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New Medicare benefits in 2005
By Margie Ware, Regional Shine DirectorStarting on January 1, 2005, Medicare now covers new preventive benefits including a “Welcome to Medicare Physical” exam, cholesterol and blood lipid screening tests, diabetes screening tests, and services for beneficiaries who are at high risk for diabetes. Medicare will also cover a one-time hospice consultation for terminally ill beneficiaries who are not yet using the hospice benefit.
With the “Welcome to Medicare Physical” exam, all new Medicare Part B beneficiaries, both those younger than 65 and those older than 65, are eligible to receive an initial preventive physical examination within the first six months of enrollment in Medicare Part B. A physician, physician assistant, nurse practitioner, or clinical nurse specialist must perform the physical. The exam includes measurement of height, weight, and blood pressure and an electrocardiogram. It also includes education, counseling and referral for other preventive services covered by Medicare. However the physical exam benefit does not cover payment for lab tests.
Services included in the initial preventive physical exam are subject to the Medicare Part B deductible ($110 for 2005) and coinsurance payments (20 percent).
Blood Screening Tests for Cardiovascular Disease, also new, promotes early detection of cardiovascular disease among people not yet showing signs or symptoms by providing cholesterol and blood lipid screening tests once every two years. The tests are at no cost to beneficiaries when ordered by their physician, and they are not subject to the Part B deductible or co-payments.
The screening tests include a cholesterol test to measure the beneficiary’s total cholesterol level, HDL cholesterol level, and triglyceride level, and are performed after a 12-hour fasting period. Other blood tests used to detect signs of an elevated risk for cardiovascular disease may be covered pending Medicare approval.
Diabetes screening tests and services for those at high risk for diabetes will help promote early detection of this disease. All Medicare beneficiaries identified as ‘high-risk’ for diabetes will be able to receive screening tests up to two times per year. The tests are free to beneficiaries who have a referral from a physician, physician assistant, nurse practitioner, or clinical nurse specialist and are not subject to the Part B deductible or co-payments. See your Medicare 2005 book for further information regarding “high risk” qualifications.
The Hospice Consultation will cover a one-time hospice consultation for beneficiaries who are terminally ill and not yet using the hospice benefit. During the consultation, the physician, who must be either a hospice medical director or an employee of a hospice program, will evaluate a beneficiary’s pain and symptom management needs, provide counseling regarding end-of-life issues and care options, and advise the individual on advanced care planning.
The SHINE program, Serving Health Information Needs of Elders, provides free, confidential and unbiased health insurance counseling for Medicare beneficiaries. To reach a trained and certified counselor in your area, contact Elder Services at 413-499-0524 or 1-800-544-5242.
Information for this article was based on the booklet, “Upcoming Changes to Medicare and the Guide to Medicare Preventative Services Center.” We also thank Lorraine York-Edberg, Director of the Franklin-Hampshire SHINE program, for her work in assembling this material.
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