Being able to treat a medical problem is good, but dodging the problem altogether is even better. That seems obvious, yet Medicare has only recently expanded coverage for services that help prevent or stave off some of the diseases that make people very ill and — not coincidentally — cost Medicare mountains of money.
Many of these preventive tests, screenings and counseling sessions are now available for free, with no copays or deductibles, thanks to the Affordable Care Act. More than 60 million people took advantage of these services, at no cost to themselves, during the first three years after the services became free in 2011, according to government reports.
Mammograms; colonoscopies; shots against flu, pneumonia and hepatitis B; screening for diabetes, depression and heart conditions; and counseling to combat obesity, alcohol abuse and smoking — these are just some of Medicare’s lengthy list of covered services. (For an updated list from my book, Medicare for Dummies, Medicare's preventive services chart.)
But to get these services for free, you need to go to a doctor who accepts Medicare “on assignment” — meaning that he or she has agreed to accept the Medicare-approved rate as full payment. Seeing a doctor who accepts Medicare, but not on assignment, means having to pay a copay. And if you go to a doctor who has opted out of Medicare, you are responsible for the total cost — not only for preventive tests and screenings, but also for any type of visit or treatment.
Also, the tests are free only if they’re used at specified intervals. For example: prostate cancer PSA tests — once every 12 months for men over 50; Pap tests and pelvic exams — once every two years, or every 12 months for women at high risk; colonoscopy — once every 10 years, or every two years if at high risk.
During your first year in Medicare, you’re entitled to a free “Welcome to Medicare” exam with a doctor, which establishes a baseline for the state of your health going forward.
Starting with your second year in Medicare, you can get annual wellness visits, which also come free provided that at least 12 months go by between each visit. These are checkups, intended to monitor your health over time, and are not the same as physical exams you may have had in the past. Medicare still doesn’t cover physicals, and if you ask for one instead of specifying a wellness visit, you would find yourself paying the full cost.
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