Medicare Preventive Services
This blog discusses the expanded preventive services that are now offered by Medicare under the healthcare reform legislation. Nurses should encourage older adults to take advantage of these preventive health services and to make healthy lifestyle changes.
Prevention is any activity that reduces the burden of mortality or morbidity from disease. Services performed in a clinical setting that are designed to prevent disease, injury, or disability, prolong life, and promote health are known as preventive health services. These important services come in many forms: screening, testing, counseling, immunization, preventive medication, and preventive treatment.
Preventive services have the potential to help people avoid disease or injury, delay the onset of disease, detect disease in its earliest and most treatable state, or alter and change the course of chronic conditions by restoring function and reducing complications. They help ensure longer, healthier, and more productive lives for older adults.
One of the identified weaknesses of medicare has been its lack of emphasis on preventive care. To address this service gap, the new healthcare reform law expanded coverage of preventive services to help older people stay healthy and experience optimal functionality and quality of life.
As of January 1, 2011, many preventive services are now covered under medicare. Some preventive services are provided at no cost to the beneficiary while others require a co-insurance payment.
Medicare covers all the cost for a one-time comprehensive "welcome to medicare preventive visit," if given within the first 12 months of enrollment in part b. There is no co-payment or deductible for this visit.
This one-time preventive visit covers a detailed medical and social history, family history, identification of modifiable risk factors for disease, review of medications, depression screen, functional ability and safety screen, a focused physical exam, counseling about preventive care services, discussion of advance directives, and referral for further tests if needed.
Services covered during this examination include measurement of blood pressure, weight, and height, vision screening, an electrocardiogram, routine immunizations, wellness education and counseling, and a list and timetable of recommended screening tests.
Those beneficiaries who have been enrolled in part b longer than 12 months are eligible for an annual "wellness" visit. There is no cost for the yearly "wellness" visit. If additional tests or services are needed during the visit, however, then the beneficiary must pay co-insurance or deductibles for the extra costs.
The following screening tests and timetable are recommended by medicare:
- Screenings for breast, cervical, vaginal, colorectal, and prostate cancer (once yearly)
- Abdominal aortic aneurysm screenings (a one-time ultrasound for people at risk)
- Alcohol misuse counseling (once yearly)
- Barium enema (once every four years for those of normal risk or every two years for those at high risk)
- Bone mass screening (once every 24 months for those at risk)
- Colonoscopy (every ten years for normal risk levels and once every two years for those at high risk)
- Counseling for those with diabetes or renal disease
- Diabetes monitoring; influenza, pneumonia and hepatitis b vaccinations
- Depression screening (once yearly)
- Fasting blood glucose screening (every six months for those at risk)
- Fecal occult blood testing (once yearly)
- Flexible sigmoidoscopy (once every four years)
- Glaucoma screening (yearly for those with high risk of glaucoma)
- Hiv screening
- Lipids, triglycerides, and cholesterol levels (every five years)
- Nutrition assessment, and
- Smoking cessation counseling.
Despite the changes in medicare to promote access to preventive services, many older adults currently do not receive vaccinations, screenings, and other preventive services that national experts recommend. A contributing factor is that many older adults are still unaware of these services. Nurses are in a pivotal position to educate and encourage older adults to take advantage of these preventive health services and to make healthy lifestyle changes.
Last edit by Joe V on Jan 15, '15
VickyRN is a certified nurse educator (NLN) and certified gerontology nurse (ANCC). Her research interests include: the special health and social needs of the vulnerable older adult population; registered nurse staffing and resident outcomes in intermediate care nursing facilities; and, innovations in avoiding institutionalization of frail elderly clients by providing long-term care services and supports in the community. She is faculty in a large baccalaureate nursing program in North Carolina.
VickyRN has '16' year(s) of experience and specializes in 'Gerontological, cardiac, med-surg, peds'. From 'Under the shadow of His wings...'; Joined Mar '01; Posts: 12,051; Likes: 6,483.Nov 29, '11Four years on Medicare, and I see nothing new in that..... the "wellness visit" has been part of what I've had (now that was an advantage plan for a while)....but it's a waste of money to require another trip for labs/tests. Diabetic teaching/dietary guidance has been part of the deal. And, I've never had any test denied.... and from the waist up, I've had most . Lipids/cholesterol every 5 years??- that's worse. OB-GYN department- don't see anything new. Advanced directive information is plastered everywhere.
Looks like they made it less beneficial. Or maybe my docs decided to provide better care than they had to ...IDK... very odd. But, if it's govt, that's about right Maybe there's some attempt to wrap it up differently.... ???