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| Medicare Preventive Services |
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There are steps you can take to lower your risk of disease and illness. Medicare is providing coverage for preventive services to help you stay healthy. Medicare covers:
- Screening for breast cancer, cervical cancer, and vaginal cancer;
- Screening for colorectal cancer;
- Screening for prostate cancer;
- Bone mass measurements;
- Diabetes monitoring and diabetes self-management;
- Flu, pneumonia, and hepatitis B shots;
- Medical nutrition therapy services; and
- Screening for glaucoma.
These new, valuable benefits from Medicare may be the key to long-lasting good health.
| Covered Services |
Who is Covered |
What You Pay |
Bone Mass Measurements:
Varies with your health status. |
Certain Medicare beneficiaries who are at risk for losing bone mass. |
20% of the Medicare approved amount after the annual Part B deductible. |
Colorectal Cancer Screening:
- Fecal Occult Blood Test - Once every year.
- Flexible Sigmoidoscopy -Once every four years.
- Colonoscopy - Once every two years if you are high risk for cancer of the colon.
- Once every 10 years, but not within 48 months of a screening sigmoidoscopy if you are not at high risk for colon cancer.
- Barium Enema - Doctor can substitute for sigmoidoscopy or colonoscopy.
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All Medicare beneficiaries age 50 and older. However, there is no age limit for having a colonoscopy. |
No coinsurance and no Part B deductible for the fecal occult blood test. For all other tests, 20% of the Medicare approved amount after the annual Part B deductible. |
Diabetes Monitoring:
Includes coverage for glucose monitors, test strips, lancets, and self-management training. |
All Medicare beneficiaries with diabetes (insulin users and non-users). |
20% of the Medicare approved amount after the annual Part B deductible. |
Glaucoma Screening:
Effective January 1, 2002, Medicare will allow payment for glaucoma screening once per year. |
All Medicare beneficiaries with diabetes
mellitus, a family history of glaucoma, or African-Americans age 50 and older. |
20% of the Medicare approved amount after the annual Part B deductible. |
Mammogram Screening:
Once per year. |
All female Medicare beneficiaries age 40 and older. |
20% of the Medicare approved amount with no Part B deductible. |
Medical Nutrition Therapy Services:
Effective January 1, 2002, Medicare will allow payment for medical nutrition therapy service when furnished by a registered dietitian or nutrition professional. |
All Medicare beneficiaries with diabetes or renal disease. |
20% of the Medicare approved amount after the annual Part B deductible. |
Pap Smear and Pelvic Examination:
(Includes a clinical breast exam)
Once per year if you are high risk for cervical or vaginal cancer, or if you are of childbearing age and have had an abnormal Pap smear in the preceding two years. |
All female Medicare beneficiaries. |
No coinsurance and no Part B deductible for the Pap smear (clinical laboratory charge).
For doctor services and all other exams, 20% of the Medicare approved amount with no Part B deductible. |
Prostate Cancer Screening:
- Digital Rectal Examination - Once per year.
- Prostate Specific Antigen (PSA) Test - Once per year.
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All male Medicare beneficiaries age 50 and older. |
Generally, 20% of the Medicare approved amount
after the annual Part B deductible for the Digital Rectal Examination. No coinsurance and no
Part B deductible for the PSA Test. |
Vaccinations:
- Flu Shot - Once per year.
- Pneumococcal Shot - Once may be all you ever need; ask your doctor.
- Hepatitis B Shot - If you are at medium to high risk for hepatitis.
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All Medicare beneficiaries. |
No coinsurance and no Part B deductible for flu or pneumococcal shots if the doctor accepts assignment. For hepatitis B shots, 20% of the Medicare approved amount after the Part B deductible. |
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| Facts & Resources |
March is Colorectal Cancer Awareness Month
Some Important Facts You Should Know about Colorectal Cancer!
- Colorectal cancer is the second leading cancer killer in the United States after lung cancer. Colorectal
cancer (cancer of the colon or rectum) is second only to lung cancer in causing cancer-related deaths in the U.S.
The American Cancer Society estimates that there will be 147,500 new cases and 57,100 deaths from colorectal cancer in
2003.
- More than one-third of colorectal cancer deaths could be avoided if people over 50 had regular screening tests.
- Most colorectal cancers begin as polyps. (Polyps are growths on the inner wall of the colon or rectum.)
- Colorectal cancer starts with no symptoms. Screening tests are so important because they can find colorectal
cancer early, when treatment works best. When colorectal cancer is detected in the earliest stage of the disease
(Stage 1), the survival rate is about 90 percent.
- Colorectal cancer is one of the most preventable cancers. Screening tests can help prevent colorectal cancer by
finding pre-cancerous polyps so they can be removed before they turn into cancer.
- Risk increases as we age. The risk of developing colorectal cancer increases with age. In fact, most cases (90%)
occur in people 50 and older.
- Both men and women are at risk. Some people think that women are not at risk for colorectal cancer. However,
both sexes may develop this cancer.
- Medicare helps pay for colorectal cancer screening tests. People with Medicare Part B coverage who are age 50 or
older are eligible for colorectal cancer screenings. However, in the case of colonoscopy, there is no age limit.
The following screening tests are covered by Medicare:
- Fecal Occult Blood Test (done at home) - Covered once per year. You pay no coinsurance and no
Part B deductible.
- Flexible Sigmoidoscopy* - Covered once every 4 years. You pay 20 percent of the Medicare approved
amount after the yearly Part B deductible.
- Colonoscopy*
High Risk Individuals - If you are at high risk for colorectal cancer, Medicare covers a colonoscopy or a barium
enema every 2 years. You pay 20 percent of the Medicare approved amount after the yearly Part B deductible.
(Your risk is greater if you have a history of inflammatory bowel disease, colorectal cancer, or polyps, and if you
have a family history of colorectal cancer or polyps, or have certain hereditary syndromes.)
Average Risk Individuals - If you are at average risk (i.e., not at high risk) for colorectal cancer,
Medicare will cover a colonoscopy every 10 years. You pay 20 percent of the Medicare approved amount after the yearly
Part B deductible. However, if you are at average risk and have had a covered flexible sigmoidoscopy, you must wait
4 years to be eligible for Medicare coverage of a colonoscopy.
- Barium Enema - This test can substitute for a flexible sigmoidoscopy or for a colonoscopy. You pay
20 percent of the Medicare approved amount after the yearly Part B deductible.
* If colonoscopy or flexible sigmoidoscopy is done in an ambulatory surgical center or hospital
outpatient department, you pay 25 percent of the Medicare approved amount.
Steps You Can Take Now To Protect Your Health
- If you are 50 years old and have not been screened, talk to your doctor about having a screening test for colorectal
cancer. Discuss the screening options that are right for you. Do not wait for symptoms.
- If you have any of the following symptoms, discuss them with your doctor. Only he or she can determine if cancer or
other conditions are causing the symptoms. The symptoms are:
- Blood in or on the stool,
- A change in bowel habits,
- Stools that are narrower than usual,
- General stomach discomfort,
- Frequent gas pains, and
- Unexplained weight loss.
- Visit the Federal Government’s Screen for Life Web site at: www.cdc.gov/cancer/ScreenforLife
for more information about colorectal cancer screening tests.
- Call the Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (TTY/TDD: 1-877-486-2048) to order a
helpful fact sheet called Colorectal Cancer Basic Facts on Screening. Ask for CMS Publication No. 11011. You also
can order the fact sheet from the Centers for Disease Control and Prevention (CDC) by calling their toll-free line at
1-888-842-6355. Ask for CDC Publication No. 996949. The fact sheet has important information about colorectal cancer
and describes the screening tests.
- Call the National Cancer Institute’s Cancer Information Service on 1-800-4-CANCER (TTY 1-800-332-9615) for more
information about colorectal cancer or any other cancer.
- When you visit the doctor, keep the following tips in mind so that you get the most from your visit.
- Do not feel uncomfortable about asking questions. Bring a list of questions with you, and have it handy when you
talk to the doctor.
- Ask about colorectal cancer screening, even if your doctor does not mention it.
- If you do not understand everything your doctor tells you, let him or her know.
- Bring a notepad and write down notes to help you remember important points.
- Ask your doctor for materials on colorectal cancer and other topics that you can read after you leave the office.
Exercise and Its Many Benefits
The American Diabetic Association notes the importance of exercise. They say that it improves the flow of blood through the small blood vessels and increases your heart's pumping power. The right exercise program may make you look and feel better. The American Diabetic Association's Web site at www.diabetes.org provides information on what kinds of exercise are best. Please note that before you begin any exercise program, you should first check with your doctor. Together, you and your doctor can decide how much and what kinds of exercise are right for you.
Facts on Osteoporosis
The National Osteoporosis Foundation provides detailed information on osteoporosis and the individuals which this disease affects. They note that osteoporosis is a major public health threat for more than 28 million Americans, 80 percent of whom are women. They advocate that a comprehensive program that can help prevent osteoporosis includes:
- A balanced diet rich in calcium and vitamin D;
- Weight-bearing exercise;
- A healthy lifestyle with no smoking and limited alcohol intake; and
- Bone density testing and medication when appropriate.
You can visit the National Osteoporosis Foundation's Web site at www.nof.org.
Get the Flu Shot, Not the Flu
The flu (or influenza) can be serious for people over age 65. It can lead to dangerous and costly health problems. Approximately 90% of all flu-related deaths in the United States occur in people age 65 and older. The Centers for Disease Control's Web site, www.cdc.gov, provides information on the importance of vaccination, not just against influenza, but also pneumococcal and hepatitis B.
10 Important Vaccine Facts for Seniors
- Each year up to 60,000 adults, many aged 65 or older, die of infectious diseases that can be prevented, such as flu and pneumococcal infection.
- All people 65 years of age or older should get flu, pneumococcal, and tetanus/diphtheria vaccines. People in certain high-risk groups should get the hepatitis B vaccine.
- Pneumonia and flu together are the 6th leading cause of death in the U.S. Most of these deaths occur in people aged 65 or older.
- Pneumococcal pneumonia is one of the most common types of pneumonia. It often leads to hospitalization.
- Pneumococcal vaccine can prevent up to 60% of serious pneumococcal infections, but it will not protect you from other types of pneumonia.
- You cannot get pneumonia from the vaccine.
- Flu vaccine can prevent up to 70% of hospitalizations and 85% of deaths from flu-related pneumonia.
- Since flu viruses change each year, people should get the new vaccine each year, usually in the fall.
- You cannot get the flu from the vaccine. However, flu vaccine will not protect you from other lung infections, such as colds and bronchitis.
- Because most cases of tetanus and diphtheria occur in adults, ALL adults should receive booster shots every 10 years. People who travel outside of the U.S. should be evaluated for other vaccines that may be necessary.
Prostate Cancer Support Line
The American Cancer Society's Web site, www.cancer.org, provides a wealth of information on cancer, however, they now also have a toll-free support line for patients who have been diagnosed with prostate cancer. This support line, called the Early Support Phone Network, provides information, education, coping skills, and referrals to support groups. Calls will be answered by 60 specially-trained prostate cancer survivors, who will be on call and available by mobile phone. This is a pilot program, and is available to all prostate cancer patients in New York State. To reach the Early Support Phone Network, call 1-800-ASC-2345.
Additional Diet & Nutrition Web Resources
www.mayoclinic.com - This is the Mayo Clinic's food and nutrition site.
www.mealsforyou.com - This site allows you to download thousands of healthful recipes and meal plans.
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