Despite tough economic times, there are some things the government can’t give away.
Starting this year, seniors enrolled in Medicare no longer have to pay for more than a dozen tests and other services to help prevent or control cancer and other costly and debilitating diseases. These benefits, which also include an annual wellness exam, are part of the new federal health-care law.
Free Benefits in Medicare
Here are some of the benefits available for free to Medicare beneficiaries – no co-payments, coinsurance or deductibles – when provided by health-care professionals who accept Medicare.
- Annual mammograms for women 40 and older.
- Cervical cancer screening, including a Pap smear test and pelvic exam, every two years or annually for women with a high
risk of cervical cancer.
- Colorectal cancer screenings every 10 years, or every two if at high risk, for people 50 and older.
- Cholesterol test and other cardiovascular screenings every five years.
- Diabetes screening for people at risk for the disease.
- Medical nutrition counseling to help people manage diabetes or kidney disease (three hours of individual counseling the first year and then two hours annually).
- Annual prostate cancer screening (for men 50 and older).
- Vaccines for influenza (annually), pneumonia (once) and hepatitis B for those at risk of the disease.
- Bone mass measurement every two years (more often if medically necessary) for people at risk of osteoporosis.
- HIV screening for people who are at increased risk.
- Smoking cessation counseling.
SOURCES: “Your Guide to Medicare’s Preventive Services,” U.S. Centers for Medicare and Medicaid Services
But big crowds aren’t lining up for free mammograms or colonoscopies, although early data indicate that the free wellness checkup is luring patients.
Advocates say details about the new benefits haven’t reached enough seniors, and Medicare’s information about it isn’t easily accessible and can be confusing.
“Our hope is that by waiving cost-sharing and making preventive care more affordable, more beneficiaries will get it,” said Jonathan Blum, deputy administrator at the Centers for Medicare and Medicaid Services.
At a senior center in Reston, roughly 35 people recently attended a “Medicare 101” meeting that provided information about the free services.
Howard Houghton, director of the Fairfax County senior health insurance information program, said he warned the seniors not to delay calling their doctor. “You want to do it sooner than later because this law might get repealed,” he said. “The law might change, so why take a chance?”
Even doctors have had some trouble figuring out what tests and exams are free and for which patients. Medicare is now paying all costs for most services that earned top ratings from the U.S. Preventive Services Task Force, an advisory group of medical experts. But if patients receive those services more often than recommended or don’t have risk factors to qualify for the tests, they can be charged a co-payment. In some cases, seniors may still have to pay for an office visit, even if the screening or test they receive is free.
To help clear things up, the American Medical Association issued a two-page guide for doctors. That’s in addition to e-mails that Medicare has sent to physicians and their professional associations.
Steven Schwartz, a family physician in Kensington who also teaches at Georgetown University’s medical school, said his group practice developed its own checklist of the preventive services and is contacting Medicare patients who haven’t had a wellness exam.
In 2008, when co-payments were required for many of the tests and screenings that are now free, only a minority of traditional Medicare beneficiaries in the District, Maryland and Virginia received them. For example:
- Fewer than 4 percent took advantage of the one-time “Welcome to Medicare” physical exam.
- Fewer than 10 percent were tested that year for diabetes.
- Only 36 to 41 percent of women received mammograms.
- Only 12 to 15 percent of women got bone density tests.
- Fewer than 20 percent of men received prostate cancer screenings.
- And even though the flu shot was available for free before 2011, fewer than half got one.
A list of which preventive services are now free and other information are included in the “Medicare & You” handbook (available at www.medicare.gov or at 800-MEDICARE), the user’s manual sent to all 48 million Medicare beneficiaries. A 48-page Medicare guide on preventive benefits is also available from Medicare.
But Joe Baker, president of the nonprofit Medicare Rights Center, said seniors usually read the handbook only when they have questions about a benefit. “If they haven’t heard about it, they’re not going to look for it,” he said.
One reason why seniors may not pay attention to the changes is that they have purchased a supplemental insurance policy or a Medicare Advantage managed-care plan that already offers some preventive health services without additional charges.
But cost isn’t the only reason that seniors may not be receiving preventive health services. Some people worry about whether procedures will be uncomfortable, and many are afraid of hearing bad news.
“It’s human nature to put off things that aren’t pleasant,” said Shawn Brennan, manager for senior health promotion in Montgomery County’s Department of Health and Human Services.
Blum thinks that attitude may be changing. In just the first three months of this year, almost 300,000 seniors nationwide received the new free wellness exam.
“Based upon what we’ve seen so far, we are very optimistic that we will have a greater proportion of beneficiaries who will take advantage of the preventive benefits,” said Blum.
Contact Susan Jaffe at firstname.lastname@example.org.