Taking advantage of preventive services while enrolled in Medicare

Medicare beneficiaries are able to receive preventive screenings and services that allow medical providers to pinpoint areas of concern early and plans can be made to address those issues before they become more significant. Here is what you should know about preventive care.

– Medicare covers the entire cost of some preventive services.

Preventive care is the care you receive to prevent illness, detect medical conditions and maintain general health. If you meet the eligibility requirements and guidelines for a preventive service, Part B of “Original Medicare” or your Medicare Advantage Plan must cover that service. Under “Original Medicare,” you pay nothing – no deductible or coinsurance – for preventive services recommended by the U.S. Preventive Services Task Force, as long as you see a health care provider who takes assignment. This is often referred to as “zero-cost sharing.” If you have a Medicare Advantage Plan and you see an in-network provider, you pay nothing for preventive services that are covered with “zero cost-sharing” by “Original Medicare,” as long as you meet Medicare’s eligibility requirements for the service. Flu shots, many cancer screenings and glaucoma tests are examples of preventive services with “zero-cost sharing.”

Call Medicare (800) 633-4227, or visit www.medicare.gov, or call SHIC to learn if a preventive service you are interested in is covered. Your provider may also be able to share this information with you.

It is important to know that you may be charged for services you receive related to your preventive service, even if the preventive service itself is covered at 100% of the cost. During the course of your preventive visit, your provider may discover and need to investigate or treat a new or existing problem. This additional care is not considered preventive and you may be responsible for the additional diagnostic and/or treatment costs.

– Providers you should see to minimize your out-of-pocket costs.

If you have “Original Medicare,” be sure to receive preventive services from providers who agree to accept Medicare’s approved amount as full payment and will not bill you for anything more than your Part B deductible or coinsurance charge. This is known as “accepting assignment.” If you have a Medicare Advantage Plan, you should not be charged for preventive care services that are free to those with “Original Medicare,” as long as you see an in-network provider. If you do not see a provider who accepts assignment or is an in-network provider, charges will typically apply to your preventive care service.

You may contact the North Dakota Insurance Department’s State Health Insurance Counseling (SHIC) program by calling 328-2440 or toll-free at (888) 575-6611 or by email at ndshic@nd.gov for a booklet that outlines various preventive services.

– How to prepare for your Welcome to Medicare and annual wellness visits.

Medicare covers one Welcome to Medicare preventive visit to your doctor within your first year of having Medicare Part B, then one annual wellness visit per year after that, with “zero cost-sharing,” as long as you see the appropriate providers. Keep in mind that these visits are not head-to-toe physicals; they are designed to discuss what preventive screenings you should have. During the Welcome to Medicare visit, your provider will review your medical and social history as well as your health status and risk factors. Your provider will then give you resources related to your risk factors and health needs along with a checklist or written plan containing information about other preventive services you may need. Annual wellness visits are yearly appointments with your provider to create or update a personalized prevention plan. This plan can help prevent illness based upon your current health and risk factors.

For both visits, be prepared with information about your medical history, your family history, the providers you see, the durable medical equipment you use and the medications or supplements you take. Remember that if your provider discovers and needs to investigate or treat a new or existing problem, you may be responsible for related diagnostic and/or treatment costs.

For more information or if you have questions about Medicare and preventive services, contact SHIC by calling 328-2440 or toll- free at (888) 575-6611, or emailing ndshic@nd.gov. You may also visit our website at www.nd.gov/ndins/shic.

SHIC offers free help with Medicare and other health insurance. Trained counselors who work through local sponsoring organizations can help answer your questions. SHIC counselors have no connection with any insurance company or product. SHIC counselors are trained in all aspects of senior insurance issues, such as Medicare, Medicare Part D and Medicare Advantage plans.