Medicare Preventive Services

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Medicare Preventive Services

• Crystal Strong
• Nutrition/Health Wellness Manager
• Lt. Governors Office on Aging
• 803-734-9889

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Session Topics

• What services are covered
• Why they are important
• Who is eligible
• How much you pay
• Information sources

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Living a Healthy Lifestyle

• Eat well
• Exercise
• Keep a healthy weight
• Dont smoke
• Get preventive services
• To keep from getting some diseases
• To find health problems early

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Medicare Preventive Services

• For disease prevention and early detection
• Coverage based on
• Age
• Gender
• Medical history
• Covered by
• Part B of Original Medicare
• Medicare Advantage and other Medicare plans

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Covered Preventive Services

• Welcome to Medicarephysical exam
• Abdominal aortic aneurysm screening
• Bone mass measurement
• Cardiovascular disease screening
• Colorectal cancer screening
• Diabetes screening, services, and supplies

• Glaucoma screening
• Pap test and pelvic exam with clinical breast
  exam
• Prostate cancer screening
• Screening mammogram
• Smoking cessation counseling
• Vaccinations (shots)

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What You Pay

• Original Medicare
• Generally 20 after Part B deductible
• Medigap or other policies may pay the 20
• May have to pay more if
• Provider does not participate in Medicare
• Provider does not accept assignment
• Some services cost less
• Medicare Advantage or other Medicare plan
• May have copayment

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Welcome to Medicare

• Initial preventive physical exam
• Within first 6 months having Part B
• Height and weight
• Blood pressure and EKG
• Education, counseling, and referrals
• In Original Medicare you pay
• 20 after Part B deductible

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Influenza (Flu)

• Flu is a serious illness
• Can lead to pneumonia
• Can be dangerous for people 50 and over
• Flu viruses are always changing
• Shot updated for most current flu viruses

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Flu Shot

• Covered for all people with Medicare
• Once each flu season
• Helps protect you for about a year
• In Original Medicare
• No deductible or copayment

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Pneumococcal Pneumonia

• Inflammation in the lungs
• Caused by
• Bacteria Streptococcus pneumoniae

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Pneumonia Vaccination

• One shot could be all you ever need
• All people with Medicare are eligible
• In Original Medicare
• No deductible or copayment

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Hepatitis B

• Serious disease
• Caused by virus that attacks the liver
• Can cause
• Lifelong infection
• Cirrhosis (scarring) of the liver
• Liver cancer or failure
• Death

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Hepatitis B Shots

• Covered for medium to high risk
• End-Stage Renal Disease
• Hemophilia
• Condition that lowers resistance to infection
• In Original Medicare you pay
• 20 after Part B deductible

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Shingles

• Painful skin rash often with blisters
• Last 2 to 4 weeks
• Pain- moderate to severe
• Can lead to pneumonia, blindness, encephalitis,
  death
• Herpes Zoster
• Caused by Varicella Zoster virus
• Chicken pox
• Common in people 50 and older
• 1 million/year

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Shingles Vaccine

• Zostavax
• Licensed in 2006
• Indicated for people 60 and older
• Effective January 1, 2008
• Medicare Part D not B
• PDP and MA-PD
• Co-pays

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Abdominal Aortic Aneurysm Screening

• Ultrasound screening
• Referred during Welcome to Medicare
• No deductible

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Osteoporosis

• Disease in which bones become weak
• Risk factors

• Age 50 or older
• Female
• Family history of broken bones
• Personal history of broken bones
• White or Asian

• Small-boned
• Low body weight (under about 127 lbs.)
• Smoke
• Drink a lot of alcohol
• Low-calcium diet

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Bone Mass Measurement

• For people at risk for osteoporosis
• Covered once every 2 years
• More often if medically necessary
• In Original Medicare you pay
• 20 after Part B deductible

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Cardiovascular Disease Screening

• Blood test for early detection
• Heart disease
• Stroke
• Tests for levels of
• Cholesterol
• Triglycerides
• Lipids
• Covered every 5 years
• Original Medicare
• No deductible/coinsurance

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Colorectal Cancer Screening

• For all age 50 and older
• Tests for cancer and pre-cancerous growths
• Fecal occult blood test
• Flexible sigmoidoscopy
• Colonoscopy
• No age limit for those at high risk
• Barium enema
• Frequency varies with type of test

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Colorectal Cancer Screening

• Payment varies with type of test
• In Original Medicare you pay
• Nothing for fecal occult blood test
• 20 for all other tests
• 25 for sigmoidoscopy or colonoscopy in all
• Hospital outpatient departments
• Ambulatory surgical centers
• No Part B deductible

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Diabetes

• Diabetes is a chronic condition
• Body does not produce or properly use insulin
• May be able to avoid or delay complications
• You can manage your diabetes
• Test blood sugar regularly
• Eat a proper diet
• Exercise regularly
• Take medication as prescribed

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Diabetes Risk Factors

• High blood pressure
• High cholesterol
• Obesity
• History of high blood sugar

• At least two of the following
• Age 65 or older
• Overweight
• Family history of diabetes
• History of gestational diabetes or delivering a
  baby over 9 lbs.

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Diabetes Screening

• Testing for people at risk
• Includes fasting blood glucose test
• Talk with your doctor about frequency
• Up to twice in a 12-month period
• Original Medicare
• No deductible or coinsurance

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Covered Diabetes Services

• Screening for all at risk
• For people with diabetes
• Self-management training
• Medical nutrition therapy
• Blood sugar testing supplies
• Insulin and related supplies
• Hemoglobin A1c tests
• Special eye exams

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Covered Diabetes Services

• People with diabetes who need them
• Insulin pumps
• Special foot care
• Therapeutic shoes
• In Original Medicare you pay
• 20 after Part B deductible
• Medicare Coverage of Diabetes Supplies
  Services, Pub. 11022

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Glaucoma

• What is glaucoma?
• Caused by above-normal pressure in eye
• Usually damages the optic nerve
• Can result in blindness
• More likely without treatment
• May occur without symptoms
• Protect yourself with screening eye exam

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Glaucoma Examination

• Individuals at high risk
• Family history of glaucoma
• Diabetes
• African Americans age 50 and over
• Hispanic Americans age 65 and over
• Covered once every 12 months
• In Original Medicare you pay
• 20 after Part B deductible

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Pap Test and Pelvic Exam With Clinical Breast
Exam

• Pap test
• To help find cervical and vaginal cancer
• Screening pelvic exam
• To help find fibroids or ovarian cancers
• Clinical breast exam
• Another way to look for breast cancer

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Cervical and Vaginal CancerRisk Factors

• High risk for cervical cancer
• Abnormal Pap test
• Infected with human papillomavirus (HPV)
• Sex before age 16
• Many sexual partners
• Not had 3 negative (or any) Pap tests in past 7
  years
• High risk for vaginal cancer
• Mother took DES when pregnant with you
• Diethylstilbestrol, a hormonal drug

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Pap Test and Pelvic Exam With Clinical Breast
Exam

• Covered for all women with Medicare
• Once every 24 months
• Once every 12 months if
• At high risk for cervical or vaginal cancer
• Childbearing age and had an abnormal Pap test in
  the past 36 months

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Pap Test and Pelvic Exam With Clinical Breast
Exam

• In Original Medicare you pay
• Nothing for Pap lab test
• 20 for Pap test collection, pelvic exam, and
  clinical breast exam
• No Part B deductible

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Prostate Cancer

• Risk increases with age
• Hereditary risk
• From higher to lower risk
• African Americans
• Whites
• Hispanic Americans
• Asians
• Pacific Islanders
• Native Americans

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Prostate Cancer Screening

• Covered
• For all men with Medicare
• Beginning the day after 50th birthday
• Tests include
• Digital rectal exam
• PSA blood test
• Prostate-specific antigen
• In Original Medicare you pay
• Nothing for the PSA blood (lab) test
• 20 after Part B deductible for digital rectal
  exam

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Breast Cancer and Mammography

• Breast cancer in women in U.S.
• Most commonly diagnosed non-skin cancer
• Second leading cause of cancer death
• Risk increases with age
• Successfully treated when found early
• Mammogram
• Checks for abnormal breast tissue
• Coverage includes digital technology

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Screening Mammogram

• Covered for all women with Medicare
• One baseline mammogram age 35 to 39
• Once a year starting at age 40
• In Original Medicare you pay
• 20 coinsurance
• No Part B deductible

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Diagnostic Mammogram

• Used when there are clinical findings
• On physical exam
• Abnormal screening mammogram
• Medicare covers as many as needed
• Also covered for men
• Different payment rates

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Smoking Cessation

• Quitting gives significant health benefits
• Even older adults who smoked for years
• Services covered for those
• With illness caused or complicated by tobacco use
• Who take medication affected by tobacco use

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Smoking Cessation Services

• Cessation counseling
• Up to 8 sessions per year
• Inpatient or outpatient
• Intermediate or intensive
• In Original Medicare you pay
• 20 after Part B deductible
• Medicare prescription drug coverage
• Can help pay for drug therapy
• Nicotine patches, for example

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Exercise

• 1. Fewer than 1 in 10 people with Medicare
  receive all the recommended screenings and
  immunizations

• True
• False

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Exercise

• 2. Your risk for osteoporosis increases if you

• Are a man
• Are African-American
• Have a low-calcium diet
• Are overweight

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Exercise

• 3. If you have diabetes, you can manage it by

• Testing your blood sugar regularly
• Eating a proper diet and exercising regularly
• Taking the medications your doctor prescribes
• All of the above

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Exercise

• 4. Medicare provides annual coverage for
  glaucoma screening for people with Medicare in
  the following high-risk categories

• Individuals who have diabetes
• Individuals who have a family history of
  glaucoma
• African-Americans age 50 and over
• Hispanics and age 65 or older
• All of the above

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Exercise

• 5. Which is true about breast cancer?

• Every woman is at risk and the risk increases
  with age
• Breast cancer can usually be successfully treated
  when found early
• Medicare covers screening mammograms to check for
  breast cancer before you or a doctor may be able
  to feel it
• All are true

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Exercise

• 6. The best time to get a flu shot is in January
  or February

• True
• False

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If You Want to Know More

• Centers for Medicare Medicaid Services
• Medicare Preventive Services, Pub. 10110
• Medicare You handbook, Pub. 10050
• Your Medicare Benefits, Pub. 10116
• 1-800-MEDICARE (1-800-633-4227)
• TTY 1-877-466-2048
• www.medicare.gov
• MyMedicare.gov

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If You Want to Know More

• Local State Health Insurance Assistance Program
  (SHIP)
• Lt. Governors Office on Aging (I-CARE)
• 1-800-886-9095 / 803-734-9900
• American Cancer Society
• www.cancer.org
• 1-800-ACS-2345

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If You Want to Know More

• Cancer Information Service
• LiveHelp link at www.cancer.gov
• 1-800-4CANCER (TTY users call 1-800-332-8615)
• Centers for Disease Control and Prevention
• www.cdc.gov
• HHS tobacco cessation resources
• www.surgeongeneral.gov/tobacco
• National Center for Infectious Diseases
• www.cdc.gov/ncidod

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Key Concepts

• Can take steps to live longer, healthier life
• Get Medicare preventive services
• Covered by all Medicare health plans
• Original Medicare
• Medicare Advantage and other Medicare plans
• Information is available
• Internet
• Publications
• 1-800-MEDICARE