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Your Guide to Preventive Health Benefits, Personal Health


New in 2007 with Medicare. Ultrasound screening. abdominal aortic aneurysms ... Only give your insurance/Medicare identification information to those who ... – PowerPoint PPT presentation

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Title: Your Guide to Preventive Health Benefits, Personal Health

Your Guide toPreventive Health
Benefits,Personal Health Wellness
SHIBA HelpLine Statewide Health Insurance
Benefits Advisors
Sponsored by the Washington State Office of the
Insurance Commissioner
SHIBA HelpLine mission
SHIBA HelpLine provides free, unbiased
information about health care coverage and access
to help improve the lives of all Washington state
residents. We cultivate community commitment
through partnership, service and volunteering.
How can I start?
Do physical activities
Get a preventive exam
Educate yourself
Avoid tobacco
Keep a healthy weight
Why use prevention benefits?
  • Evidence based on a 1995 U. S. Preventive
    Services Task Force
  • Reactive care vs. Proactive care

Reactive care
  • Seek medical care after you have a problem or
    become sick
  • Problems with Reactive Care approach
  • much damage has already occurred
  • treatment can be very expensive

Proactive care
Taking action early to prevent disease, minimize
complications, and contain costs --
Wellsource, Inc.
  • Prevention
  • Health promotion
  • Primary prevention
  • Secondary prevention
  • Tertiary prevention

For example Diabetes
  • The problem (2005)
  • 18.3 million Americans have diabetes
  • 1.3 million folks diagnosed with diabetes (2,200
    every day)
  • Diabetes was the 6th leading cause of death in
  • Diabetes increased 33 in the last decade

Consequence Cost for diabetes management
  • Direct health care costs 92 billion/year
  • Lost productivity 40 billion/year
  • Total costs 132 billion/year
  • Cost per person
  • Non-diabetic 2,560/year
  • Diabetic 13,243/year

Based on 2003 figures
Risk factors
  • Individual/family medical history
  • Lifestyle behaviors choices
  • Age
  • Gender
  • Multiple risk stacking

Types of preventive services
  • Health screening/exams
  • Counseling/supervised unsupervised intervention
  • Education
  • Immunizations

Who provides services?
  • Employer plans
  • Public health plans programs
  • Community outreach
  • Individual plans

Sample program Medicare Preventive Services
  • Disease prevention early detection
  • Coverage based on
  • age, gender, medical history
  • Covered by
  • Original Medicare Plan (Part B)
  • Medicare Advantage and other Medicare plans

Medicare-covered preventive services
  • Welcome to Medicare exam
  • Abdominal aortic aneurysm
  • Bone mass measurement
  • Cardiovascular disease screening
  • Colorectal cancer screening
  • Diabetes screening, services supplies

Medicare-covered preventive services
  • Glaucoma screening
  • Pap test pelvic and breast exam
  • Mammogram screening
  • Prostate cancer screening
  • Smoking cessation counseling
  • Vaccinations (shots)

New in 2007 with Medicare
  • Ultrasound screening
  • abdominal aortic aneurysms
  • referred during Welcome to Medicare
  • no deductible
  • Colorectal cancer screening
  • no deductible

What you pay
  • Generally pay 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 plans
  • May have copayment

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

Preventive benefits tracking
  • My Medicare Preventive Benefits Checklist
  • Sign up at to track your
    preventive benefits you use each year
  • Call 1-800-MEDICARE (1-800-633-4227)
  • TTY users may call 1-877-486-2048
  • Use My Health My Medicare CMS publication 11308

Key points to remember
  • Take steps to live a longer, healthier life
    remember proactive vs. reactive
  • Find out what preventive services are included in
    your health plan public health programs

Key points to remember
  • Use information resources
  • Your health care provider
  • Call 1-800-MEDICARE
  • Internet

If you want to know more
  • Publications
  • Medicare Preventive Services, CMS Pub
  • My Health, My Medicare, CMS
    Pub 11308
  • A Consumers Guide to Health Care Coverage, SHP

If you want to know more
  • Web sites
  • Insurance Commissioner,
  • Medicare,,
  • Phone numbers
  • SHIBA HelpLine, 1-800-562-6900
  • 1-800-MEDICARE (633-4227)
  • TTY, 1-877-466-2048

Protect yourself from fraud
  • Do not give out your Social Security, Medicare,
    and bank account numbers over the phone or in
  • Be cautious if a company requests you pay for
    premiums in cash, pay a year's premium in
    advance, or pressures you to buy right away
    because "it's your last chance."

Protect yourself from fraud
  • Review your insurer's explanation of benefits
  • Only give your insurance/Medicare identification
    information to those who provide you with medical
  • If you suspect fraud, call the Insurance Consumer
    Hotline at 1-800-562-6900.

SHIBA HelpLine volunteer opportunities
You might be interested in becoming a volunteer
if you
  • Love to learn and help people
  • Like problem solving
  • Dont mind paper work or computer work
  • Are organized
  • Can attend regular training
  • Speak English and a foreign language

Contact the SHIBA HelpLine
1-800-562-6900 TDD 1(360)586-0241
This publication may have been partially funded
by grants from the Centers for Medicare
Medicaid Services and the U.S. Administration on