It’s not surprising that when the Affordable Care Act was signed into law on March 23, 2010, many Medicare beneficiaries wondered how it would affect Medicare. One of the key changes has been to make preventive care more available to all Americans. For those enrolled in Medicare Part B, that means no-cost annual wellness check-ups and many preventive screenings. These changes have been in effect since January 1, 2011. If you haven’t seen your doctor for an annual check-up or certain recommended preventive screenings, such as a mammogram, you may be able to now do so without any out-of-pocket costs1
Here are highlights of the benefits you can expect to receive.
When you first sign up for Medicare you’re entitled to an Annual Wellness Visit. This visit serves as a planning session between you and your doctor. You can take this time to discuss any health issues you may have, how to manage your conditions, and steps you can take to live a healthier, happier life. It also includes a personalized prevention plan -- you’ll learn which screenings you should get, based on your health and risk factors.2
For those who are not at high risk for colorectal cancer, Medicare, covers a colonoscopy every 10 years after your last screening. If you are at high risk, you can get the test every 2 years. Out-of-pocket expenses vary depending on whether you have Original Medicare or Medicare Part B and the benefits of your plan.3
However, there is one exception: If the doctor finds any polyps and removes them, the procedure is considered diagnostic.4 Medicare and some insurers may bill you for the cost of treatment, which means you could owe a copayment and (Humana does not charge members for cost-sharing if a polyp is found.) If you get a barium enema instead of a colonoscopy for this screening, Medicare covers this test every 4 years, but if you’re at high risk for this form of cancer , it’s covered once every 2 years. Again, check with your plan regarding any out-of-pocket expenses for which you would be responsible.5
Medicare Part B covers screenings to check for diabetes. If you’re at risk for developing the condition, you can be checked twice a year. Risk factors that you would be screened for include high blood pressure, obesity, a history of high blood sugar, and abnormal cholesterol and triglyceride levels.6
Every 5 years Medicare Part B covers blood tests for cholesterol, lipid and triglyceride levels. These screenings are important for detecting conditions that could lead to a heart attack or stroke. Those without Part B pay 20% of the Medicare-approved amount for the doctor’s visit.7
Original Medicare covers a breast cancer screening, or mammogram, every 12 months with no cost-sharing. Diagnostic screenings are covered as medically necessary for those with Part B. Others pay 20% of the Medicare-approved amount for the doctor’s visit.8
Men can get a digital rectal exam every 12 months under Part B (but check with your plan to see if there is any cost-sharing). A Prostate Specific Antigen (PSA) test is covered every 12 months at no cost, regardless of your plan.9
One flu shot per flu season – in the fall or winter – is covered at no cost.10 A pneumococcal shot to prevent pneumonia is also covered. Most people only need this once in their lifetime.11 The shingles vaccine isn’t covered by Medicare Parts A or B, although many Medicare Prescription Drug Plans (Part D) cover it. Check with your plan to see if you can get the shot at no cost.12
If you smoke, you can get counseling to help you quit. This is the first time a smoking cessation program has been covered as a preventive service. While the counseling itself is 100% covered, those with Part B coverage will still need to meet the deductible if they smoke and have been diagnosed with a tobacco-related condition.13
Have questions? Contact us
This information is only a high-level summary of certain provisions of the health care law. This information does NOT attempt to summarize all provisions of the health care reform law. This information is not and should NOT be used as legal or tax advice; it should not be used as a basis for decisions regarding how the health care reform law will affect you and/or your business. Should you have any questions on how the health care reform law (including the high level summary of certain provisions of health care reform) will affect you and/or your business, you should seek professional advice from attorneys or other advisors.
Insured by Humana Insurance Company, Humana Health Plan, Inc., Humana Health Insurance Company of Florida, Inc., or Humana Health Benefit Plan of Louisiana, Inc. or offered by Humana Medical Plan Inc., Humana Employers Health Plan of Georgia, Inc., or Humana Health Plan of Texas, Inc.
For Arizona residents: Insured by Humana Insurance Company. For Texas residents: Insured by Humana Insurance Company or offered by Humana Health Plan of Texas, Inc.
Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, call or write your Humana insurance agent or broker.