Medicare Pays - Get the Most from It!

Medicare Pays - Get the Most from It!

Senior citizens who want to keep the pink in their cheeks without losing the green in their wallets should check out the free and almost-free preventive-health-care services offered by Medicare.

Many older people have been overlooking these services -- and putting their health and wealth in jeopardy.

Here's a list of what people 65 years of age, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant) can get with little or no money:

1. One-time "Welcome to Medicare" Physical

This exam will include a thorough review of your health, education and counseling about the preventative services you need like certain screenings and shots, and referrals for other care if you need it.

  • Eligible patients: All people whose Medicare Part B begins on or after January 1, 2005
  • How often: One time only within the first six months that you have Part B
  • Cost: 20% of the Medicare-approved amount after the yearly Part B deductible

2. Cardiovascular screening

  • Eligible patients: Talk with your doctor to see if you qualify
  • How often: Talk with your doctor about how often
  • Cost: free

3. Flu shot

  • Eligible patients: Medicare beneficiaries
  • When Needed: Medicare will pay for the flu shot once every flu season. In some cases this may mean twice in one year. For example, if you received a shot in January 2005 for one flu season, you could be inoculated again in October 2005 for another flu season.
  • Cost: Free if your doctor or provider accepts Medicare. Medicare will pay about $18 for your flu shot if you go to a doctor or provider who doesn't participate in Medicare. This amount varies by State and could be less than a doctor or provider charges you.

4. Pneumonia shot

  • Eligible patients: Medicare beneficiaries
  • When needed: Once for some patients, more than once for others
  • Cost: Free

5. Hepatitis B shot

  • Eligible patients: Medicare beneficiaries at high or medium risk for hepatitis B
  • When needed: Three shots are needed for complete protection. Check with your doctor about when to get these shots if you qualify to get them.
  • Cost: 20 percent of Medicare-approved amount after yearly Part B deductible
  • At risk for Hepatitis B: These common factors put you at medium to high risk for hepatitis B: hemophilia, end-stage renal disease, a condition that lowers your resistance to infection. Check with your doctor if you are unsure as to your risk.

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6. Mammogram to screen for breast cancer

  • Eligible patients: Female Medicare beneficiaries age 40 and older. Medicare also pays for one baseline mammogram for women with Medicare between the ages of 35 and 39.
  • When needed: Once a year
  • Cost: 20 percent of Medicare-approved total (no Part B deductible)

7. Pap smear and pelvic exam to screen for cervical cancer

  • Eligible patients: female Medicare beneficiaries
  • When needed: Once every 24 months (2 years). However, if you are of childbearing age and have had an abnormal Pap test within the past 36 months, or if you are at high risk for cervical or vaginal cancer, Medicare will cover a Pap test and pelvic exam every 12 months.
  • Cost: Pap smear lab test free (no co-pay, no Part B deductible); Pap test collection and pelvic exam, 20 percent of Medicare-approved total (no Part B deductible)

8. Colorectal cancer screening

Eligible patients: Medicare beneficiaries age 50 and older, except there is no minimum age for having a screening colonoscopy.

  • Fecal occult blood test - Once every 12 months
  • Flexible sigmoidoscopy - Once every 48 months
  • Screening colonoscopy - Once eery 24 months (if you are at high risk); once every 10 years, but not within 48 months of a screening sigmoidoscopy (if you're not at high risk)
  • Barium enema - Your doctor can decide to use this test instead of a flexible sigmoidoscopy or colonoscopy. This test is covered every 24 months if you are at high risk for colorectal cancer and every 48 months if your are not at high risk.

Cost: Fecal occult blood test is free; For ALL other tests, you pay 20% of the Medicare-approved amount after the yearly Part B deductible.

NOTE: If the flexible sigmoidoscopy or colonoscopy is done in a hospital outpatient department, you pay 25% of the Medicare-approved amount after the yearly Part B deductible.

9. Bone density scan for osteoporosis (bone thinning and weakening)

  • Eligible patients: Medicare beneficiaries at risk for osteoporosis
  • When needed: Once every 24 months (more often if medically necessary)
  • Cost: 20 percent of Medicare-approved total after Part B deductible

10. Diabetes screening and monitoring

  • Diabetes screening (fasting plasma glucose test) beginning January 1, 2005
    • When needed and for whom - talk with your doctor
    • Cost: free
  • Diabetes glucose monitors, test strips, and lancets
    • Eligible patients: All Medicare beneficiaries with diabetes
    • Cost: 20 percent of the Medicare-approved amount after the yearly Part B deductible
  • Diabetes self-management training
    • Eligible patients: For certain Medicare beneficiaries who are at risk for complications of diabetes. Your doctor must request this service.
    • Cost: 20% of the Medicare-approved amount after the yearly Part B deductible

11. Prostate cancer screening

  • Eligible patients: All men with Medicare age 50 and older (coverage for this test begins the day after your 50th birthday)
  • What's covered:
    • Digital rectal examination - once every 12 months
    • Prostate specific antigen (PSA) test - once every 12 months
  • Cost: Generally, you pay 20% of the Medicare-approved amount for the digital rectal exam after the yearly Part B deductible. There is no coinsurance and no Part B deductible for PSA test.

12. Glaucoma tests

  • Eligible patients: Medicare beneficiaries at high risk for glaucoma
  • When needed: Once every 12 months
  • Cost: 20% of the Medicare-approved amount after the yearly Part B deductible
    High risk: Your risk for glaucoma increases if you: have diabetes, have a family history of glaucoma, are African American and age 50 years or older.


Please remember that Medicare pays in part or in full for all ten of these health maintenance measures. If you have Medicare, we very strongly recommend that you enjoy these services so you can stay in the best of health. For more Medicare coverage information, please visit http://www.medicare.gov/default.asp.

-- The Medical Editors, MedicineNet.com


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Reviewed on 5/4/2005

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