Preventive Services Covered by Medicare under Affordable Care Act

As of January 1, 2011, Americans covered by Medicare were able to begin taking advantage of benefits and savings available through the Affordable Care Act. According to a report from the US Department of Health and Human Services, >150,000 seniors and people with disabilities have taken advantage of the improvements offered by the new law, particularly in the area of preventive services. The report was published online [www.HealthCare.gov].

Medicare beneficiaries are no longer required to pay a deductible, coinsurance, or copayment for many preventive services covered by Medicare. There are also other recommended services newly covered by the program. Services now fully covered by Medicare include certain cancer screenings, such as mammograms and colonoscopies, and an annual wellness visit. At the wellness visit, physicians and beneficiaries can develop and/or update a personalized prevention plan, taking into account medical and family history, detection of any cognitive impairment, potential risk factors for depression, and a review of the patient’s functional ability and level of safety. Physicians can also make referrals as needed for preventive counseling services and programs.

Between January 1 and February 23, 2011, 152,764 Medicare beneficiaries had an annual wellness visit—an average of 2800 seniors and Americans with disabilities utilizing the new benefit per day. An average wellness visit in a physician’s office is an estimated $160 for the first visit and $105 for the years thereafter; the new benefit provides the service free of charge. In addition, according to the HealthCare.gov report, it “means better health, quality of life, and potentially lower Medicare costs due to a decrease in preventable illnesses over time.” The report offered rationale for the increased coverage of preventive services, noting that studies have shown that nearly 80% of healthcare costs in the United States are associated with potentially preventable chronic conditions such as diabetes and cancer. By utilizing physician-recommended preventive services, the chances that these diseases will be identified in early stages are increased, making it possible to treat, manage, and, in some cases, cure the condition before it worsens.

Preventive services for seniors can improve the quality and length of life and reduce healthcare costs. Immunizing persons ≥65 years of age against pneumococcal disease has been shown to be particularly cost-effective, but the vaccine is underutilized. An estimated 40,000 Americans die each year due to pneumococcal infections. The mortality rate is highest among seniors, but only 58% of Americans >65 years of age receive the vaccination. One study estimates that if all seniors in the United States received the pneumococcal vaccine, healthcare costs would be reduced by $1 billion per year. Prior to enactment of the healthcare reform law, Medicare beneficiaries were often required to pay as much as $160 in coinsurance for colorectal cancer screening. Medicare did not cover the costs of smoking cessation or counseling programs until beneficiaries had met their deductible ($155 in 2010); after meeting the deductible, beneficiaries paid 20% of the services in coinsurance costs.

The HealthCare.gov report continued by noting that “in addition to improving the use of preventive services and increasing savings for beneficiaries, Medicare’s new prevention enhancements will lead to lower premiums for employers who now fill this gap in coverage. The same is true with states that fill in Medicare’s benefit gaps and cost-sharing for low-income seniors through Medicaid. Lastly, many seniors buy Medigap insurance to cover Medicare’s cost-sharing; with Medicare now paying for annual wellness visits and recommended preventive services cost-sharing, Medigap premiums should be lower.”