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Medicare Preventive Benefits

Helping You Stay Healthy

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Updated August 11, 2006

Medicare is the largest provider of health insurance and provides coverage for over 40 million older and disabled adults. Over the last few years the importance of preventive health has been reflected in changes and additions to the Medicare benefit.

Mammograms On January 1, 1998, Medicare coverage expanded to include annual screening mammograms for all women age 40 and over. Medicare also will cover a one-time initial, or baseline, mammogram for women ages 35 to 39. Beneficiaries will pay the usual 20 percent copayment, but Medicare will pay the other 80 percent with no Part B deductible.

Pap Smears On January 1, 1998, Medicare coverage expanded to include a screening pap smear to include both a pelvic exam and clinical breast exam every three years for most women. The exams are covered every year for women at high risk for cervical or vaginal cancer; those of childbearing age who have had an indication of cervical or vaginal cancer; and those who have had an abnormal pap smear during the preceding three years. Medicare will pay the full claim for the pap smear, and 80 percent of the claim for the pelvic and clinical exams, even if the beneficiary has not yet met their annual deductible. Beneficiaries continue to pay no coinsurance or Part B deductible for any clinical laboratory tests, including pap smears.

Colorectal Cancer Medicare coverage includes fecal-occult blood tests, flexible sigmoidoscopy, colonoscopy (for people at high risk for colorectal cancer), and in certain cases, barium enemas. Each of these tests are covered under different circumstances, so patients should check with their physician to determine what is best for them. Medicare beneficiaries pay no coinsurance and no Part B deductible for the fecal occult blood test. For all other tests, beneficiaries pay 20 percent of the Medicare approved amount after the yearly Part B deductible has been met.

Flu, Pneumonia, and Hepatitis B Vaccination Program Since 1993, Medicare has covered the cost of the immunizations with no coinsurance and no Part B deductible for doctors that accept assignment. Hepatitis B shots are covered only for persons at risk for Hepatitis B, such as those with end-stage renal disease or hemophilia. Medicare pays 20 percent of the approved amount after the Part B deductible has been met.

Prostate Cancer Screening Medicare began covering Prostate Specific Antigen (PSA) tests January 1, 2000, for the early detection or treatment of prostate cancer. The PSA test is covered once every 12 months as are digital rectal exams. Medicare pays 80 percent of the Medicare approved amount for digital rectal exams after the yearly Part B deductible has been met. The PSA test does not have a coinsurance or deductible payment.

Glucose Monitoring for Diabetics Since July 1, 1998, all Medicare beneficiaries with diabetes, whether or not they use insulin, have had coverage for blood glucose monitors and testing strips so they can monitor their own blood glucose levels. Diabetics who keep their blood glucose levels within the normal range reduce the risk of complications, such as blindness and amputations that are associated with uncontrolled diabetes. Medicare beneficiaries pay 20 percent of the Medicare approved amount after the yearly Part B deductible has been met.

Diabetes Education Medicare also covers a wide range of education and training programs to help teach diabetics to control their blood glucose levels. These training programs, which began July 1, 1998, do not have to be based in hospitals. A physician must certify that a patient needs the service under a comprehensive plan of care.

Bone Mass Measurement Medicare has covered bone density measurement for beneficiaries at risk for osteoporosis and other bone abnormalities as of July 1, 1998. Beneficiaries should consult with their doctors about whether and when they might need one of these tests. Medicare beneficiaries pay 20 percent of the Medicare approved amount after the yearly Part B deductible has been met.

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