Baby Boomers Insurance –
your tool for navigating the path to Medicare
Your Preventive Care and Medicare
Welcome to the Medicare Preventive Visit and Yearly Wellness Exam
Once you sign up for Medicare Part B, you are eligible for the Welcome to Medicare preventive visit. Assuming your provider accepts assignment, your out-of-pocket cost for this service is zero. This screening gives your doctor a baseline reading of your current health. Your provider measures a variety of vitals, including height, weight, and blood pressure. They also take a complete medical history and discuss behavioral health issues. The screening also includes a basic vision test and a body mass index calculation.
Your doctor should also offer flu and pneumococcal shots if appropriate and explain advance directives. The visit should end with a written plan that lists other preventive screenings your doctor recommends.
After your first 12 months, Part B covers a Yearly Wellness Exam. This is essentially the same visit and, again, your out-of-pocket cost is zero. Medicare covers this visit every 12 months.
Your Cancer Screenings Covered by Medicare
Medicare Part B covers numerous cancer screenings, including:
- Colorectal cancer screenings, including multi-target stool DNA test, fecal occult blood test, colonoscopy, and barium enema
- Lung cancer screenings for qualified patients
- Pap test
- Pelvic exam, including clinical breast exam
- Prostate cancer screenings, including digital rectal exam and prostate specific antigen blood test
Patients may need to meet certain criteria regarding age and health status. For example, to qualify for the lung cancer screening, you must be aged 50 to 77 and have smoked an average of one pack per day for 30 years. Out-of-pocket costs vary, from zero to the standard co-insurance amount of 20 percent. Frequency of the screening varies as well.
Your Screenings for Chronic Conditions
Chronic conditions are much easier to treat if you catch them early. In fact, you may be able to avoid them altogether.
Medicare Part B covers the following screenings for beneficiaries who qualify. These include:
- Abdominal aortic aneurysm screening: Males aged 65 to 75 who smoked at least 100 cigarettes during their lifetime
- Bone mass measurements: Prescribed if doctor suspects you have or are at risk of osteoporosis
- Cardiovascular disease screenings: Tests cholesterol, lipid, and triglyceride levels every five years for all Part B beneficiaries
- Depression screenings: Covered as part of your Yearly Wellness Visit in a primary care setting
- Diabetes screenings: Covered twice per year if diagnosed with pre-diabetes or doctor determines you are at elevated risk
- Glaucoma tests: Must meet one of the following criteria: family history, African American aged 50 or older, Hispanic aged 65 or older, have diabetes at any age
- Hepatitis B virus infection screenings: Yearly screening for those who don’t get a Hepatitis B shot and are considered high risk
- Hepatitis C screenings: Single screening for beneficiaries born between 1945 and 1965, those who had a blood transfusion before 1992, and intravenous drug users
- HIV screenings: Yearly screenings for those aged 15 to 65 or any age considered high risk
Preventive Shots Covered by Medicare Part B
In addition to preventive screenings, Part B covers certain immunizations. These include:
- Flu shots: Once per flu season
- Hepatitis B shots: Qualifiers include living with someone who has Hepatitis B, being a healthcare worker, and having diabetes, End-Stage Renal Disease, or hemophilia
- Pneumococcal shots: You qualify for two pneumococcal shots as long as the second one is administered at least 12 months after the first
Medicare Lifestyle Screenings and Counseling
Medicare Part B covers many services designed to support healthy lifestyle changes. These include:
- Alcohol misuse screenings and counseling
- Cardiovascular behavioral therapy
- Diabetes self-management training
- Nutrition therapy services
- Obesity screenings and counseling
- Smoking and tobacco use cessation counseling
- Sexually transmitted infections (STI) screenings and counseling
Guidelines vary but are mostly based on age and medical history. Talk to your doctor to get started.
The short answer is yes, you may apply for Medicare by calling Social Security’s 800 number. The longer answer is yes, but Social Security is warning people to expect long hold times. They predict the 800 number will be overwhelmed with people calling with questions about their benefits, disability applications, etc. SSA is prioritizing “critical claims” calls. This includes Medicare applications for healthcare coverage.