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What qualifies as preventative under Medicare and how do you ensure you take full advantage of these benefits? Because preventive care is an essential part of staying healthy and managing potential health risks before they become serious, Medicare recognizes the importance of preventive care and offers a range of services to help beneficiaries maintain their health.

What Is Preventive Care

Preventive care refers to medical services that aim to prevent illness, detect conditions early, or promote overall good health. These services can include screenings, vaccines, counseling, and much more. By focusing on prevention, Medicare helps beneficiaries proactively manage their health and reduce the need for more costly treatments in the future.

Click here to download a copy of a comprehensive list or covered preventative services

Medicare Coverage for Preventive Services

Medicare provides a wide array of preventive services under Part B (Medical Insurance). Many of these services are available to beneficiaries at no cost. These services may help detect health problems early when treatment is sometimes more effective and less expensive.

Some common types of preventive care Medicare covers:

Wellness Visits

Within the first 12 months a beneficiary enrolls in Medicare Part B, they are entitled to a “Welcome to Medicare” preventive visit. This one-time visit includes a review of your medical and family history, as well as basic measurements like height, weight, and blood pressure.

After your initial visit, Medicare covers an annual wellness visit each year. This can help create or update a personalized prevention plan. This plan can help beneficiaries stay on top of their health by identifying risk factors and setting health goals.

Vaccinations and Immunizations

Medicare covers vaccines that help prevent serious illnesses, including:

1. Flu Shot (Influenza): Covered once per flu season, typically every fall or winter.

2. Pneumococcal Vaccines: Medicare covers two different pneumococcal shots. The initial shot as well as a second shot a year later if appropriate.

3. Hepatitis B Vaccine: Available to those at medium or high risk for Hepatitis B.

4. COVID-19 Vaccines and Boosters: Medicare covers COVID-19 vaccines and booster shots as recommended by health authorities.

5. The Shingles Vaccine: This vaccine is administered in two doses. The second dose is given two to six months after the first. Medicare covers the cost of both doses.

Read more about Medicare coverage of vaccines

Screenings and Tests

Medicare offers a variety of preventive screenings and tests to help detect health issues early, including:

1. Mammograms: Medicare covers mammograms for the purpose of screening once every 12 months for women aged 40 and older. Medicare may also cover diagnostic mammograms if medically necessary.

2. Colon Cancer Screenings: Medicare covers multiple types of colon cancer screenings, including fecal occult blood tests, multi-target stool DNA tests (like Cologuard), flexible sigmoidoscopy, and colonoscopy. The frequency of these tests depends on the specific test and risk factors.

3. Bone Density Tests: Covered once every two years (or more often if medically necessary) for individuals at risk for osteoporosis.

4. Diabetes Screenings: Medicare covers up to two diabetes screenings per year for individuals at risk. This includes those with a history of high blood pressure, high cholesterol, obesity, or a family history of diabetes.

5. Cardiovascular Screenings: Medicare covers a screening blood test every five years to check for conditions like high cholesterol and triglyceride levels.

Cancer Screenings

Because early detection of cancer can lead to better treatment outcomes. Medicare covers:

1. Cervical and Vaginal Cancer Screenings: Medicare covers pap tests and pelvic exams are once every two years, or every year for women at high risk

2. Prostate Cancer Screenings: Annual prostate-specific antigen (PSA) tests and digital rectal exams for men aged 50 and older.

3. Lung Cancer Screenings: Low-dose CT scans are covered annually for individuals at high risk, particularly heavy smokers or those who have quit smoking within the past 15 years.

Cardiovascular Health

Medicare covers several services to help maintain cardiovascular health, including:

1.Cardiovascular Behavioral Therapy: This includes counseling on diet and exercise to help reduce the risk of heart disease.

2. Blood Pressure Screenings: These are typically part of your annual wellness visit.

Diabetes Prevention Program

The Medicare Diabetes Prevention Program offers lifestyle coaching and resources to help beneficiaries at risk for diabetes prevent the onset of the disease. The program is designed to encourage weight loss, healthy eating, and regular physical activity.

Mental Health and Wellness

Medicare also covers preventive services aimed at mental health, including:

1. Depression Screenings: Medicare includes an annual screening for depression as part of the yearly wellness visit.

2. Alcohol Misuse Counseling: Medicare covers counseling for beneficiaries who are screened and found to have alcohol misuse issues.

3. Smoking Cessation Programs: Medicare covers up to eight counseling sessions per year to help beneficiaries quit smoking.

Obesity Screening and Counseling

For individuals with a body mass index (BMI) of 30 or higher, Medicare covers counseling sessions to help promote weight loss and healthy living. This coverage includes regular face-to-face meetings with a healthcare provider.

Screenings for Infectious Diseases

Medicare also offers coverage for screenings to detect infectious diseases, including:

1. HIV Screenings: Covered once every 12 months, or more frequently for individuals at higher risk.

2. Hepatitis C Screenings: Covered once if born between 1945 and 1965, or annually for those at high risk.

3. Sexually Transmitted Infections (STIs): Medicare covers both screenings and counseling sessions annually for individuals at risk.

Make the Most of Medicare Preventive Services

1. Schedule an annual wellness visit: This visit is a great opportunity to discuss overall health and get a personalized prevention plan. It’s also a good time to make sure you’re up to date on all the preventive services you’re eligible for.
2. Know What Medicare Covers: Familiarize yourself with the list of preventive services Medicare covers and discuss these options with your healthcare provider. They can help determine which screenings and vaccines are appropriate for you.
3. Keep Track of When You’re Eligible: Medicare covers some services once a year or every few years. Make a note of when you’re eligible for your next screening or vaccination.

Preventive care is an important part of Medicare coverage and can help you stay healthier, detect potential problems early, and avoid costly treatments. Whether it’s a simple flu shot, a cancer screening, or an annual wellness visit, Medicare makes it easy for beneficiaries to access a wide range of preventive services. Understanding what’s covered and taking advantage of these benefits can play a key role in maintaining health and well-being.

If you need help choosing a Medicare plan, click here to learn why you should use a licensed Medicare agent

Medicare income limits 2024

The Medicare income limits 2024 effect about 7% of Medicare beneficiaries.  Each year, the Social Security Administration determines the income limit that the IRMAA is based on.  It’s crucial to stay up to date on the annual income limits weather you are an agent or a beneficiary. In this post, we go over Medicare income limits for 2024 and how they can impact beneficiaries.

Why Medicare income limits matter

Extra Help income limits 2024

Medicare Extra Help is a federal program put in place to help individuals whose income and financial resources are limited.  It provides help for those who qualify to pay the costs of their Medicare prescription drugs. The subsidies provided by this program cover premiums, deductibles, as well as co-pays for the costs of Medicare prescription drug plans (Part D).  To qualify for this program, individuals must meet the income criteria set by the federal government each year.  In this post, we will go over the Extra Help income limits 2024.

How to Qualify for Extra Help

1.  Be a U.S. citizen or legal resident

To enroll in Original Medicare, individuals must either be a United States citizen or a legal resident for at least 5 years. In turn, to enroll in Medicare’s Extra Help program, an individual must qualify for Medicare.

Extra Help is crucial for individuals who require assistance with the costs of prescription drugs. Understanding the requirements is the first step to finding the necessary help to ensure the needed coverage is received.

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Medicare leads

If you are a Medicare agent, one thing that you are always looking for is Medicare leads.  There are many places you can find leads. The most valuable leads are T-65 leads.  These leads are the best to get because insurance carriers pay the highest commissions for new to Medicare enrollments.

Watch a YouTube video on Medicare commission payments

Individuals turning 65 are also a great lead to get because an agent that does their job well, now has a new client on his books for quite a long time to come.  As long as the agent provides useful guidance to the beneficiary and ensures they are happy with their plan choice, they can develop a mutually beneficial relationship.

Before you contact anyone, it is very important to understand the CMS rules of how to do it.  Click here for details.

Click here to find out about our Medicare lead program.

In reality, many leads sources like online leads, inbound calls and pre-set leads do not produce many T-65 prospects. What they do provide is the contact information for current Medicare beneficiaries.  In reality, many of the people already have an agent and are not seeking guidance, although agents may find individuals who are unhappy with their current plan and/or their agent.  If you find a valid enrollment period, you can provide the assistance and coverage that the beneficiary is looking for.

If the potential client decides to enlist your assistance as an agent, you may need them to list you as their AOR.  Some Insurnace carriers allow clients to designate an agent as AOR even if they do not write a plan at that time.  When this happens, you have a client added to your book and can help them change their plan at a later date if it is appropriate. Learn how to make AOR changes.

T-65 Seminars

A great way to meet several individuals turning 65 is by hosting an educational event.  Our seminar selling program is an effective tool to provide needed information to the people who need it. This is truly a turn-key program that guarantees agents get in front of T-65 leads. Find out more about the seminar program.

Watch a video on the T-65 seminar program

If you decide to host an educational event, it is important to follow CMS guidelines for hosting an educational event.  If you decide to do a sales event, there are specific guidelines to follow as well.

Additionally, Crowe agents can access to a preset lead program.  This program provides leads at a very good close ratio.

Watch a video on our preset lead program.

Free leads

Agents who put in the effort to ensure their clients are happy with their coverage choices can easily earn referrals.  In order to ensure clients are happy, agents must be in contact with their clients and go over new plan options each year during the AEP.  As well as other times during the year to maintain the relationship and ensure clients are happy and do not seek answers to Medicare questions elsewhere.

Read more about how to get Medicare referrals

Establish relationships with other local professionals

It is a great idea to introduce yourself to healthcare professionals, doctors and clinics in your area as well as other professionals who work with clients that may need your advice.  Once they know you and are aware of the services you provide, it is easy to build a partnership and open doors to new lead prospects.  This will help establish you as a knowledgeable resource for anyone who needs advice.

Take a look at a few more Medicare marketing ideas

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Medicare enrollment dates

If you are either getting close to your 65th birthday or are in Medicare sales, you should understand the Medicare enrollment dates.

Enrolling in Medicare can be confusing for beneficiaries and understanding the enrollment process is crucial to access the benefits your clients need. From IEPs to SEPs, the Medicare system is designed to accommodate various life circumstances. In this post, we go over several of the Medicare enrollment periods and how beneficiaries can use them to get the healthcare coverage they need.

Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) is the first opportunity for most individuals to enroll in Medicare. IEP is a 7 month time frame that starts 3 months before the month of your 65th birthday, includes your birthday month, and ends three months after the month you turn 65.  During this period, individuals can sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) if they choose to.

Learn more about enrollment periods

Special Enrollment Periods (SEPs)

Special Enrollment Periods (SEPs) are designated times outside the initial enrollment period when individuals can sign up for Medicare due to specific qualifying events. Some of the most common qualifying events include:

Loss of Employer Coverage

If a beneficiary is covered under a group health plan through their own  or their  spouse’s current employment, they are eligible for an SEP when they lose the employer coverage.

Moving out of the plans service area

When a client moves out of their plan’s service area, they qualify for an SEP to enroll in a new Medicare plan.

Becoming Eligible for Extra Help

Individuals who become eligible for Extra Help with Medicare prescription drug costs qualify for an SEP to enroll in a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C) that includes prescription drug coverage.

General Enrollment Period (GEP)

For individuals who miss their initial enrollment period, the General Enrollment Period (GEP) provides another chance to enroll in Medicare. The GEP runs each year from January 1st to March 31st. Coverage obtained during this period begins the first of the month after you enroll.  it’s important to note, beneficiaries who wait until the GEP may have to pay a late enrollment penalty.

Click here to learn about late enrollment penalties LEPs

Annual Enrollment Period (AEP)

The Annual Enrollment Period (AEP), also known as the Medicare Open Enrollment Period, runs each year from October 15th until December 7th. During this time, Medicare beneficiaries can make changes to their Medicare coverage.  This includes; switching from Original Medicare and Medicare Advantage plans, as well as joining, dropping, or switching prescription drug plans.

How to best use the Medicare enrollment dates

1. Stay Informed: Keep track of your eligibility and enrollment periods to ensure you don’t miss important deadlines.
2. Review Your Coverage Needs: Regularly assess your healthcare needs to determine if  current coverage is still suitable or if changes are necessary.  Agents make sure you contact your clients regularly, especially during AEP to go over coverage options for the following year and ensure they are happy.
3. Seek Assistance if Needed: If you have questions or need guidance regarding Medicare enrollment, it is best to reach out to a licensed insurance agent.

Medicare agents be sure to maintain your book of business, click here for some ideas.

Agents, are you ready to join a winning team, click here for Crowe contracting!

Understanding Medicare enrollment dates is essential for to ensure beneficiaries have access to the healthcare coverage they need. By familiarizing yourself with the various enrollment periods and their significance, you can navigate the Medicare system with confidence and peace of mind. Remember, staying informed and proactive is key to making the most of your Medicare enrollments.

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Medicare Supplement Free Look Period

If you are an agent who offers Medicare plans, it is important to understand opportunities to provide clients with the coverage they deserve.  For those enrolled in Medicare, supplement plans offer an additional coverage option.  Because choosing the right supplement plan is an important decision, sometimes a client may change their mind. To safeguard against errors, Medicare offers the free look period.  In this post, we discuss the Medicare supplement free look period, why it’s important, and how beneficiaries can use it.

Learn the difference between Medicare Supplement and Medicare Advantage plans

What is the Medicare Supplement Free Look Period

The Medicare supplement free look period is a time beneficiaries can review their new Medicare supplement plan and, if unsatisfied, make changes without penalty. This period typically lasts for 30 days after the plan’s effective date.

If the client buys a Medicare Supplement policy during their 6-month Medicare Supplement OEP and are unhappy with it, they can change to another Medicare Supplement policy. When the client gets a new (second) Medicare Supplement policy, they have 30 days to decide if they are going to keep it.  This time period is called the 30-day free look period. The client shouldn’t cancel the first Medicare Supplement policy until they are sure they want to keep the second Medicare Supplement policy. Unfortunately, they have to pay both premiums for the month they have both.

Reasons to change a supplement plan

1. Paying for benefits you don’t need.
2. Client needs more benefits.
3. Do not like the insurance company
4. They need a lower cost plan

Are you looking for an FMO, see why you should consider joining the Crowe team!

Why Does the Free Look Period Matter

Peace of Mind

Because choosing a Medicare supplement plan is overwhelming, sometimes beneficiaries make decisions in haste or without full understanding.  This can lead to dissatisfaction. The free look period offers reassurance to beneficiaries, allowing them to thoroughly evaluate their plan and its benefits at their own pace.

Risk Mitigation

Mistakes in selecting a Medicare supplement plan can be costly, both financially and in terms of coverage gaps. The free look period serves as a safety net, enabling beneficiaries to rectify any errors or misunderstandings without facing financial penalties or being locked into a plan that doesn’t meet their needs.

Consumer Protection

The free look period is designed to protect Medicare beneficiaries from being pressured into purchasing plans that may not be suitable for them. It empowers individuals to make informed decisions about their healthcare coverage without feeling rushed or coerced.

Medicare supplement plan comparison – click here

Making the Most of the Free Look Period

Thoroughly Review the Plan

It is important to go over all aspects of the Medicare supplement plans your client is considering.  Please remember, this not only includes coverage but all costs involved.

Compare Plans

To ensure the client has made the best plan choice, agents should comparing it with other available plans. This can help you identify any discrepancies or better alternatives.

Seek Guidance

Beneficiaries should reach out to a licensed insurance agent for assistance. They provide valuable insights and help navigate the confusing landscape of Medicare coverage.

Document Everything

Important: clients should keep detailed records of their conversations with insurance provider representatives.  They need to include any changes made to their plan or communications regarding the free look period. This documentation serves as evidence in the event there are any disputes or discrepancies.

The free look period is an opportunity for beneficiaries to ensure they have the right coverage for their healthcare needs. Individuals who take advantage of the free look can make informed decisions.  They can also, rectify mistakes, and achieve peace of mind regarding their healthcare coverage. Remember, health is invaluable, and the right Medicare supplement plan can make all the difference in accessing quality healthcare.

Medicare annual wellness visits

For Medicare beneficiaries, it is very important to stay vigilant with their health care.  Medicare annual wellness visits (AWV) are an essential tool to maintain good health.  Unfortunately, many beneficiaries are unaware of how significant this is and what it entails.  In this post, we discuss the importance of wellness visits and their benefits.

Understanding Medicare Annual Wellness Visits

Medicare Annual Wellness Visits (AWVs) are preventive care appointments.  These appointments help assess and maintain the overall health of Medicare beneficiaries. Unlike traditional annual physical exams, AWVs focus on preventive care planning, risk assessment, and health promotion.  The purpose of these appointments in not to diagnose or treat existing conditions. Please note; anyone who has has Medicare Part B for over 12 months, is eligible for an annual wellness visit.  It is important to understand; these visits are not a physical exam.

There is not cost for the visit as long as the provider accepts Medicare assignment and the Medicare Part B deductible does not apply. Although, if your provider preforms additional test, you may have to pay the Part B deductible as well as co-insurance.  In the event these services are not cover under the preventative visit.

Why are annual wellness visits so important

1. Prevention Over Cure: When providers use this approach, they prioritize preventive care, to detect potential health risks early on.  This helps prevent them from escalating into serious conditions. By identifying risk factors and developing personalized prevention plans, beneficiaries can take proactive steps towards better health outcomes.
2. Comprehensive Health Assessment: AWVs provide beneficiaries with a comprehensive overview of their current health status.  By taking a holistic approach that includes screenings for cognitive impairment, depression, and functional ability, all aspects of health are addressed and monitored.
3. Establishing a Baseline: Regular AWVs enable healthcare providers to establish a baseline of a beneficiary‘s health status.  This facilitates better care management and early detection of changes in health in subsequent visits.
4. Patient-Centered Care: ensures patient-provider communication is a priority.  This fosters open dialogue about health concerns, lifestyle factors, and goals. This collaborative approach allows beneficiaries to actively participate in their healthcare decisions and take steps toward good health.
5. Cost-Effective Care: Preventive care, as emphasized in AWVs, is proven to be more cost-effective in the long run compared to treating advanced diseases.  Medicare can reduce healthcare costs by investing in preventive measures to avoid chronic conditions.

Watch a YouTube video on the changes to Medicare Part D coverage

Components of an annual wellness visit

1. Health Risk Assessment: Beneficiaries undergo a thorough assessment of their medical history, current health status, and risk factors for chronic diseases.
2. Personalized Prevention Plan: Based on the health risk assessment, healthcare providers develop a personalized prevention plan that fits the individual’s needs and goals. This may include recommendations for screenings, vaccinations, lifestyle modifications, and community resources.
3. Health Education: AWVs offer an opportunity for beneficiaries to receive education on various health topics.  This helps them make informed decisions about their well-being.
4. Review of Medications: Healthcare providers review the beneficiary’s current medications to verify they are safe, effective, and appropriate for their needs.
5. Referrals and follow-up visits: If necessary, healthcare providers refer beneficiaries to specialists or other healthcare services for further evaluation or treatment. Follow-up appointments are scheduled, when needed, to check progress and adjust the plan accordingly.

To sum it up

Medicare annual wellness visits are an important tool for the promotion of good health and well-being of Medicare beneficiaries.  When we  prioritize preventive care, health assessments, and patient-centered approaches, beneficiaries have the information they need to be proactive in their healthcare and wellbeing.

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Vaccines covered by Medicare

Medicare prescription drug plans cover wide variety of prescription drugs, this includes several vaccines covered by Medicare.  Medicare covers vaccines in more than one way; either by Part D  or by Part B (medical coverage) or Part C MA/MAPD plans that may provide coverage for all the parts of Medicare.  It all depends on the type of vaccination and what facility the patient receives it at. As of January 2023, all vaccines covered by Medicare should be free to beneficiaries. This means they should not have any cost-sharing such as; co-pays, co-insurance or deductibles.

Find out about Medicare Part D enrollment periods

Part B covers vaccine coverage

In many cases, if the vaccination is part of a treatment for an illness or injury, it is usually covered by Part B.  In other words, if a beneficiary gets a puncture wound, they may need a tetanus shot. When this is the case, the vaccination falls under Medicare Part B coverage (Part C, if they have an MA/MAPD plan).  If the beneficiary opts to receive a tetanus booster shot, that charge falls under their Part D plan.

Watch a quick YouTube video on enrollment periods including Part B late enrollment

Here are some common vaccines that Part B covers:

*Flu

*Covid 19

*Pneumonia

*Hepatitis B – in cases where the individual is at high to intermediate risk.

*Some necessary vaccines needed to treat an injury, illness or exposure to a disease.

Part B covers some drugs

In some instances, Part B covers drugs beneficiaries do not normally give themselves.  In other words drugs that you receive either in a doctor’s office or in an outpatient hospital setting.

A few of the drugs covered by Part B

Part D vaccine coverage

Part D Vaccines are provided in an effort to prevent illness as opposed to treating one.  Medicare Part D plans cover commercial vaccines if they are reasonably necessary.

Some vaccines covered by Part D

1. Shingles vaccines
2. Tdap (tetanus-diphtheria-whooping cough) vaccines
3. In cases that a PDP plan’s formulary does not list a vaccine, it must provide coverage if a physician prescribes it as a prevention measure.

Learn about the Medicare Part D drug cap

As of January 2023, patients with Medicare Part D plans or MAPD plans pay no out-of-pocket costs for adult vaccines.  This is part of the Inflation Reduction Act of 2022.  If the patient is charged a vaccine administration fee at the time of service, they can submit this amount to their Part D plan for full reimbursement.

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Medicare financial assistance

Aetna fitness reimbursement

Aetna has expanded their commitment to wellness by adding the Aetna fitness reimbursement benefit to some of their MAPD plans.  This benefit provides members of participating plans an allowance for activities or equipment for things such as; golf, pickleball, swimming, running, or even entrance fees for state and national parks.  Members can also use the benefit for fitness equipment such as athletic shoes, exercise mats, weights, wearable fitness trackers or any other equipment that helps them stay healthy.

Please note; this benefit does not cover expenses for fitness attire other than shoes.

Watch a quick video on Medicare advantage plans vs Medicare supplements

More about this benefit

Once the calendar year ends, you cannot roll over any portion of this benefit allowance.  This is a (DMR) direct member reimbursement, this means the member pays for the qualified item or activity up front and then submits the paid receipt to Aetna for reimbursement. Please make sure all fields are completed and receipts included before you send in the request to avoid delays in payment receipt.
If you are unsure if your plan offers this benefit,  either check the Evidence of Coverage for your specific plan or contact your broker to confirm this benefit as well as any other plan questions you have.

Learn the pros and cons of Advantage plans

Please note:  Members do not use the Fitness Reimbursement Form for reimbursement of benefits other than; fitness activity fees, or fitness supplies or wearable items.  Reimbursements  of any other expenses require a specific form for that purpose.

To determine if you should send in an item for reimbursement, make sure you can answer yes to the following 3 questions:

1.  Did you purchase this item or service this year to use this year?
2.  Is the item or service for your benefit/use only?
3. Do you have an itemized receipt for the items or services you are requesting the reimbursement for.  Please make sure the receipt includes the date of purchase, name of retailer, location of retailer and a description of the item as well as the amount paid.

How this benefit works

1.  The member pays up front for the qualified fitness-related services, activity fees or supplies from licensed provider or retail store.  They collect a detailed receipt that contains costs, date of purchase and payment method.
2. Plan member makes the request for reimbursement.  This can be done online at AetnaMedicare.com/Reimburse, once you are on the site, just follow the prompts and fill out the required form and upload a copy of your paid receipt.  If you do not want to fill it out online, you can either print out a copy from the website or request a form from the member services number on the back of your plan ID card. Please see below for more ways to submit your reimbursement.
3. Wait for your reimbursement to arrive.  Aetna will send members a check to reimburse them for qualified purchases.  Please allow up to 45 days to receive your payment.  Aetna must receive both the form and receipt within 365 days of the original purchase.  Allowance amounts do not roll over to the next calendar quarter or plan year.

To download a copy of the Fitness Reimbursement Form, click here

How to request the reimbursement

1. Members can go to AetnaMedicare.com/Reimburse or scan the QR code in this flyer.
2. You can either complete the form online or download, print and complete the reimbursement form and mail it to the claims address found on the back of your member ID card.  If you are requesting the reimbursement by mail, you should make a copy of your original documents; Aetna will not return them to you.

Please note:  any item you purchase from private, non-retail seller will not be accepted for reimbursement.  Plan members should always check their EOC for a full description of plan benefits, exclusions and limitations.

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