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V I E W P O I N T
Medicare's Preventive Care Benefits Would
Improve with Health Care Reform
There is a growing awareness of the importance of preventive services in the early detection of health problems and of risk factors for future problems. Congress has expanded Medicare coverage of preventive services in recent years and is currently considering health care reform legislation that would enhance Medicare by eliminating beneficiary cost-sharing for preventive services.
Medicare Coverage of Preventive Services
Under current law, Medicare provides coverage for the following preventive services: abdominal aortic aneurysm screening, bone mass measurement, cardiovascular screenings, colorectal cancer screenings, diabetes screenings, diabetes self-management, flu shots, glaucoma tests, hepatitis B shots, screening mammograms, medical nutrition therapy services, Pap tests and pelvic exams, one-time "Welcome to Medicare" physical exams, pneumococcal shots, prostate cancer screenings and smoking cessation counseling.
However, beneficiary cost sharing for preventive services varies greatly. Some services are covered 100 percent; others are covered at 80 percent with the beneficiary paying 20 percent. In some cases, the annual Part B deductible must be met before Medicare pays its share; in other cases, Medicare pays even if the beneficiary has not met the Part B deductible. For example, Medicare covers 100 percent of the Medicare-approved amount for diabetes screenings, flu and pneumonia shots; and beneficiaries are not required to pay the Part B deductible. For screening mammograms, Medicare pays 80 percent of the Medicare-approved amount; beneficiaries have a 20 percent copayment but they are not required to have met the Part B deductible. However for bone mass measurements, Medicare pays 80 percent of the Medicare-approved amount only if beneficiaries have met the Part B deductible.
Medicare Improvement for Patients and Providers Act
In 2008, Congress passed the Medicare Improvement for Patients and Providers Act (MIPPA), which makes some improvements in preventive services benefits. This legislation waives the deductible for the "Welcome to Medicare" initial preventive exam and extends the eligibility period for the exam from six months to one year after enrollment in Part B. In addition, MIPPA makes it easier for the Secretary of Health and Human Services to add coverage for new preventive services if they are recommended by the U.S. Preventive Services Task Force and will aide in the prevention or early detection of an illness or disability.
Health Care Reform Proposals
The health care reform bills now being considered in the House of Representatives and the Senate would make further improvements to Medicare's preventive services benefits.
H.R. 3200, America’s Affordable Health Choices Act, which is being considered in the House of Representatives, includes a provision to improve the Medicare program by waiving deductible and coinsurance for Medicare-covered preventive benefits, as of January 1, 2011. This means that these services would not require any out-of-pocket payments from beneficiaries. The legislation also provides Medicare coverage for all federally-recommended vaccines, as of January 1, 2010.
The Senate Finance Committee is drafting health care reform legislation that is expected to include provisions regarding prevention and wellness programs for Medicare beneficiaries including limiting or removing the deductible and copayments for most preventive services. The Committee is also considering proposals to provide a Wellness Visit in Medicare every 5 years that includes development of a Personalized Prevention Plan, and to provide incentives to encourage healthy behaviors such as refunding costs associated with successfully completing programs like weight loss or smoking cessation.
NATIONAL COMMITTEE POSITION
- The National Committee supports provisions in health care reform legislation that will enhance Medicare benefits by eliminating out-of-pocket costs for preventive services. This will encourage seniors to maintain a routine schedule of physician visits, identifying health issues while they are manageable and improving their health status.
- The National Committee also believes that routine dental, vision and hearing services are very important to older adults and should be covered more extensively in Medicare.
Government Relations and Policy, October 2009
The National Committee is a nonprofit, nonpartisan organization that acts in the interests of its membership through advocacy, education, services, grassroots efforts and the leadership of the board of directors and professional staff. The work of the National Committee is directed toward developing a secure retirement for all Americans.