What is Preventive Care?

Preventive care is exactly what the name suggests. It is care provided to you that prevents disease, illnesses, and injuries. It is accomplished through various health and wellness treatments and interventions; all to keep you healthy in mind, body, and spirit. Medicare Part B (medical) provides coverage for many preventive services, such as vaccines, screenings, and counseling. If you meet the requirements for eligibility and guidelines for preventive services, you must be allowed to receive the service. This is the case for both Medicare Advantage plans and Original Medicare. ***Note: Your plan’s coverage rules may apply.

The Role of Primary Care Physicians

Your primary care physician (PCP) is an essential part of your healthcare delivery. They are often the first point of contact with other parts of the healthcare system. They eventually foster long-term relationships with their patients which becomes the foundation of your interactions with the healthcare system.

As the first point of entry into the healthcare system, primary care doctors are normally the first to detect disease and offer an early intervention when conditions, injuries, or illnesses are discovered. This adds to a better quality of life for their patients and offers them a preventive approach to their care.

For seniors, primary care goes way beyond just treating and managing illnesses; it comprises a holistic approach to healthcare management that includes each aspect of health and wellness and prevents conditions and illnesses from developing in the first place. Primary care doctors are normally the first to notice any changes in a senior patient’s physical and mental health, providing a special opportunity to intervene when the illness or condition is easier to manage.

Personalized care plans, routine check-ups, and continuous monitoring and evaluation are all important parts of primary care. Primary care physicians also initiate the collaboration of specialized care, making sure senior patients receive comprehensive treatment designed to their evolving health needs.

The Importance of Early Detection and Intervention

As most doctors are already aware, early discovery and intervention can impact the health of any senior patient profoundly. For older adult patients especially, this can mean being able to manage an illness or condition that majorly impairs their quality of life. Some of the essential benefits of early detection and intervention include:

• Stopping or slowing the progression of chronic diseases
• Reducing healthcare costs by avoiding expensive or long-term treatments
• Increased independence and improved quality of life
• Better state of mental health through improved quality of life and cognitive impairments are severely reduced.
• Prevention of complications caused by comorbid conditions.

While preventive care is usually viewed as preventing illnesses, it can also involve preventing complications from conditions or illnesses that inevitably occur. Early detection and intervention are both forms of preventive care and preventive medicine that prevent complications from delaying diagnosis or treatment.

Key Strategies for Early Detection and Intervention

While most doctors recognize the benefits of practicing detection, prevention, intervention, and adopting strategies that help us to understand these benefits are as equally important. Regular screenings and assessments designed to each patient’s risk factors and age are

While most clinicians recognize the benefits of early disease detection and intervention, adopting strategies that help realize these benefits is equally important. Regular screenings and assessments tailored to each patient’s age and risk factors are foundational. These include screenings for high blood pressure, osteoporosis, cancer, diabetes, and cognitive function.

Important strategies that all providers should consider include:

• Performing comprehensive annual wellness visits for every patient
• Integrating evidence-based screening tools into each patient’s visit
• Improving accessibility to healthcare through tools like online messaging portals and telehealth.
• Ensuring adherence to age-related screening recommendations, like mammograms and colonoscopies.
• Keeping up to date on recent advances in screening tools and engaging with continuous education relating to senior care.

Coverage: When Does Medicare provide coverage for preventive care?

Original Medicare

Most preventive services are covered 100% of the Medicare-approved amount by Original Medicare when you get the treatment from a participating provider. This means you have no copay or deductible.

• You might be charged the Original Medicare cost-sharing for certain preventive services.
• You might be charged if you see an opt-out or non-participating provider.
  • Doctors and other healthcare practitioners who have decided to not enroll in the Medicare program may “opt out” or they can also decide to not participate in Medicare (they don’t take Medicare).

Medicare Advantage

• Medicare Advantage uses the networking system. When visiting an in-network provider, you are not charged anything for preventive services that are covered with a $0 cost-sharing by Original Medicare. This means the Medicare Advantage plans are mandated to cover the cost of your care without charging copayments, coinsurance, or deductibles, as long as you have met Original Medicare’s eligibility requirements for the service.
• Medicare Advantage Plans may charge you for preventive services not covered by Original Medicare with $0 cost-sharing.
• You may be charged if you visit an out-of-network provider.

Diagnostic Care

Throughout receiving your preventive care, your doctor may find and need to examine or treat a new or existing problem. This additional care is considered diagnostic. This means your doctor is treating you due to specific symptoms or risk factors. You may get a bill from Medicare for any diagnostic care that you get during a preventive care visit.

You may have expenses from some preventive services if your physician makes a diagnosis during the treatment or decides to do more tests or procedures.

Services Original Medicare Covers Without a Deductible or Coinsurance

1. ABDOMINAL AORTIC ANEURYSM (AAA SCREENING)

Abdominal aortic aneurysm (AAA) is where the aorta is ballooning. The aorta is a large blood vessel that supplies blood throughout the body. When left untreated, the aorta can rupture causing life-threatening internal bleeding. AAA screening can help in determining if you need to be treated.

A one-time ultrasound is covered by Medicare Part B (medical) to determine if you are at risk for AAA and receive a specialist referral from your doctor.

***Note: Bear in mind that you can only receive one AAA ultrasound per lifetime.

2. ALCOHOL MISUSE SCREENING AND COUNSELING

Alcohol misuse refers to unhealthy drinking habits which can be a problem but does not yet meet the DSM Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) requirements for alcohol dependency. Counseling and screening can help identify, manage, and treat alcohol misuse.

Original Medicare Part B covers a once-per-year alcohol misuse screening.

You don’t have to show symptoms or signs of alcohol misuse to get screening. However, Original Medicare only covers counseling afterward if your PCP (Primary care physician) or psychiatrist determines that you are misusing alcohol.

Medicare Advantage

Medicare Advantage plans are approved by Medicare and are sold by private insurance companies. In most if not all of the cases, physicians must be in the plan’s network, and most of these plans cover counseling, and other additional benefits such as hearing, dental, and vision, as well as gym memberships, OTC cards, etc. Under the Medicare Advantage Plan, people have HMOs, PPOs, Private Fee-for-Service Plans (PFFS), and Special Needs Plan (SNP) options.

Annual Wellness Visit (AWV)

The AWV is an annual appointment with your primary care physician (PCP) or an update to your personalized prevention plan. Your treatment plan may aid in preventing illnesses based on your current health status and risk factors.

With Original Medicare, keep in mind, that this annual appointment is not a head-to-toe physical. Also, this service is similar to the one-time Welcome to Medicare preventive appointment.

Original Medicare Part B provides coverage for the Annual Wellness Visit if you have been enrolled for more than 12 months and you have not received your Annual Wellness Visit in the last year. Plus, you can’t get your Annual Wellness Visit within the same year as your Welcome to Medicare preventive visit.

Medicare Advantage and Annual Physical Checkup

• Medicare Advantage covers the Welcome to Medicare Visit/Initial Preventive Physical Examination (IPPE)
• Annual Wellness Visit (AWV)
• Annual Physical Exam

BODY MASS INDEX SCREENING AND BEHAVIORAL COUNSELING

Body mass index (BMI) is a measurement of your body fat. BMI screenings and follow-up behavioral counseling can help you lose body fat if your BMI” is high.

Original Medicare Part B covers BMI screenings and behavioral counseling to help you get the excess weight off if you are obese. If you have a BMI of 30 or more you are considered obese.

BONE MASS MEASUREMENTS

Measuring your bone mass helps determine if you have osteoporosis and need treatment. Osteoporosis is a condition where the person’s bones have become brittle. It primarily affects seniors.

Original Medicare and Medicare Advantage cover bone mass measurements every two years if you are considered at risk for osteoporosis. You will need a referral from your primary care physician.

***Disclaimer: A Senior Healthcare medical specialist has reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.