By Dr. Gerard Muraida,
Medicare turned 60 years old this year. On July 30, 1965, President Lyndon B. Johnson signed into law the bill called the Social Security Amendments, creating Medicare Parts A and B for those individuals age 65 and over. The original Medicare program included Part A (hospital insurance) and Part B (medical insurance). Today, these two parts are called “Original Medicare.”
Medicare has expanded with age to include the disabled, as well as people with end-stage renal disease requiring dialysis or kidney transplantation. By the late 1970s, a hospice benefit was added. Then came a Medigap program, a group of supplemental plans to help cover out-of-pocket costs not covered by Original Medicare.
The Balanced Budget Act of 1997 established Medicare Part C, allowing private health plans like HMOs to participate and offer coordinated care. A Part D benefit followed, adding a prescription drug benefit. In 2010, the Affordable Care Act was passed and provided provisions for free preventive services and screenings.
Medicare covers evidence-based screenings and immunizations for older adults, with no cost-sharing for most services under Part B, including the Annual Wellness Visit.
This AWV is a yearly visit to develop or update a personalized prevention plan, including health risk assessment, cognitive impairment detection, and preventive screening recommendations. This may include mammography, colorectal cancer screening, diabetes and cardiovascular screening, and vaccine administration, such as influenza, pneumococcal, and shingles.
A closer look reveals that cardiovascular screenings include blood pressure measurement, cholesterol screening, and abdominal aortic aneurysm screening if indicated.
For diabetes screenings, fasting blood glucose testing and a hemoglobin A1C measurement are covered. The AIC test screens for prediabetes as well as monitors diabetic sugar levels. This test shows what percentage of your hemoglobin is coated in glucose. A higher percentage indicates higher average blood sugar levels.
In terms of cancer screenings, mammography, colorectal cancer screening (colonoscopy, fecal occult blood test, fecal immunochemical test), prostate-specific antigen (PSA) testing, and lung cancer screening are covered if pertinent to one’s health history.
Other preventive services are bone density testing, depression screening, alcohol misuse screening, tobacco use counseling, and obesity counseling.
Medicare’s preventive care services have demonstrated effectiveness in improving health outcomes and reducing disparities. More covered individuals are receiving cancer screenings with increased early detection and improved survival rates. Furthermore, Medicare’s diabetes prevention program has improved diabetes prevention and management among its beneficiaries.
The Medicare picture does face some challenges and barriers. One of the main challenges is underutilization of the above preventive services with missed opportunities in clinic visits. Also, patients’ awareness of these offerings and a limited number of providers in underserved communities, including rural areas, may contribute to weak participation.
Medicare does not fully cover all recommended preventive services, particularly those not endorsed by the U.S. Preventive Services Task Force. The USPSTF is an independent volunteer group of national experts in prevention and evidence-based medicine that makes recommendations about clinical preventive services, such as screening tests, counseling services, and preventive medications.
The coordination of preventive services covered by Medicare and those services recommended by not only the USPSTF but also by individual medical specialty societies can be an arduous undertaking for your primary care physician.
Frank discussions with your PCP regarding your individual health history and how preventive care addresses your needs is of paramount importance. This is especially true as we enter flu season. An amendment to an old adage is apropros: “An ounce of Medicare prevention is worth a pound of cure.”
