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How Medicare covers preventive healthcare

SAVVY SENIOR

By Jim Miller

Dear Savvy Senior,

How does Medicare cover preventive health screenings? I’m due to get a physical and a colonoscopy this year, but I want to find out what I’ll have to pay for before I go in.

Just Turned 65

Dear Just Turned,

You’ll be happy to know that Medicare covers a wide array of preventive and screening services to help you stay healthy, but not all services are completely covered.

Most of Medicare’s preventive services are available to all beneficiaries (through Part B) completely free with no co-pays or deductibles, as long as you meet basic eligibility standards. Mammograms; colonoscopies; shots against flu, pneumonia, COVID-19 and hepatitis B; screenings for diabetes, depression, osteoporosis, HIV, various cancers and cardiovascular disease; and counseling to combat obesity, alcohol abuse, and smoking are just some of Medicare’s covered services. But to get these services for free, you need to go to a doctor who accepts Medicare “on assignment,” which means he or she has agreed to accept the Medicare approved rate as full payment. Also, the tests are free only if they’re used at specified intervals. For example, cardiovascular screening blood tests once every five years; or colonoscopy once every 10 years or every two years if you’re at high risk.

Medicare also offers a free “Welcome to Medicare” exam with your doctor in your first year, along with annual “Wellness” visits thereafter. But don’t confuse these with full physical exams. These are prevention-focused visits that provide only an overview of your health and medical risk factors and serve as a baseline for future care. 

Cost-sharing

There are a few Medicare preventive services that require some out-of-pocket cost-sharing. You’ll have to pay 20 percent of the cost of the service after you’ve met your $226 Part B yearly deductible. The services that fall under this category include glaucoma tests, diabetes self-management trainings, barium enemas to detect colon cancer, and digital rectal exams to detect prostate cancer. For a complete list of services along with their eligibility requirements, visit Medicare.gov/coverage/preventive-screening-services.

If you’re enrolled in a Medicare Advantage (Part C) plan, your plan is also required to cover the same preventive services as original Medicare as long as you see in-network providers.

You also need to know that while most of the previously listed Medicare services are free, you can be charged for certain diagnostic services or additional tests or procedures related to the preventive service. For example, if your doctor finds and removes a polyp during your preventive care colonoscopy screening, you will pay 15 percent of the doctor’s service fee. Or, if during your annual wellness visit, your doctor needs to investigate or treat a new or existing problem, you’ll probably be charged. You may also have to pay a facility fee depending on where you receive the service. Certain hospitals, for example, will often charge separate facilities fees when you’re receiving a preventive service. And you can also be charged for a doctor’s visit if you meet with a physician before or after the service.

To eliminate billing surprises, talk to your doctor before any preventive service procedure to find out if you may be subject to a charge, and what it would be.  

Jim Miller is a contributor to NBC TV’s “Today.” Send senior questions for him to Savvy Senior, P.O. Box 5443, Norman, OK 73070, or at savvysenior.org.

srmedia by — October 5, 2023 in Health & Fitness
Puyallup Tribe going airborne with Kenmore Air

Members of the Puyallup Tribal Council and Kenmore Air leadership recently touched down at the Puyallup Tribal Air Terminal for the first official seaplane flight into Ruston Way, marking the start of flights from Tacoma’s Commencement Bay.

The first public flights began in August and are continuing at a new seaplane dock positioned between the RAM Restaurant and Brewery at 3001 Ruston Way and the site of the former C.I. Shenanigan’s restaurant. Tickets are on sale at kenmoreair.com.

Tribal Council and Kenmore Air representatives attended a grand-opening that included a blessing, drumming and dancing. Council Chairman Bill Sterud spoke about the significance of the terminal to the tribe’s economic development, and Kenmore Air president David Gudgel shared his thoughts about the seaplane operator’s partnership with the tribe and expansion into the South Sound.

“This is a fun day, a historic day,” Sterud said. “Not to brag, but we like to think big, we like to think out of the box, and you never know where we’re gonna go. We’re going up in the air now.”

Other elected officials at the ceremony included U.S. Rep. Marilyn Strickland, state Sen. Yasmin Trudeau, and Pierce County Executive Bruce Dammeier.

Kenmore Air’s current scenic-flight season will run until Oct. 15, with planes taking passengers on a 20-minute flight over the South Sound. The flights will then resume in April, and flight operations may expand with service to the San Juan Islands and Victoria, B.C., officials said.

Expanded air service would also open the tribe’s casinos and hospitality venues to visitors from British Columbia and beyond. In May 2020, the tribe opened its $400 million Emerald Queen Casino in Tacoma next to Interstate 5 and an accompanying 155-room hotel in December 2021. More recently, the tribe inaugurated sports betting at its Tacoma casino and its EQC location in Fife through a partnership with BetMGM.

srmedia by — October 5, 2023 in Lifestyle, Home, Adventures

Barbara Jenkins became famous when she walked 3,000 miles across America with her new husband. “We were nowhere upon nowhere, but we pushed ahead with the tumbleweeds, spending six days and nights between towns and eating a lot of peanut butter sandwiches,” she says. “We drank out of windmills and camped in waist-high golden grass. Snow drifts in the Rockies were deep and dangerous as we walked on horizontal ice shelves, testing each step to make sure the ground would hold us. A gang out of the Culebra Mountains threatened to kill us. A car was forced off the road in one city and ran into us. I wondered if this was the end. Maybe I was dying. Toward the end of our journey, I had learned I was pregnant. To top it off, I had 200 miles to walk before I reached the Pacific Coast.”

In “So Long as It’s Wild: Standing Strong After My Famous Walk Across America,” Jenkins breaks over 40 years of silence. The couple co-authored the New York Times bestseller “The Walk West” (15 million copies), but now the grandmother offers a platform for discussions around heartache, love, loss, marriage, and fame. She is stepping out from the mountain of the man she followed to find her voice and claim her story.

She is also the subject of “Mother Nature,” a book by her son, Jedidiah Jenkins, scheduled for release in the fall of 2023.

Jenkins lives in Tennessee, where she has served in the administrations of two of the state’s governors and spends some of her time painting and in other creative projects.

srmedia by — October 5, 2023 in Lifestyle, Home, Adventures
Three shots at not getting sick

The national Centers for Disease Control (CDC) recommends getting vaccinated against flu by October and getting the latest anti-COVID shot. And for the first time, vaccines are available for RSV – another anticipated virus to contend with this year.

To help make that happen locally, information on where and how to get a flu shot and other vaccinations is available from the Tacoma-Pierce County Health Department (tpchd.org, 253-649-1500), Seattle-King County Public Health (kingcountywa.gov, 206-296-4774), the Washington Department of Health (doh.wa.gov, 800-525-0127), and vaccines.gov,a CDC-hosted website.

Here’s what else to know:

Flu.

Anyone can get sick with flu, some worse than others. People with the highest risk of severe illness include those 65 and older, children younger than 5, and pregnant women. Adults with asthma, heart disease, diabetes, and chronic kidney disease also are high-risk. Medical experts say a flu shot is the best way to avoid getting the fever, cough, sore throat, and achiness that comes with the bug. The CDC and other health authorities note the potential spread of flu will likely increase in October, peak between December and January, and continue into next May. And while getting a shot early in the flu season is best, it’s not too late to do it later in the season.

RSV.

Respiratory syncytial virus, or RSV, is a common virus that affects lungs and makes breathing difficult. It’s more common in the spring and fall. While people of all ages can get it, the virus is worse for children under 5 years old and older adults, especially ones in poor health. The CDC has reported that RSV causes approximately 160,000 hospitalizations and 10,000 deaths among adults 60 and older every year, and the agency recommends that older adults receive the RSV vaccination.

COVID.

A new CDC-recommended COVID-19 vaccine is expected to be widely available this fall. One dose of the 2023-24 Moderna or Pfizer vaccines are urged for virtually all ages, starting at 6 months old. An alternative vaccine, Novavax, is offered for anyone unable or unwilling to go with Moderna or Pfizer. While hospitalizations and deaths due to COVID-19 are low compared to the height of the pandemic, the virus still exists and could, like other viruses, spread this fall and winter as people spend more time indoors with others. Most people can be vaccinated for free, and if there is a cost, consumers with health insurance can have it covered through their plans.

Private medical and healthcare providers, plus pharmacies such as CVS, provide vaccinations.

Influenza claims lives annually. The 2022-23 flu season ended with 261 deaths statewide attributed to flu, according to the state Department of Health. Of those, 35 were reported in Pierce County and 57 in King County.

srmedia by — September 25, 2023 in Spotlight