Many people on Medicare may not realize that a wide range of preventive benefits, including screenings and counseling sessions, are free of charge. Another complimentary benefit is the SilverSneakers exercise program, which is available through more than 65 major plans across the United States.
While most seniors heave a huge sigh of relief when they finally qualify for Medicare at age 65, many are unaware of another special bonus: Medicare Part B offers a wide range of preventive benefits, many of which are completely free of charge—thanks to the Affordable Care Act. Free benefits include screenings and counseling sessions.
The services below are just a few items on the long list of Medicare’s preventive benefits:
- Flu, pneumonia and hepatitis B shots
- Mammograms
- Colonoscopies
- Screening for diabetes, depression and heart conditions
- Counseling to combat obesity, alcohol abuse and smoking
Most of the screenings and tests are free, but some require a copay. For example, for alcohol abuse, one screening and up to four counseling sessions a year are free. Also, there’s no charge for a screening for depression once a year in a primary-care setting—but for a doctor visit and follow-up care, there’s a copay. For colorectal cancer screening, the colonoscopy is free, but a copay is required if a polyp is removed during the test.
In a Nutshell
Because what is free and what requires a copay can be confusing, several resources are available to sort this out. Medicare for Dummies creates a useful chart that lists the preventive services, their frequency covered and cost, if any. Medicare.gov, the official U.S. site for Medicare, contains even more detailed descriptions of the preventive services, along with links to additional resources and information. The website also has helpful explanations and recommendations: for instance, what to do if your doctor or other healthcare provider recommends that you get services more often than Medicare covers, or services that Medicare doesn’t cover. If this happens, you should ask your doctor why you need the additional screenings or services, because you may have to pay some or all of the costs.
Medicare’s easy-to-use interactive site also has a box labeled “Is my test, item or service covered?” You can type in the service in question and get all the details. For those not certain of the type of service, you can click on an item in a listing of services below the box.
Medicare’s Wellness Visit
Since January 1, 2015, Medicare has initiated an annual wellness visit as a new benefit, paying doctors to perform this free service for patients. This appointment is different than the Welcome to Medicare visit, which is an introductory appointment available only within the first 12 months you have Part B. This initial visit includes a review of your medical and social history related to your health and education, and counseling about preventive services, including screenings, shots and referrals for other care. (For a more complete list of the services offered at Welcome to Medicare session, see Medicare.gov.)
Don’t confuse the Welcome to Medicare or the annual wellness visit with a traditional physical. The wellness visit is a sit-down talk with your healthcare provider about your medical and surgical history and your family medical history. A doctor, nurse, nurse practitioner or physician assistant may take your blood pressure, measure your height and weight, and listen to your heart through your clothes, but that’s about the extent of physical contact. The purpose of the visit is to establish a baseline of your current health, investigate possible problems and establish wellness practices and preventive goals.
The healthcare provider will also ask about any illnesses, hospital stays, operations, allergies, injuries and treatments; use or exposure to medications and supplements, including calcium and vitamins; and medical events of your parents, siblings and children, including diseases that may be hereditary or place you at increased risk. From this information, you will be given personalized health advice, a list of risk factors and treatment options and a screening schedule (like a checklist) for appropriate preventive services.
Don’t accidentally make an appointment for a traditional physical exam, expecting the free wellness or Welcome to Medicare session. A physical could cost you anywhere from $70 to $400, depending on your health provider and insurance plan. Make sure you ask for the free Medicare wellness visit with the billing code G0438. For more information on the wellness visit, go to Medicare.gov/welcome, or call 1-800-MEDICARE (1-800-633-4227).
SilverSneakers Exercise Program
One of Medicare’s most valuable and far-reaching benefits is SilverSneakers Fitness. Not just an exercise program, it’s also a venue that fosters social interaction, healthy aging and all-around well-being.
Unfortunately, not all Medicare recipients qualify for the program, but more than 65 major plans across the United States offer this active-adult wellness program. According to the SilverSneakers website, 1 in 5 people 65 and older—more than 12 million people—are eligible for membership. Some 13,000 facilities across the U.S. offer the program, and, best of all, it’s free. Once you enroll in SilverSneakers and get a membership card, there is no copay.
Group retirees or those with the Medicare Advantage or Medicare Supplement Health plan may already have a Healthways SilverSneakers membership, as it’s officially known. To find out if your health plan offers the SilverSneakersFitness program, visit the health plan locator.
Different states have different plans that include SilverSneakers membership. For instance, in Colorado the following plans qualify for SilverSneakers: AARP Medicare Supplement Insurance Plan, Aetna Medicare, Humana, Kaiser Permanente of Colorado and United Health Care. In several cities, program members can attend drop-in classes at city recreation centers, the YMCA, Curves and 24-Hour Fitness, as well as other community and private recreation centers and gyms.
Success Stories
Whether you are recovering from a major illness or just trying to stay in good physical shape, SilverSneakers can offer assistance and has an inventory of success stories on its website.
Diagnosed with stage IV breast cancer in 2012, Sandy Eberle attended SilverSneakers classes during chemo to distract her from the cancer and its treatment and also to give her an incentive to be active each day. SilverSneakers classes eventually replaced her physical therapy sessions after her mastectomy, and her oncologist was amazed by her progress. In April 2013, she went into remission. Her SilverSneakers classmates became her second family and encouraged her to continue to stay in shape, with the bonus of a social group to enjoy after class.
Active his whole life, Peter Eisenklam was shocked when he developed a heart virus at age 62, and his doctor confined him to his couch. This diagnosis prompted him to get second and third opinions from other cardiac specialists, and Eisenklam found one who encouraged him to continue an exercise program. A natural-born swimmer, he was not only back in the pool at the YMCA five months after his diagnosis, but he began competing in the U.S. Masters Swimming at the Arizona Senior games, literally blowing the term "cardiac patient" out of the water. He remarks, “It’s really not about winning. It’s the energy I’m addicted to . . . the energy of seeing 'older' people still going for it. The energy of feeling connected with people.”
Medicare Offers Many Free Preventative Benefits was featured in the December 2015 Senior Spirit Newsletter.
Blog posting provided by Society of Certified Senior Advisors
