January 5, 1998
New Medicare preventative benefits
Mammograms: As of Jan. 1, 1998, Medicare coverage will be expanded to include annual screening mammograms for all women age 40 and over. Medicare will also cover a one-time initial, or baseline, mammogram for women age 35-39. Beneficiaries will pay the usual 20 percent copayment for mammograms, but Medicare will pay the other 80 percent even if the beneficiary has not yet met their annual deductible.
In the past, Medicare covered annual screening mammograms for women age 50-64, and for women age 40-49 at high risk of breast cancer. Screening mammograms for women age 40-49 at normal risk and women age 65 and over were covered only every 2 years, and one baseline mammogram was covered for women age 35-39. Beneficiaries paid both 20 percent coinsurance and any unmet portion of their deductible.
Pap Smears: As of Jan.1, 1998, Medicare coverage will be expanded for a screening pap smear to include both a pelvic exam and clinical breast exam every 3 years for most women. The exams are covered every year for women at high risk of cervical or vaginal cancer; those of childbearing age who have had an indication of cervical or vaginal cancer; and, those who have had an abnormal pap smear during the preceding 3 years. Medicare will pay the full claim for the pap smear, and 80 percent of the claim for the pelvic and clinical exams, even if the beneficiary has not yet met their annual deductible.
In the past, screening pap smears were covered every 3 years (or more often for women at high risk for cervical cancer). The accompanying pelvic exam and/or clinical breast exam were not covered. Beneficiaries will continue to pay no coinsurance or the Part B deductible for any clinical laboratory tests, including pap smears.
Colorectal Cancer: As of Jan. 1, 1998, Medicare will cover colorectal cancer screening. This coverage includes fecal-occult blood tests, flexible sigmoidoscopy, colonoscopy (for people at high risk for colorectal cancer), and in certain cases, barium ememas. Each of these tests are covered under different circumstances, so patients should check with their physician to determine what is best for them. In the past, these tests were covered only when a physician already suspected the patient had cancer or other disease, and was using them for diagnostic, rather than screening purposes.
Glucose Monitoring for Diabetics: As of July 1, 1998, Medicare beneficiaries with diabetes, whether or not they use insulin, will have coverage for blood glucose monitors and testing strips so they can monitor their own blood glucose levels. Diabetics who keep their blood glucose levels within the normal range reduce the risk of complications, such as blindness and amputations that are associated with uncontrolled diabetes. In the past, Medicare covered blood glucose monitors and testing strips only for insulin-dependent diabetics.
Diabetes Education: As of July 1, 1998, Medicare will cover a wider range of education and training programs to help teach diabetics to control their blood glucose levels. These training programs do not have to be based in hospitals. A physician must certify that a patient needs the service under a comprehensive plan of care. In the past, Medicare covered only education and training furnished by hospital-based programs.
Bone Mass Measurement: As of July 1, 1998, Medicare will cover bone density measurement for beneficiaries at risk for osteoporosis and other bone abnormalities. Beneficiaries should consult with their doctors about whether and when they might need one of these tests. In the past, bone mass measurement coverage was decided by the many regional contractors that process Medicare claims, resulting in wide variation across the country. The new law makes sure that all beneficiaries who need this testing, no matter where they live, will be covered.
Flu and Pneumococcal Vaccination Program: Medicare's existing flu and pneumococcal vaccine outreach program will continue through the year 2002. This program is a joint effort by Medicare, the Centers for Disease Control and the National Coalition for Adult Immunization. Medicare has covered flu shots since 1993. Thanks to the outreach program, Medicare has already met and is now working to exceed the Department of Health and Human Services' goal of having 60 percent of all senior citizens immunized by the year 2000.