Preventive care helps avoid illness, detect medical conditions, and keep you healthy. A preventive medical service is conducted when you have no prior symptoms of disease. In contrast, diagnostic services address symptoms or conditions that you already have. In this month’s article I will describe how Medicare covers preventive care.
Medicare covers preventive services
Medicare’s Part B outpatient care covers many preventive services, such as screenings, vaccines, and counseling. To find out if Medicare covers any test, service or treatment visit www.medicare.gov, call 1-800-MEDICARE (1-800-633-4227), or read your “Medicare & You” handbook. If you meet the eligibility requirements and guidelines for a preventive service, the service is covered. You should pay nothing for most preventive services when you visit a provider who accepts Medicare assignment.
During your preventive visit, your provider may discover and need to investigate or treat a new or existing problem. This additional service may be diagnostic or treatment. Medicare covers diagnostic and treatment services differently than preventive services, and you may be charged coinsurances or copays. You also may be responsible for paying a facility fee, depending on where you receive the service.
Welcome to Medicare visit and Annual Wellness visits
Medicare covers an initial “Welcome to Medicare” preventive visit during your first year enrolled into Medicare Part B, then one Annual Wellness Visit per year after that, when you visit a physician who accepts Medicare assignment. Keep in mind that these visits are not all-encompassing physicals. During the “Welcome to Medicare” visit, your provider will review your medical and social history as well as your health status and risk factors. Your provider will then give you resources related to your risk factors and health needs and will give you a checklist or written plan with information about other preventive services you may need.
Annual Wellness visits, which Medicare will cover once you have had Part B for 12 months, are yearly appointments with your primary care provider to create or update a personalized prevention healthcare plan. This plan can help prevent illness based on your current health and risk factors. For both kinds of preventive visit, be prepared with information about your medical history, family history, doctors, medications and durable medical equipment you use.
Twice now, I’ve mentioned that you can save money when you see providers who accept assignment. These providers accept Medicare’s approved amount for a service as payment in full. For preventive services that Medicare covers at 100%, you owe no deductible or coinsurance when you see a provider who accepts assignment. And if you receive additional services that do have a cost, these providers cannot charge you more than the Medicare-approved deductible and coinsurance.
Learn to prevent, detect and report fraud, errors or abuse
Medicare fraud and abuse costs all of us money that could better be spent on caring for you. Billing errors can be reduced by reviewing your Medicare Summary Notice, which are provided every three months. One example of tests which are not medically necessary are genetic testing which has not been ordered by your treating physician. Scammers offer cheek swab tests to obtain your Medicare information, which the scammers can then use for fraudulent billing or medical identity theft. You may hear these cheek swabs or genetic tests also called DNA testing, hereditary cancer screening, dementia test, or Parkinson’s screening.
To prevent genetic testing fraud and abuse, make sure to work with your trusted health care provider on your preventive health. Do not give out your personal information or accept genetic screenings or tests from a person or company you meet at a public event or over the phone. Always read your Medicare Summary Notices and watch for words like “gene analysis” or “molecular pathology” that may indicate questionable genetic testing. And finally, if you received a cheek swab or genetic screening/test that was not medically necessary, report your concerns to our office.
To discuss any Medicare preventive care concerns, or to ask any questions regarding your specific situation, contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers Act (MIPPA) program. If you are part of an agency or organization that assists seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor for the Alaska Medicare Information Office.
