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Medicare Expands Preventive Services
Beginning July 1, people with Medicare will receive expanded coverage for
screening tests for breast, cervical and colorectal cancers. And starting on
January 1, 2002, Medicare will cover an annual glaucoma screening test and
medical nutrition therapy by registered dieticians for people with diabetes and
a renal disease.
The extended coverage results from the Beneficiary Improvements and Protections
Act (BIPA) enacted by Congress in December, 2000. The legislation calls for The
Centers for Medicare & Medicaid Services (CMS), formerly known as the Health
Care Financing Administration, to phase in specific coverage for certain tests
and therapies that can detect diseases early, when they are most easily treated
or cured.
"Medicare must play a leading role in preventing, containing, or slowing
illness," said HHS Secretary Tommy G. Thompson. "By increasing preventive
services we can help save lives. We know that as women get older their risk of
getting breast cancer increases. As both men and women get older their risk of
colorectal cancer increases. By expanding preventive services we are starting to
change how Medicare helps beneficiaries think about their health care choices.
We want to encourage beneficiaries to act before they get sick, to feel
comfortable about asking their health care professionals for screening exams
that can detect disease early."
CMS is working closely with the National Cancer Institute of the National
Institutes for Health, the Centers for Disease Control and Prevention and other
agencies within Health and Human Services to raise awareness of expanded
coverage for preventive services among people with Medicare and their health
care providers.
The New Preventive Services Include The Following:
 | Effective July 1, 2001, a Pap test and pelvic exam
every two years instead of every three for women not at high risk for uterine
or vaginal cancers. (Medicare covers these tests annually for women at high
risk.)
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| Effective July 1, 2001, a screening colonoscopy every
10 years for people not at high risk for colorectal cancer. (Medicare covers
this test every two years for people at high risk.)
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| Effective January 1, 2002, an annual glaucoma screening
for people at high risk, a family history of the disease, or with diabetes.
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| Effective January 1, 2002, medical nutrition therapy by
registered dieticians or other qualified nutrition professionals for people
with diabetes, chronic renal disease and post-transplant patients. |
Other Preventive Services Now Covered By Medicare
Include:
| Four types of colorectal cancer screening tests
including a yearly take-home fecal-occult blood test; a flexible sigmoidoscopy
every four years; a colonoscopy every two years for high risk individuals, or
a barium enema as an alternative to the colonoscopy or sigmoidoscopy.
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| A baseline mammogram for women with Medicare aged 35 to
39. An annual mammogram for women with Medicare aged 40 and older.
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| Bone mass measurements for people at risk for
osteoporosis.
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| Prostate cancer screening exams for men with Medicare
aged 50 and older. These exams include a digital rectal exam and a Prostate
Specific Antigen (PSA) test annually.
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| A flu shot each season.
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| A pneumonia shot if needed.
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| A hepatitis B shot for people with medium to high risk
for hepatitis. |
By law, most of these preventive services require about a
20 percent co-pay of a Medicare-approved amount. Some, like the annual flu shot,
and pneumonia shot when necessary, are free when given by doctors who accept
Medicare assignment. A chart with specific benefits and payment information is
attached.
The expansion of preventive services augments the original vision of the
Medicare program, established 36 years ago to provide acute health care for
people in inpatient settings. Medicare has given the elderly access to high
quality medical care and protection from the devastating cost of illness. In
1973, Medicare began covering people with disabilities. In aggregate over the
past 36 years Medicare has provided health care coverage to more than 93 million
elderly and people with disabilities.
Currently, about 5.6 million Medicare beneficiaries, out of at total of nearly
40 million people with Medicare, have chosen to enroll in Medicare HMOs, called
Medicare+Choice organizations. Original fee-for-service Medicare, chosen by more
than 34 million beneficiaries, is available to most people 65 and older.
For more information on preventive services covered by Medicare, visit the
Medicare Web site at www.medicare.gov.
Or call toll-free, 1-800-MEDICARE (1-800-633-4227). The TTY/TDD
number is 1-877-486-2048. The information is also contained in the Medicare &
You handbook, which will be mailed to all homes of people with Medicare this
fall.
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