There are two main types of prevention. In primary prevention, the goal is to promote good health. In secondary prevention, the goal is to detect disease at early stages when it is most treatable. To help achieve both these goals, the Affordable Care Act (ACA) introduced Medicare’s Welcome to Medicare Visit, a one-time preventive physical examination within the first 12 months of becoming eligible for Medicare Part B. Annual wellness visits are available thereafter. These exams, which are not subject to a deductible or copayment, must include a comprehensive health risk assessment and the development of a personalized prevention plan. Medicare also waives deductibles or copayments for other preventive care that meets certain criteria. Cost-sharing is also waived for preventive services that have a U.S. Preventive Services Task Force rating of A or B. The ACA also provides enhanced federal funding to states that eliminate cost-sharing for recommended preventive services in their Medicaid programs. In addition, the ACA waives Medicare Part B cost-sharing for vaccines recommended by the Advisory Committee on Immunization Practices. Vaccines covered under Medicare Part D are not exempt from cost-sharing.
Although all Medicare beneficiaries underutilize many evidence-based preventive services, this is more pronounced among historically disadvantaged racial and ethnic groups. To address the disparity, the ACA requires federally conducted or federally supported health care activities or public health efforts to collect and report data on race, ethnicity, and primary language. The law requires the Department of Health and Human Services to develop standards for collecting these data to provide statistically reliable population estimates. Another way to reach underserved populations is to provide information about preventive services in senior centers and other congregate facilities, such as affordable housing.
PREVENTIVE SERVICES IN MEDICARE: Policy
PREVENTIVE SERVICES IN MEDICARE: Policy
Federal, state, and local governments should fund community-based outreach, education, and promotion efforts that include targeted initiatives for at-risk and underserved beneficiaries. The aim is to increase the number of Medicare beneficiaries who use covered preventive services and screenings.
Outreach, education, and promotion efforts should be culturally competent and language accessible. In addition, to the extent possible, these efforts should be evidence-based. States and localities have a vested interest in doing this because they provide funding, often through care coordination arrangements, for dual-eligibles (e.g., Medicare beneficiaries who are also eligible for Medicaid).
Cost-sharing for preventive services
The Department of Health and Human Services should make A- and B-rated preventive services available without cost-sharing only for those beneficiaries for whom the U.S. Preventive Services Task Force finds evidence to support such a provision. Vaccines recommended by the Advisory Committee on Immunization Practices should be made available without cost-sharing in Medicare Part D.
Congress should continue to adequately fund research to identify and evaluate appropriate preventive and screening services that Medicare does not cover.
Comprehensive risk assessment
The federal government should ensure that an evaluation of medical and family history for purposes of developing a comprehensive risk assessment includes cognitive ability, diet and exercise history, depression screening, substance use history, and social and sexual history.
Research on utilization of preventive services
Federal, state, and local governments should fund research to better understand why evidence-based Medicare-covered preventive services are underutilized in the general Medicare population, particularly among historically disadvantaged groups.
Special care should be taken to include older adults with disabilities and, where appropriate, people with chronic conditions in this research.
In developing standards for the collection of data on race and ethnicity, the federal government should take steps to ensure that such data reflect statistically reliable population estimates. They should develop criteria for whether and how such methods as geocoding and surname analysis may be used, as well as when the use of such strategies is contraindicated.