Medicare Update 2005 (cont.)
So our challenge is to work in a new way with Medicare beneficiaries to prevent these health problems that subtract years from our beneficiaries' lives and add billions to Medicare costs.
Medicare allows for a 'free' routine physical exam in the early months after sign-up. Does this mean that routine exams are not covered or, to put it another way, does one have to be sick or have some sort of complaint to see a doctor under Medicare?
Until now, Medicare has focused on treating health problems after they occur. That is changing with the new "Welcome to Medicare Exam." This is an important step toward helping our beneficiaries lead a prevention-focus approach to their health care. For beneficiaries who have been in Medicare for a long time, we want to make sure they are taking advantage of all of the preventive treatments we now cover for heart disease, diabetes, cancer, thin bones, and other preventable illnesses. In addition, people in Medicare can also choose to enroll in what are called "Medicare Advantage" health plans. These coordinated-care health plans generally offer even more extensive preventive benefits.
For those of us already on Medicare, will Medicare pay for a routine check-up (a wellness checkup)?
For people who have already been in Medicare, Medicare now covers a full range of preventive treatment. Medicare's new coverage for exams is only for new beneficiaries. However, with all of the new coverage for screening tests and all of the new support for coordinated care to prevent diseases, Medicare is offering much more than ever before for all of our beneficiaries to help them stay healthy.
So someone with existing coverage will have to pay for the doctor visit, but Medicare would cover screening tests?
That's right. Most Medicare beneficiaries who have been in the program for some time have one or more chronic illnesses, ranging from high blood pressure to complex diabetes or lung disease or kidney failure. Medicare will cover doctor visits that include exams or treatments related to any medical condition, like all of these. And that's a good opportunity to make sure you are up to date on all of the preventive services that Medicare now offers. And again, for our beneficiaries who choose to enroll in a Medicare Advantage Plan, they will get access to even more comprehensive preventive services.
Dr. McClellan, can you tell us how the "Welcome to Medicare" exam will be billed? It seems like it would be a Part B expense. How will those with Part A only be billed?
This is a Part B benefit; however, it's important to know that over 99% of Medicare beneficiaries have both Part A and Part B of Medicare. Part B is a voluntary benefit for physician and outpatient services. Because it is so important in modern medicine and because Medicare pays 75 percent of the cost of Part B, almost all of our beneficiaries choose to enroll. And with the additional preventive benefits, it's even more important today.
Medicare will soon offer new voluntary drug coverage that works in a similar way; that is, Medicare pays 75% of the cost and beneficiaries pay a premium for 25%. We expect that millions of beneficiaries will also choose to enroll in the drug coverage for the same reason they almost always choose to enroll in Medicare Part B. This is an essential part of modern prevention-oriented medicine.
|"Today, only about half of the people who are eligible for free Medicare Part B ... actually take advantage of it."|
Dr. McClellan, the 1% not covered under Part B may include those persons who cannot afford to pay for it. How do we help them?
That's a very important question because we have ways to help people pay for Part B and many of our beneficiaries are not yet taking advantage of it. People with limited incomes, below about $17,000 for a couple (and that includes over a third of all Medicare beneficiaries), can qualify for what is called the Medicare savings program. This program is administered by Medicare with the states, so you apply through your state. You can get more information about how to sign up at our web site, www.medicare.gov.
Today, only about half of the people who are eligible for free Medicare Part B through this important program actually take advantage of it. We have a major outreach campaign underway now to cover more people so that they can lower their medical costs and get access to up-to-date coverage right away. MEMBER QUESTION:
Can you explain the Medicare Advantage programs? Are these HMOs?
Medicare Advantage includes HMO health plans, but it also includes a growing range of other ways to get your Medicare benefits. Many Medicare beneficiaries today are enrolled in private fee-for-service health plans and some are enrolled in PPO, preferred provider organization, health plans, in addition to the over 4 million Medicare beneficiaries who are enrolled in HMOs in the Medicare Advantage Program. Different beneficiaries like to get their health care coverage in different ways, and I think it's very important for Medicare to give our beneficiaries the option of coverage that best meets their needs. Beneficiaries in Medicare Advantage Plans today, for example, have out-of-pocket medical costs that average $700 less per year than beneficiaries in the traditional Medicare plan. That's important for people who want to use coordinated care to lower their medical costs.