By Mary Johnson
Seniors are reporting that in recent years they have frequently
put off visits to the doctor and other healthcare providers due to economic
reasons, according to recent TSCL surveys. You may have been told that the new
healthcare reform law provides “free” new preventive benefits. While that made
a good sound bite for the TV news and those Andy of Mayberry ads, the reality is
that most Medicare beneficiaries will probably still have some out-of-pocket
costs. Here are the rules to qualify for those free preventive services:
• You must get your health services through Original
Medicare. If you are enrolled in a Medicare Advantage plan,
deductibles and co-pays may apply to these preventive services. Check with your
plan to see what costs and rules apply.
• Your doctor or provider accepts “assignment,” the
Medicare-approved payment, as payment in full. There may be some
doctors in your area that accept assignment but fewer do so anymore. You will
need to call your doctor to find out if he or she accepts assignment. Many are
charging more than the Medicare-approved amount and you or your Medigap plan
will need to cover the “excess” charges. Even if you do locate a doctor who
accepts assignment, a growing number of doctors are not accepting new Medicare
patients. To find a doctor who accepts assignment call the customer service
number of your Medigap supplement. Then call the physician to find out if he or
she is accepting new Medicare patients.
• Services must be those that have earned an “A” or “B”
recommendations by the U.S. Preventive Services Task Force. They
include: annual wellness visit, blood tests for heart disease, bone mass
measurements, diabetes screening, colon cancer screening, diabetes screening,
flu shot, hepatitis B vaccine, medical nutrition therapy, pap smears, pelvic
exams and clinical breast exams, pneumonia vaccine, prostate cancer screening
(PSA test), and screening mammograms.
• You must follow Medicare guidelines for receiving the
services to ensure coverage. Find out how often you should receive a
service. Some preventive services are covered only once every few years, others
are covered only if you meet specific criteria. To learn more, read “Your Guide
to Medicare’s Preventive Services,” CMS Product No. 10110. Download a copy at
www.Medicare.gov or call 1-800- Medicare
(1-800-633-4227).
Mary Johnson is a Social Security and Medicare policy analyst for
The Senior Citizens League, one of the nation’s largest nonpartisan seniors
groups, and editor of The Best Ways to Save newsletter. To request your free
special issue of The Best Ways to Save send $1 for postage and handling to: The
Senior Citizens League, ATTN: BWTS, 1001 N. Fairfax St., #101, Alexandria, VA
22314, or visit TSCL at www.SeniorsLeague.org.
