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Three Ounces Of Prevention

New Medicare Screening Benefits Kick In

By Lisa Barrett Mann
Special to The Washington Post
Tuesday, January 4, 2005; Page HE01

When Congress passed the Medicare Modernization Act last year, it was the prescription drug program that made headlines. But the law also added some features to the federal health program for seniors -- a "Welcome to Medicare" physical, diabetes screening and cholesterol screening -- aimed at catching common problems early, while they're easier to treat. The new benefits begin to kick in this week.

"Medicare's coverage and Medicare's expenses have historically focused on paying to treat costly health problems after they occur," said Mark McClellan, administrator of the Center for Medicare & Medicaid Services (CMS), in a December statement. "With Medicare's new support to help seniors use recommended preventive care and prescription drugs to avoid these costly and debilitating problems, that's going to change."

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The new services "could save many thousands of lives and billions of dollars in avoidable medical expenses for preventable complications associated with heart disease, diabetes, cancer, weak bones, high blood pressure, smoking, inactive lifestyles and other illnesses and unhealthy behavior," according to the CMS statement.

CMS estimates the new preventive benefits will cost Medicare approximately $2.1 billion from fiscal 2005 to 2013.

As for the anticipated savings and the health benefits for those eligible to participate, CMS has made no firm estimates, and some experts are dubious. "The results of a CMS demonstration conducted in the late 1980s and early 1990s indicated that offering Medicare beneficiaries packages of broad-based preventive services slightly improved the use of some services, such as immunizations and cancer screenings, but did not consistently improve health or lower costs," Janet Henrich of the Government Accountability Office told a congressional panel in September.

Offering preventive services doesn't guarantee seniors will use them. For example, in 2000, 30 percent of Medicare beneficiaries didn't get a flu shot, and 37 percent had never received a pneumonia vaccination (both of which were already recommended, and paid for, by Medicare), Henrich testified. "A one-time preventive care examination will add a dedicated opportunity for delivering preventive care and could help reduce the gap in the preventive services that Medicare beneficiaries receive. At the same time, it is not a panacea. Ensuring that beneficiaries receive needed services and follow-up care is likely to remain a challenge."

Such challenges and uncertainties aside, here's a look at Medicare's new features:

"Welcome to Medicare" Preventive Physical Exam

Who qualifies? New Medicare Part B beneficiaries whose coverage began on or after Jan. 1, 2005.

What's covered? A thorough physical.

How often? Only once, within the first six months of enrolling in Medicare Part B.

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