Preventive Services in Medicare

Background

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. The Welcome to Medicare Visit is 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 and for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). States that eliminate cost-sharing for recommended preventive services in their Medicaid programs also get higher federal matching payments.  

Although all Medicare beneficiaries underutilize many evidence-based preventive services, this is more pronounced among racial and ethnic groups that are discriminated against. To address the disparity, the federal government conducts and supports efforts to collect and report data on race, ethnicity, and primary language. The Department of Health and Human Services must 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

Community outreach to increase preventive services

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. 

Preventive services research

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. 

CMS should determine the conditions and for whom Medicare coverage for comprehensive geriatric assessment is warranted. 

Research on utilization of preventive services

Federal, state, and local governments should fund research to understand better why evidence-based Medicare-covered preventive services are underutilized in the general Medicare population, particularly among groups that are discriminated against. 

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 collecting data on race and ethnicity, the federal government should 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.