and screening tests for heart disease and diabetes. Here is some additional information about these services.
Initial Physical Exam
If your Medicare Part B coverage began on or after January 1, 2005, Medicare will cover a one-time preventive physical exam, sometimes called the "Welcome to Medicare" exam. This exam must occur no later than six months after you enroll in Medicare. (If your doctor thinks the six month period may have already passed, he or she should give you a notice explaining that Medicare probably won't pay for the exam. If you still want the exam, you will be asked to sign a form that states you will pay for the exam if Medicare does not pay for it.) The exam will include an evaluation of your health. It will also include information and counseling about the preventative services you may need, such as shots and/or screenings. If necessary, you may also be referred for additional medical care.
During the exam, your doctor will review your medical history and check your blood pressure, height, and weight. Your doctor may also give you a vision test and an electrocardiogram (a test that records the electrical activity of the heart). Your doctor will make sure that you are up to date with all your shots. In addition, your doctor will give you information to help you prevent disease, and maintain or improve your health. You will be given a written plan that will list the screenings and other preventative services you should get and when you should get them.
In 2006, the Medicare Part B deductible (the amount you must pay prior to Medicare paying anything) is $124. If you have used your Medicare insurance prior to your physical, you will have already paid some or all of your deductible. If this is the first time you use your Medicare coverage, and the exam costs more than $124, you may satisfy your deductible for the year. Either way, the amount you will have to pay for the "Welcome to Medicare" physical will include any unpaid deductible, plus 20% (often called coinsurance) of the Medicare approved cost of your physical (Medicare pays 80%).
Please note that many doctors accept what Medicare approves, but some do not. Since you may have to pay extra if a doctor does not accept what Medicare approves, you should check to see if the doctor accepts "assignment" or the Medicare approved amount for services rendered.
Be prepared for your exam. Bring the following items with you for your visit:
- A list of the prescription drugs you currently take, the dosage, how often you take them, and for what condition.
- Your medical records, including all records of the shots you have had, a list of the medical tests and/or surgeries you have had, and when. (Especially if you are seeing a new doctor).
- Your family health history information. You should especially include any details you can give your doctor that can help determine if you are at risk for specific diseases
Please note: AARP has a Fact Sheet called: "How to Ask the Right Questions and Get the Most from Your Medicines" and a companion piece "My Medication Record" that makes it easy for you to keep information about your medical history and the prescription drugs you take. It's a good thing to take with you when you see your doctor, and to share with family members in case of an emergency. To obtain a free copy of these documents, you can order them by writing: AARP Fulfillment, 601 E. St., NW, Washington, DC 20049, and asking for AARP publications D18365 and D18358. You can also download these documents from AARP's Medicare website: www.aarp.org/medicarerx.
Screenings for Heart Disease and Diabetes
Medicare now covers screenings for heart disease, also known as cardiovascular screenings, to check your cholesterol level and other blood fat (lipid) levels. Medicare will pay for these tests every five years, if you have not previously been diagnosed with heart disease. You will not have to pay the 20% coinsurance or the Part B deductible for these screenings.
If you are at risk for getting diabetes, Medicare also covers a blood sugar screening to check for diabetes. You are considered at risk if you have any of the following: high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar. Depending on you health, Medicare may pay for up to two screenings each year. Also, you will not have to pay the 20% coinsurance or the Part B deductible for these screenings. Medicare may also cover certain diabetic supplies, such as glucose testing monitors and strips, as well as personal diabetic counseling to help you better manage self-administered treatments such as insulin shots, for instance.
Medicare will soon offer insurance coverage to help people pay for prescription drugs. The new program, known as Medicare Part D, will start January 1, 2006. To help you understand this new benefit, AARP has two basic publications: "What You Need to Know: The New Medicare Prescription Drug Coverage," and "Extra Help for People With Limited Income: The New Medicare Prescription Drug Coverage," and a series of supplemental facts sheets that provide more in depth information about the new Medicare Modernization Act of 2003. "New Preventative Services for People with Medicare: The New Medicare Prescription Drug Coverage" is one of these fact sheets.
