10 Surprising Benefits Every Medicare Beneficiary Should Know About
Medicare Part B helps cover a wide range of medical costs for people age 65 years or older and people younger than 65 who have certain disabilities or medical conditions.
What you may not know, however, is that Medicare Part B covers a number of preventive services and screenings to help ensure beneficiaries receive the support and care they need to stay healthy and live a healthy lifestyle.
Below we examine 10 Medicare benefits that are often overlooked.
1. Welcome to Medicare Visit
The Welcome to Medicare Visit is a one-time preventive visit available to people who are enrolled in Medicare Part B. 1 You must schedule your Welcome to Medicare Visit within the first 12 months of your Part B enrollment to be eligible.
During your Welcome to Medicare Visit, your doctor will likely:
- Evaluate and record your medical history, current health conditions, and any prescriptions you’re taking
- Check your blood pressure, vision, height, and weight
- Ensure you’re up-to-date on preventive screenings and shots
- Order further tests if necessary*
Original Medicare covers the Welcome to Medicare Visit at 100% of the Medicare-approved amount when you receive the services from a participating provider.
*Additional testing may fall outside of the scope of the Welcome to Medicare Visit and there may be out-of-pocket costs associated with such tests.
2. Annual Wellness Visit
Unlike the Welcome to Medicare visit (which only occurs once), the Annual Wellness visit is a yearly appointment with your primary care physician where the two of you create or update your personalized health care plan.
Some services you may receive at your Annual Wellness Visit may include:
- Certain screenings and shots
- Height, weight and blood pressure measurements
- Vision test
- Body mass index calculation
Typically, Medicare Part B covers the Medicare Annual Wellness Visit at 100% if you’ve been enrolled in Part B for 12 months or longer and you have not received an Annual Wellness Visit within the past 12 months.
You cannot receive your Annual Wellness Visit the same year as your Welcome to Medicare Visit.
3. Alcohol Misuse Screening and Counseling
Medicare Part B covers an annual alcohol misuse screening to help identify, manage and treat alcohol misuse. You do not have to show signs of alcohol misuse to be eligible for a yearly screening. However, your primary care physician must determine that you’re misusing alcohol for you to be eligible for alcohol misuse counseling.
If your primary care physician determines that you’re misusing alcohol, Medicare Part B typically covers 4 brief face-to-face alcohol misuse counseling sessions per year. 2
Mammograms help detect early breast cancer in women who show no signs of the disease.
Medicare Part B typically covers yearly mammograms for women age 40 and older, and one baseline mammogram for women between the ages of 35 and 39. 3
Medicare Part B also typically covers diagnostic mammograms that are considered medically necessary by a doctor.
Annual mammograms for women age 40 and over are 100% covered by Medicare Part B as long as your health care provider accepts Medicare.
Diagnostic mammograms usually require you to meet your Part B deductible before Medicare will pay it share for the service. Once your deductible is met, you’re typically responsible for 20% of the Medicare-approved amount for your mammogram.
5. Depression Screening
Medicare covers one depression screening per year for individuals who are enrolled in Medicare Part B. The screening must occur in a primary care setting that can provide follow-up treatment and/or referrals. You do not have to show signs or symptoms of depression to qualify for a depression screening,
If you’re enrolled in Medicare Part B and your doctor accepts Medicare assignment, your yearly depression screening is covered 100% by Medicare. 4
6. Glaucoma Tests
Medicare does not typically cover routine eye care services. However, Medicare Part B will cover certain eye care services if you have a chronic eye condition such as glaucoma.
Medicare Part B covers one glaucoma test every 12 months for people at high risk for the condition. 5 Some examples of people who may be considered high risk for glaucoma include:
- People with a family history of glaucoma
- People with diabetes
- African American people who are age 50 or older
- Hispanic people who are 65 or older
Before Medicare Part B will pay its share for your glaucoma test, you must meet your Part B deductible ($183 per year in 2018). 6 Once you meet your Part B deductible, Medicare will pay 80% of the Medicare-approved amount for your glaucoma test and you’ll pay 20%.
7. Bone Density Tests
Medicare Part B covers one bone density test every 24 months for people who meet the criteria listed below. 7
- A person whose x-rays show possible osteoporosis, osteopenia or vertebral fractures
- A woman whose doctor determines she is estrogen deficient AND at risk for osteoporosis
- A person who has been diagnosed with primary hyperparathyroidism
- A person taking prednisone or steroid-type drugs or is planning to begin this treatment
- A person who is being monitored to see if their osteoporosis drug therapy is working
If your doctor or other health care provider accepts Medicare assignment and you meet the above qualifications, Medicare Part B covers your bone density test 100%.
8. Weight Loss Counseling
Medicare Part B may cover weight loss counseling for people who have a body mass index of 30 or higher. In order for Medicare Part B to cover your weight loss counseling, you must get it in a primary care setting (such as a doctor’s office).
Once your doctor diagnoses you as obese, Medicare Part B typically covers: 8
- One face-to-face visit per week for the first month
- One face-to-face visit every other week for the next five months
9. Nutrition Therapy
Medicare Part B covers some medical nutrition therapy services, which can include:
- An initial nutrition and lifestyle assessment
- Individual and group nutrition therapy services
- Follow-up visits to check on your progress in managing your diet
Typically, Medicare part B covers nutrition therapy for people who:
- Have kidney disease
- Have had a kidney transplant in the last 36 months
- Have diabetes
People with Medicare Part B must get a referral from their primary care physician for medical nutrition therapy. 9
10. Tobacco Cessation Counseling
Tobacco cessation counseling helps smokers and tobacco users determine their triggers and figure out how to avoid or cope with them in healthy ways.
Medicare Part B covers up to 8 face-to-face counseling sessions per year to help people stop smoking or using tobacco products.
If you qualify, Medicare Part B covers smoking cessation counseling at 100% of the Medicare-approved amount (if your doctor accepts Medicare assignment). 10
Know Your Medicare Costs
Original Medicare covers many different hospital and medical services, but it leaves some out of pocket costs to you. Some of the costs you can expect to pay for your Medicare coverage include: 11
Deductibles are what you must pay out of pocket before Medicare begins paying its share for covered services.
In 2018, the Medicare Part A deductible is $1,340 per benefit period, and the Medicare Part B deductible is $183 per year.
Coinsurance is the percentage you pay for covered services once your deductible is met.
In 2018, the Medicare Part A coinsurance amounts are as follows:
- $0 for days 1-60 spent in a hospital
- $335 per day of each benefit period for days 61-90
- $670 per each “lifetime reserve day” after day 90
- 100% of costs once lifetime reserve days* are used up
* Lifetime reserve days are additional days that Part A will pay for if you’re in the hospital for more than 90 days during a single benefit period. Medicare beneficiaries are limited to a total of 60 lifetime reserve days over the course of their life.
In 2018, the Medicare Part B coinsurance is typically 20% of the Medicare-approved amount for most doctor’s services.
Medigap Helps Cover Some Of These Costs
Medicare Supplement Insurance (Medigap) helps cover some of your Medicare out-of-pocket costs. There are 10 standardized Medigap plan options in most states, labeled A, B, C, D, F, G, K, L, M and N.
All 10 Medigap plans provide at least partial coverage for:
- Medicare Part A coinsurance and hospital costs
- Medicare Part B coinsurance or copayment
- First 3 pints of blood
- Medicare Part A hospice care coinsurance or copayment
Beyond these 4 benefits, each Medigap plan may provide a combination of up to 5 additional benefits. Medigap Plan F is the most comprehensive Medigap plan and the only Medigap plan that provides coverage for all 9 benefit areas.
Find a Plan
Speak with a licensed insurance agent to find Medicare Supplement Insurance plans in your area and to enroll in a plan that works for you.
Compare Medicare Supplement plan costs in your area.
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