Medicare Minute: Medicare Preventive Services

Author

Area Agency on Aging for Southwest Florida

For more information about the author, click to view their website: Area Agency on Aging

Posted on

Nov 12, 2024

Book/Edition

Florida - Sarasota, Bradenton & Charlotte Counties , Florida - Southwest

share-this
Share This

What is preventive care?

Preventive care is the care you receive to prevent illness, detect medical conditions, and keep you healthy. During this Medicare Minute, we’ll look at Medicare’s coverage of preventive services and review the screening, vaccines, and counseling that can help you stay on top of your health. A quick reference handout is available for download that will include everything covered in this blog post and more.

Medicare Part B covers many preventive services with no cost-sharing, as long as you meet the eligibility requirements and follow the guidelines below.

Is it covered by Medicare?

Preventive services recommended by the U.S. Preventive Services Task Force are covered with zero cost-sharing, so you will not owe any deductible or coinsurance when you receive them. You can find a list of those services on Medicare.gov’s page on Preventive & Screening Services. You can also call 1-800-MEDICARE or read your Medicare & You handbook for a full list.

Do I meet the coverage criteria?

For many of the covered preventive services, you have to meet certain criteria based on your age, sex, or certain risk factors. Your health care provider should be able to tell if you qualify.

Am I seeing the right kind of provider?

  • Original Medicare: To get preventive services with no cost-sharing, you should see a provider that accepts assignment, also known as a Medicare-participating provider. Many providers accept assignment, but you should ask your provider in advance if they accept assignment. If you see a non-participating or opt-out provider, you may be responsible for part or all of the cost of your service.
  • Medicare Advantage: It is usually best to receive services from an in-network provider. Contact your provider to learn if they are in-network for your plan, or contact the plan to learn which providers are in-network. If you go out-of-network, you might be responsible for part or all of the cost of your preventive service.

What will happen during my annual wellness visit?

The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider to create or update a personalized prevention plan. Medicare Part B covers the AWV if you have had Part B for over 12 months and you have not received an AWV or your Welcome to Medicare Visit in the last 12 months.

At your Annual Wellness Visit, your doctor may:

  • Check your height, weight, blood pressure, and other routine measurements
  • Give you a health risk assessment, which might include a questionnaire that you complete before or during the visit
  • Review your functional ability and level of safety
  • Learn about your medical and family history
  • Make a list of your current providers, durable medical equipment (DME) suppliers, and medications
  • Create a 5-10 year screening schedule or check-list
  • Identify risk factors and current medical and mental health conditions along with related current or recommended treatments
  • Screen for cognitive impairment, including diseases such as Alzheimer’s and other forms of dementia
  • Screen for depression
  • Provide health advice and referrals to health education and/or preventive counseling services aimed at reducing risk factors and promoting wellness

What the annual wellness is not:

  • It is not a head-to-toe physical
  • Although Medicare Part B covers the Annual Wellness Visit with no cost-sharing, depending on your visit, you may be responsible for paying a facility fee and/ or cost-sharing on any diagnostic services you receive

What is genetic testing fraud and abuse?

Genetic testing fraud or abuse can occur when Medicare is billed for genetic screenings or tests that are not medically necessary and were not ordered by the beneficiary’s treating physician. We often see scammers offering cheek swab tests to obtain a beneficiary’s Medicare information, which the scammers can then use for fraudulent billing or medical identity theft. Genetic testing is often advertised as one of the following:

  • Cardio/cardiac genetic screening/test
  • DNA screening/test
  • Hereditary cancer screening/test
  • Dementia screening/test
  • Parkinson’s screening/test
  • Pharmacogenetics (medication metabolization)

Look for these red flags to avoid genetic testing fraud and abuse:

  • A company offers you “free” testing without your treating physician’s order
  • A company uses “telemedicine” to offer you testing over the phone and arrange for an unrelated physician or “teledoc” to order the tests
  • Medicare is billed (often thousands of dollars) for a broad range of genetic tests that you do not request or possibly even receive
  • A company requests your Medicare number at a health fair, senior center, assisted living facility, mall, farmers market, or church-sponsored wellness event

To prevent genetic testing fraud and abuse, make sure to work with your trusted health care provider on your preventive health. Protect your personal information and Medicare number. Always read your Medicare statements for any suspicious charges. And finally, if you received a cheek swab or genetic screening/test that was not medically necessary, report your concerns to your local Senior Medicare Patrol (SMP).

Who to contact for more information:

  • Your doctor: If you would like to schedule preventive care (such as an Annual Wellness Visit or Welcome to Medicare visit) contact your doctor or health care provider.
  • State Health Insurance Assistance Program (SHIP): Contact your SHIP if you would like to learn more about how Medicare covers preventive services or if you are confused why a provider is charging you for preventive care. SHIP counselors are trained and trusted to provide unbiased Medicare counseling. In Florida the program is referred to as SHINE (Serving Health Insurance Needs of Elders). In Southwest Florida, call toll-free: 866-413-5337 or email shineinfo@aaaswfl.org.
  • Senior Medicare Patrol (SMP): Contact your SMP if you believe a provider is fraudulently billing you for preventive services or if you have experienced genetic testing fraud. SMPs empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report potential health care fraud. In Southwest Florida, call toll-free: 866-413-5337 or email shineinfo@aaaswfl.org.

The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,534,081 with 100 percent funding by ACL/HHS.  The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.

Other Articles You May Like

Safeguarding Seniors: How to Avoid Scammers

In recent years, scammers have increasingly targeted seniors, preying on their trust and vulnerability to perpetrate fraudulent schemes. According to a report by the FBI, Baby Boomers alone were scammed out of more than $3.4 billion in 2023, with losses from reported scams surging by 11% from the previous year. With imposter scams on the rise, it's essential for seniors to be vigilant and informed to protect themselves from falling victim to these schemes.Imposter scams often involve criminals impersonating trusted figures, such as relationship managers or financial advisors, and setting up fraudulent websites to deceive victims. To avoid falling victim to these scams, it's crucial to recognize the warning signs, including:Unexpected phone calls or emails requesting personal information or payments.Phone calls stating you have missed Jury Duty and have to pay a fine or you will be arrested. Urgent requests to fill out forms or provide sensitive information.Poor website design quality, grammatical errors, or misspellings on fraudulent websites.Website domains that use the name of the relationship manager rather than a reputable firm. To protect themselves from imposter scams follow these best practices:Verify all anomalous communications or requests for payments by double-checking the sender information and independently confirming the source using verified contact information.Do not open emails that do not look normal - it could be a phishing email which could put a virus on your computer. Never rely solely on caller ID to determine the legitimacy of a caller. Let an unknown caller go to voicemail. Refrain from sending payments or sensitive information without independently verifying the identity of the recipient.Avoid giving out sensitive information, such as account numbers, over the phone or through a website unless certain of the recipient's identity.Cut off contact with anyone suspected of impersonating a professional and report the incident to authorities.Never give cash to a vendor, Zelle payments or meet them in a common area. Additionally, you can decrease any chances of falling victim to imposter scams by proactively establishing mutually understood defense measures with professional contacts.By remaining vigilant and informed, seniors can protect themselves from falling victim to imposter scams and safeguard their financial well-being. Education and awareness are key to empowering seniors to recognize and avoid fraudulent schemes targeting them.

Day Services at Savannah Grand of Sarasota

Savannah Grand of Sarasota is delighted to offer Adult Day Care for seniors in the Sarasota area. Our day programs provide a welcoming, engaging, and supportive environment for seniors who may benefit from socialization and structured activities during the day. Available nearly every day of the week, our Adult Day Care Programs offer a perfect alternative to staying at home, allowing seniors to enjoy enriching activities and companionship. These programs also offer prospective residents a worry-free glimpse into the life and community at Savannah Grand.The Grand Day ProgramOur signature Grand Day Program allows seniors to join our assisted living residents for a 4-6 hour experience filled with engaging activities, entertainment, and two nutritious meals. Tailored for the more independent senior, this program encourages social interaction and mental stimulation in a vibrant community setting.The Grand Day Program is designed with both seniors and their caregiver families in mind, offering a flexible solution for families who may have work, school, or other commitments. While seniors enjoy a day of activities and camaraderie, families can have peace of mind knowing their loved one is in a safe and supportive environment.What Our Day Services IncludeThe Day Services at Savannah Grand go beyond mere entertainment to include full-service support:Engaging Activities and Entertainment: Our program is filled with planned activities that promote mental engagement, creativity, and social interaction.Delicious Meals and Snacks: Day guests enjoy two freshly prepared meals and snacks, ensuring proper nutrition during their time with us.Companionship and Personalized Services: We provide social support and companionship to help seniors feel connected and valued. Personalized services can be arranged to accommodate each individuals needs.Comfortable Resting Spaces: For those who need a moment to rest, Savannah Grand offers a variety of comfortable spaces to relax and recharge during their visit.Explore Our Respite ProgramOur Adult Day Care services are a wonderful way to experience the warmth and care of Savannah Grand. For families who are exploring longer-term care options, the day program offers a worry-free introduction to our community. Additionally, our respite program provides short-term stays for seniors who may need temporary care or for families seeking relief from caregiving duties.Discover the Enriching World of Savannah Grand Day ServicesAt Savannah Grand of Sarasota, were dedicated to creating a vibrant and supportive environment where seniors can enjoy a fulfilling day surrounded by friends, activities, and compassionate care. If youre considering day services for yourself or a loved one, or if youre interested in our respite program, contact us to learn more. Discover how Savannah Grand can make every day an enriching experience!

Financial Options for Affordable Senior Living

Moving to a senior living community is an exciting step that offers the chance to enjoy a maintenance-free lifestyle with access to social engagement, amenities, and care as needed. When considering this transition, one of the biggest questions is often how to cover the costs. Fortunately, a variety of financial options can help fit the needs of different budgets and situations.At Senior Living Management, our communities are dedicated to guiding residents and families through this financial decision-making process. Our partners at ElderLife Financial and AidandAttendance.com work closely with each family to evaluate available resources and identify the best options for funding senior living. Below, we outline some of the top financial solutions that families use to make senior living affordable.Understanding Personal ResourcesCreating a budget is the first step in understanding the affordability of senior living. Over time, you may have accumulated savings, assets, or insurance policies that can be used for senior care. Some common resources to consider include:Savings accounts, 401(k) plans, stocks, bonds, and CDs: These financial assets can often be drawn upon to pay for ongoing care expenses.Home equity: For many seniors, the equity in their home is a significant asset. Working with a Seniors Real Estate Specialist (SRES)a Realtor who specializes in helping older adultscan help maximize the homes value and provide funds for senior living. During this process, families can also choose to liquidate belongings or hold an estate sale to generate additional resources.Financial Benefits for VeteransThe Department of Veterans Affairs (VA) offers benefits to veterans that can help cover senior care costs. The Aid and Attendance benefit is available to eligible U.S. military veterans and their spouses, providing up to $2,600 of monthly, tax-free income to help offset care expenses. Eligibility can typically be determined quickly by reviewing key factors like wartime service dates, discharge type, care needs, income, and assets.Long-Term Care InsuranceLong-term care insurance is often purchased to cover the future costs of senior care. These policies vary in terms of the services and care types they cover, so its essential to review the policy details or consult the insurance provider to confirm coverage for assisted living or memory care needs. ElderLife offers complimentary policy reviews to ensure families are maximizing their benefits and fully understanding available options.Life Insurance OptionsWhile life insurance is traditionally intended for beneficiaries after the policyholders passing, some policies allow seniors to access funds during their lifetime to pay for care. This option may include surrendering the policy, borrowing against it, or selling it in a life settlement. Since not all policies offer this flexibility, its advisable to review your policy terms to see if it can contribute to senior living costs.Tax DeductionsThe IRS offers tax deductions for certain medical expenses that exceed 7.5% of an individuals adjusted gross income, which can include some senior care costs. Since tax rules regarding medical deductions can be complex, consulting a tax advisor can be helpful to identify deductions and potentially free up more resources for senior living expenses.Additional Financing SolutionsWhen immediate funding isnt available, short-term financing options like bridge loans and reverse mortgages can help cover costs temporarily or unlock funds tied up in home equity.Bridge Loans: Bridge loans are often used to cover the gap between moving to a community and receiving funds from other resources, such as home sales, VA benefits, or insurance policy payouts. ElderLife Financial offers bridge loans that can be approved quickly, often within 24 hours, allowing seniors to move into their desired community without delay. Once other resources become available, families can repay the loan and continue funding care with the released assets.Home Equity Conversion Mortgage (HECM): A reverse mortgage, or HECM, allows homeowners aged 62 and over to tap into their home equity for funds while remaining in the home. This type of loan is federally regulated, ensuring fair lending practices. A mandatory counseling session helps homeowners determine if a reverse mortgage is the right solution. For seniors who plan to stay in their home but need access to funds for care, an HECM may offer a viable financial solution. Consulting with a federally approved lender can help explore this option further.Embracing Affordable Senior LivingMoving to a senior living community offers a new chapter filled with comfort, engagement, and care. With many financial solutions available, paying for senior living can be manageable and customized to fit individual circumstances. Senior Living Management is committed to supporting families through every financial decision. If youre ready to explore affordable options, contact us to learn more about how our trusted partners and financial guidance can help you transition into a vibrant, fulfilling senior living experience.

Local Services By This Author

Area Agency on Aging for Southwest Florida

Senior Organizations & Services 2830 Winkler Avenue, Suite 112, Fort Myers, Florida, 33916

The Area Agency on Aging for Southwest Florida (AAASWFL) is a nonprofit organization serving older adults (age 60-up) and adults with disabilities. We serve Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties. AAASWFL is committed to connecting older adults and adults with disabilities to resources and assistance for living safely with independence and dignity.AAASWFL is also the states designated Aging and Disability Resource Center for Southwest Florida. We provide information and resources for seniors and adults with disabilities. We also help their families and caregivers. AAASWFL can connect you with local resources like elder care, adult day care, housing assistance, home care, meals, housekeeping, legal assistance, personal care, and even volunteer opportunities.Providing Long-Term Care (LTC) services to Floridas most vulnerable citizens is a multi-agency effort. The Agency for Health Care Administration (AHCA) administers the Statewide Medicaid Managed Care (SMMC) Long-Term Care program, sets coverage policy, and gets those eligible for services enrolled in a LTC plan. The Department of Elder Affairs (DOEA) is responsible for determining medical eligibility and level of care needed. We are one of eleven regional Area Agencies on Aging in the state of Florida. Nationwide, there are more than 600 Area Agencies on Aging serving elders and adults with disabilities.Please contact the Area Agency on Aging for Southwest Florida if we can be of assistance to you, a friend or a family member!The AAASWFL Elder Helpline is available between 8:00 am-5:00 pm Monday through Friday:  866-413-5337 (866-41-ELDER)Contact Phones:Telephone: 239-652-6900FAX: 239-652-6989Toll Free: 866-413-5337 (in the State of Florida)Postal address:Area Agency on Aging for Southwest Florida2830 Winkler Avenue, Suite 112Fort Myers, FL 33916Hours of Operation:Monday-Friday: 8am 5pm

Area Agency on Aging for Southwest Florida

Grocery Shopping 2830 Winkler Avenue, Suite 112, Fort Myers, Florida, 33916

The Area Agency on Aging for Southwest Florida (AAASWFL) is a nonprofit organization serving older adults (age 60-up) and adults with disabilities. We serve Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties. AAASWFL is committed to connecting older adults and adults with disabilities to resources and assistance for living safely with independence and dignity.AAASWFL is also the states designated Aging and Disability Resource Center for Southwest Florida. We provide information and resources for seniors and adults with disabilities. We also help their families and caregivers. AAASWFL can connect you with local resources like elder care, adult day care, housing assistance, home care, meals, housekeeping, legal assistance, personal care, and even volunteer opportunities.Providing Long-Term Care (LTC) services to Floridas most vulnerable citizens is a multi-agency effort. The Agency for Health Care Administration (AHCA) administers the Statewide Medicaid Managed Care (SMMC) Long-Term Care program, sets coverage policy, and gets those eligible for services enrolled in a LTC plan. The Department of Elder Affairs (DOEA) is responsible for determining medical eligibility and level of care needed. We are one of eleven regional Area Agencies on Aging in the state of Florida. Nationwide, there are more than 600 Area Agencies on Aging serving elders and adults with disabilities.Please contact the Area Agency on Aging for Southwest Florida if we can be of assistance to you, a friend or a family member!The AAASWFL Elder Helpline is available between 8:00 am-5:00 pm Monday through Friday:  866-413-5337 (866-41-ELDER)Contact Phones:Telephone: 239-652-6900FAX: 239-652-6989Toll Free: 866-413-5337 (in the State of Florida)Postal address:Area Agency on Aging for Southwest Florida2830 Winkler Avenue, Suite 112Fort Myers, FL 33916Hours of Operation:Monday-Friday: 8am 5pm

Area Agency on Aging for Southwest Florida

Adult Day Services 2830 Winkler Avenue, Suite 112, Fort Myers, Florida, 33916

The Area Agency on Aging for Southwest Florida (AAASWFL) is a nonprofit organization serving older adults (age 60-up) and adults with disabilities. We serve Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties. AAASWFL is committed to connecting older adults and adults with disabilities to resources and assistance for living safely with independence and dignity.AAASWFL is also the states designated Aging and Disability Resource Center for Southwest Florida. We provide information and resources for seniors and adults with disabilities. We also help their families and caregivers. AAASWFL can connect you with local resources like elder care, adult day care, housing assistance, home care, meals, housekeeping, legal assistance, personal care, and even volunteer opportunities.Providing Long-Term Care (LTC) services to Floridas most vulnerable citizens is a multi-agency effort. The Agency for Health Care Administration (AHCA) administers the Statewide Medicaid Managed Care (SMMC) Long-Term Care program, sets coverage policy, and gets those eligible for services enrolled in a LTC plan. The Department of Elder Affairs (DOEA) is responsible for determining medical eligibility and level of care needed. We are one of eleven regional Area Agencies on Aging in the state of Florida. Nationwide, there are more than 600 Area Agencies on Aging serving elders and adults with disabilities.Please contact the Area Agency on Aging for Southwest Florida if we can be of assistance to you, a friend or a family member!The AAASWFL Elder Helpline is available between 8:00 am-5:00 pm Monday through Friday:  866-413-5337 (866-41-ELDER)Contact Phones:Telephone: 239-652-6900FAX: 239-652-6989Toll Free: 866-413-5337 (in the State of Florida)Postal address:Area Agency on Aging for Southwest Florida2830 Winkler Avenue, Suite 112Fort Myers, FL 33916Hours of Operation:Monday-Friday: 8am 5pm