Here is an update on preventive services that are paid for by Medicare. This press release is written by David Sayen,  Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories.

You may have heard something lately about “preventive health care.” What does that mean, exactly?

At its most basic level, preventive health care means living a healthy lifestyle. Eat a balanced diet. Exercise regularly. Maintain a healthy weight. And stop smoking.

People with Medicare can benefit from these healthy living habits as much as anyone. But Medicare also covers a wide variety of screenings and tests to help detect preventable and chronic diseases early, when they’re at their most treatable and curable stages.

The federal health reform law made significant improvements to Medicare’s preventive health benefits by eliminating cost-sharing requirements for many of them. The idea was to encourage people with Medicare to get more preventive screenings and counseling to help them lead healthier and longer lives.

For example, there are no longer any out-of-pocket expenses when you get a “Welcome to Medicare” physical exam. This one-time exam is offered during the first 12 months after you’ve enrolled in Medicare Part B.

During the exam, your doctor will record your medical history and check your height, weight, and blood pressure. He or she will also calculate your body mass index, give you a simple vision test, and give you advice on preventing disease and staying healthy.

In addition, the health reform law makes it possible for people with Medicate to get a free annual wellness exam.

When you get this exam, your doctor will go over your medical and family history and develop or update a personalized prevention plan for you. Your doctor also will check for any cognitive impairment and risk factors for depression, and review your functional ability and level of safety.

During the first two months of this year, more than 150,000 people with Medicare got a wellness exam.

Medicare also covers shots for flu, pneumococcal disease (which can cause pneumonia and meningitis), and Hepatitis B. Flu, pneumococcal infections, and Hepatitis B can be life threatening for older people, and we recommend that all people over age 65 get flu and pneumococcal shots. Most people only need the pneumococcal vaccine once in their lifetime.

And remember: these shots are free for Medicare beneficiaries.

Beneficiaries also can get screened for cardiovascular disease and for several kinds of cancer, including breast, prostate, cervical/vaginal, and colorectal cancer.

Take colorectal cancer, for example. This type of cancer is usually found in people age 50 and older and the risk of getting it increases with age.

Medicare covers screening tests to help find pre-cancerous polyps, which are growths in the colon, so they can be removed before they turn cancerous. Medicare will pay for a fecal occult blood test, a flexible sigmoidoscopy, a screening colonoscopy, or a barium enema.

Medicare beneficiaries pay nothing for fecal occult blood tests. And they pay nothing for the flexible sigmoidoscopy and the screening colonoscopy, if their doctor accepts the Medicare-approved payment amount.

Diabetes is a big problem in this country and Medicare covers screening for people at risk for the disease. For people who have diabetes, Medicare covers certain supplies and educational training to help them manage it.

If you need help to stop smoking, Medicare pays for up to eight face-to-face counseling sessions per year with a doctor or other Medicare-recognized practitioner.

Medicare also help pay for tests for glaucoma, HIV, and osteoporosis (brittleness that places people at risk for broken bones).

The truth is that Medicare beneficiaries don’t use these preventive health services as much as they should. But getting screened can help them stay healthy and live longer – and save the government billions in healthcare costs.

It’s a classic win-win.

One of the suggestions for saving Medicare is to raise the eligibility age to 67 or 68 – or higher. This reminded me of a blog post I wrote in April, 2010.

Originally posted on April 21, 2010:

I hit the trifecta this week by meeting three women who will turn 65 in July.  All three of them told me they had been without health insurance for many years. They are thrilled to be turning 65 -  so they can get on Medicare.

Linda told me that she and her husband have spent most of their retirement savings on her medical bills over the last ten years.  Karen said she has had pain in her left leg for quite a while, and she worries about what  a doctor might find when she gets her Medicare and goes for a physical exam. Gayle looks like she’s 55, not 65.  She has no health problems and takes no medications.

As an insurance broker, I have met too many women in their 50′s and 60′s who cannot get health insurance – and it’s just not right.

I have also met men who have continued to work well into their 70′s so they could keep their employer health insurance for their younger wife – who was uninsurable because of some health problem.

Earlier this year I met with a man who was 68 years old and finally leaving work and signing up for Medicare.  His wife was sitting at the kitchen table with us, and her arms were trembling. I couldn’t help but ask her what her medical problem was.  She told me she has Parkinsons… and she no longer had health insurance.  She is 62 years old.

About two years ago, I met a  woman who was 64 and had lost her group coverage because her artists’ co-op had disbanded.  She wanted to buy individual health insurance, but was refused because her cholesterol was too  high.  When I talked to her last fall, as she was approaching her 65th birthday, I said, “You’re gonna make it to 65 in one piece!  Now let’s get you signed up for your Medicare coverage!”  Turning 65 was a blessing for her.

Yesterday I met with Karen, the woman who has had pain in her leg for a while, but was waiting for her Medicare coverage to start before going to a doctor. After we discussed her Medicare coverage options,  she turned to her 40 year-old disabled daughter and shouted gleefully, “Mommy’s getting health insurance! Mommy’s getting health insurance!”

When politicians talk about raising the eligibility age for Medicare, I think of Karen and the relief – and joy – she felt about getting Medicare… and  it makes me want to cry.

Senator Lieberman, Paul Ryan, and all those politicians who have excellent health insurance, have no clue as to what millions of Americans are going through.

How can they talk about raising the Medicare eligibility age AND killing the Affordable Care Act?  Without the Affordable Care Act, people like those I have written about would continue to go without health insurance and medical care. Raising the Medicare age will keep them without health insurance even longer – and  they’ll just get sicker and sicker, and be more expensive when they finally get Medicare. What a brilliant idea!

WellPoint, the largest health insurance company in the country, will purchase CareMore, a Medicare Advantage plan with around 10,000 members in Arizona and 44,000 in California. The deal is worth a reported $800 million for the private investment firm that owns CareMore.

An article in the Indianapolis Star, the local paper in WellPoint’s home town said:

“The for-profit Medicare contractor, CareMore Health Group, has pioneered the practice of intensely monitoring and treating chronically ill older patients in order to improve their health while holding down their government-paid medical bills.

CareMore uses a sophisticated information technology system, with proprietary products that include remote monitoring devices, to coordinate care to 54,000 patients who have multiple health problems and are the costliest segment of the population to treat. Payment comes from Medicare, typically in fixed monthly amounts. There are typically no additional fees, copayments or deductibles for patients.

CareMore says its approach saves Medicare money by reducing multiple doctor visits, decreasing hospital stays and offering better instructions and care to patients so they stay on their treatment plans.”

The article is wrong about “no additional fees, copayments, or deductibles”. CareMore members do not pay a monthly premium, but they have co-pays for all medical services – though they are lower than most other Medicare Advantage plans’ co-pays.

Does Medicare Advantage have a future?

Medicare Advantage is very much out of favor with the current administration that runs Medicare – and the Affordable Care Act requires Medicare to cut payments to Medicare Advantage plans like CareMore. The reductions will go into effect over the next three years and will cut into profit margins for all Medicare Advantage plans and the companies that run them. So it is very interesting that the largest insurance company in the country is investing nearly $800 million in a company that is in a business that is supposed to go out of business over the next few years. WellPoint must know something we don’t know!

An editorial earlier this year in the journal of the American Geriatrics Society said:

“The CareMore model may emerge as the dominant model for healthcare delivery for seniors with chronic diseases.”

As Medicare tries desperately to cut expenses while 1 million baby boomers turn 65 each year, the CareMore model – and the Medicare Advantage model – might get a new look. The problem I see for these models is that they are for-profit. But the CareMore model is so cost efficient that they can probably handle lower reimbursements from Medicare.