Medicare To Cover Preventative Care

A nice surprise buried somewhere  in the Health Care Reform Bill is that starting next year Medicare patients will be able to get annual preventative care exams that are paid for by their health insurance. It may come as a surprise to those of you with commercial insurance who think of  coverage of an annual exam as a routine thing for insurance to cover, but up to now Medicare has only covered a “Welcome to Medicare” exam in the first year after turning 65.  From then on no physical exams at all are covered, and many preventative services like colonoscopy and mammography were either not covered, or subject to fairly high copays and deductible costs.  As a physician this has always seemed like this is backwards. I can make a pretty good argument that a physical exam for a 27 year old man is not needed annually, but it is essentially always a covered benefit in any plan the young insured patient has through an employer. Older adults are far more at risk for cancer, heart disease, diabetes, hypertension, depression, and safety at home issues than young adults. I am pleased that better preventative services coverage for our older and more vulnerable adults will be a paid service starting in 2011. This is discussed nicely in a recent NY Times article by Leslie Alderman in his Patient Money column.

Starting Sept 23, 2010, 6 months after the signing of the bill, all new insurance plans, or current plans which make certain changes will be required to cover preventative services recommended by the United States Preventative Services Task Force as category A or B ratings (A = conclusive evidence and B = very strong evidence showing benefit of receiving the services) and beginning Jan. 1, 2011 Medicare will also cover these services with no copay or deductible applicable.

This is good news for our seniors and should make it much easier for their physicians to convince our seniors, some of whom now have to choose between shelter, food or medicine on their poverty level fixed incomes, to receive preventative care.

Ed Pullen, MD, is a board certified family physician practicing in Puyallup, WA. Dr. Pullen shares his viewpoints on medical news and policy from a primary care physician’s perspective at his blog, DrPullen.com.

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6 replies »

  1. This may not be the best place to ask this, but I want to find the best insurance company and I have no idea where to look. Do you know anything about this insurance company? They’re based out of Louisville, close to my apartment, but I haven’t been able to find reviews on them. — Braden Insurance Agency Inc., 3069 Breckenridge Lane, Louisville, KY 40220, (502)454-9191

  2. The 12 supplemental insurance policies assisting with costs not dealt with with the Original Medicare Plan are called Medigap or Medicare supplement insurance. These plans are all required to deliver certain basic benefits.Medigap insurance policies are sold by private insurance companies and are designed to supplement Medicare.

  3. Dear Judi Emmett, Have you tried applying for medical assistance for the Medically indigent, I had this before my social security attorney went to court for me in 2008/2009, and I was already disabled in 2007, and I had to wait, even though I have worker’s comp and the Dr. already claimed that I was disabled due to a knee injury, and back as well. Try your local community Medical center/regional medical hospital.They treat all sorts of medical issues, once you are assigned a regular physician. Don’t allow them to assign you to an intern however, they don’t have the same privilges to write necessary prescriptions, even though they have recent medical knowledge, they don’t have much medical clout until they are reisdent’s. Try that and good luck!

  4. I am currently on SSD. I have worked for 40+ years and now can not work. I was always covered medically, but now I pay $500 a month from $45 a month. NYS Employees have health insurance like the congress. Here I am looking for an insurance company to cover me until I get Medicare in another 8 months ( they make you wait 24 months even though your totally disabled) makes no sense. Where can I go for some medical coverage until medicare kicks in and I can afford a supplement? I may have to go without health insurance as I can’t afford the $500 a month for just one person…. Please any suggestions will help. I already looked at ehealthh.com, etc… I never thought I would become permanently disabled. I had a great job, made good money now look at me. It can happen to you too. We need to remember the disabled. It makes me mad to see people in jail, murders, rapits, etc get medical, shelter, food, etc.. for nothing! and yet I worked all my life and now disabled. Please Help if you can…. I anexiety of having no insurance makes my disablity worse.. Thank you……

  5. I am on Medicare and never had treatment denied to get GYN or chest xray or mammogram. I dont know what is being denied that they needed to add it. the more they add to make medicare employees evaluate the longer it will take to get these claims paid in a timely manner. The coverage is already there. What is needed is permission for alternative or holistic care which is often less expensive and gives more hands on care. Example. Chiropractic adjustments at$40.00 a visit vs physical therapist at $119.00 a visti and more of the physical therapy. I asked Medicare will you pay for 2 visits a month of chiro care at $80.00 they said no. I checked with 9 phy therapy centers and the orthopedic dr will cost me $400 plus xrays and the PT will be 3 x week for 5 weeks at $119.00 a visit.. SO MEdicare if it was flexible could save around $1500 on same pain relief i could receive for soft tissue chronic pain.. FLEXIBILITY AND ACCEPTANCE OF other kinds of care need to be INSERTED.. its not all hoaxy it helps or i wouldnt use it. This is from a person who was a claims adjustor and taught to deny holistic care also! it works better than traditional therapies!

  6. There remains a category of seniors who are duo-eligible and as such does not have to choose between shelter, food, or medicine. Generally these seniors’ incomes are at the poverty level or lower.
    The good news may be that those whose incomes are above the poverty level may be relieved of the obligation to pay the fairly high co-pays and deductibles.