Medicare will soon cover preventive exams

A nice surprise buried somewhere in health care reform is that, starting next year, Medicare patients will be able to get annual preventative care exams that are paid for by their health insurance.

It may come as a surprise to those of you with commercial insurance who think of coverage of an annual exam as a routine thing for insurance to cover, but up to now Medicare has only covered a “Welcome to Medicare” exam in the first year after turning 65.

From then on, no physical exams at all are covered, and many preventative services, like colonoscopy and mammography, were either not covered, or subject to fairly high co-pays and deductible costs. As a physician this has always seemed like this is backwards.

I can make a pretty good argument that a physical exam for a 27 year old man is not needed annually, but it is essentially always a covered benefit in any plan the young insured patient has through an employer. Older adults are far more at risk for cancer, heart disease, diabetes, hypertension, depression, and safety at home issues than young adults. I am pleased that better preventative services coverage for our older and more vulnerable adults will be a paid service starting in 2011.

Starting September 23, 2010, 6 months after the signing of the bill, all new insurance plans, or current plans which make certain changes will be required to cover preventative services recommended by the United States Preventative Services Task Force as category A or B ratings (A = conclusive evidence and B = very strong evidence showing benefit of receiving the services) and beginning January 1, 2011, Medicare will also cover these services with no co-pay or deductible applicable.

This is good news for our seniors and should make it much easier for their physicians to convince our seniors, some of whom now have to choose between shelter, food or medicine on their poverty level fixed incomes, to receive preventative care.

Edward Pullen is a family physician who blogs at

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