Now is the time to protect yourself against the flu by getting your flu vaccine before flu season hits full force. Medicare covers the flu vaccination, along with many other preventive-health services.
People with Medicare can get the flu shot at no cost to them. There’s no coinsurance, copayment or deductible.
Keep in mind that the flu shot helps prevent the flu; it doesn’t give you the flu. Getting the vaccine is the best way to avoid getting sick this flu season. Also, by protecting yourself, you’re protecting those you care about from getting the flu from you.
Who should get a flu shot?
All adults, especially those 65 and older. People under 65 should get vaccinated if they have chronic illness, including heart disease, lung disease, diabetes, or end-stage renal disease (permanent kidney failure).
• Cover your nose and mouth with a tissue when you cough or sneeze — and throw the tissue in the trash after you use it. If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners also work.
• Don’t touch your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• Stay home if you’re sick. Wait at least 24 hours after you no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius) or signs of a fever without using a fever-reducing medicine.
In addition to flu shots, Medicare also covers vaccinations for pneumonia and hepatitis B (if you’re at medium to high risk for hepatitis B.)
And while we’re on the subject, don’t overlook other Medicare-covered preventive services such as cancer screenings (mammogram, colorectal, prostate) and cardiovascular screenings.
Each of these services is critical to your overall health and can help you prevent diseases or detect them early, when treatment works best. Check with your doctor or other healthcare provider to see if you might need other vaccines, in addition to the flu vaccine.
For more information visit medicare.gov/share-the-health or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You can also visit flu.gov for specific information about the flu. More information is available at healthcare.gov.
(If you have or know of a child 6 months or older that qualifies for Medicaid or the Children’s Health Insurance Program, the child may qualify for a flu vaccination at no cost. Check with your state Medicaid office.)
FRIENDLY REMINDER: Medicare’s annual open enrollment period ends Dec. 7. If you want to sign up for, or switch, a Medicare Advantage health plan or Medicare prescription drug plan, this is the time to do it.
Plans can change their costs and benefits from year to year, so be sure to review your coverage and make sure it still works for you. Medicare has these resources to help you:
• Visit medicare.gov/find-a-plan to compare your current coverage with all of the options that are available in your area, and enroll in a new plan if you decide to make a change.
• Call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week to find out more about your coverage options. TTY users should call 1-877-486-2048.
• Review the “Medicare & You 2013″ handbook. It is mailed to people with Medicare in September.
• Get free, personalized help from a counselor from your State Health Insurance Assistance Program (SHIP). Visit medicare.gov/contacts or call 1-800-MEDICARE to get the phone number for your state. Counseling is available over the phone or in person.
The Affordable Care Act strengthened Medicare in important ways. Signed in 2010, the federal health law already has provided free preventive health benefits to millions of people with Medicare, and saved billions of dollars for those who hit the gap in their Part D prescription drug coverage.
In 2013, discounts on prescription drugs for people who reach the Part D “donut hole” will increase, and Medicare will cover screenings and counseling for alcohol misuse, behavioral therapy for cardiovascular disease, counseling for obesity, and more.
If you reach the donut hole in 2013, you’ll pay only 47.5 percent for covered brand-name drugs and 79 percent for generic drugs.
Thanks to the Affordable Care Act, these discounts will gradually increase until the hole is closed in 2020.
In 2013, Medicare will cover one alcohol misuse screening per year for adults with Medicare (including pregnant women) who use alcohol, but don’t meet the medical criteria for alcohol dependency.
If your primary-care doctor or other primary-care practitioner determines you’re misusing alcohol, you can get up to four face-to-face counseling sessions per year (if you’re competent and alert during counseling). A qualified primary-care doctor or other primary-care practitioner must provide the counseling in a primary-care setting such as a doctor’s office.
Medicare also will cover one visit per year with your primary-care doctor to help lower your risk for cardiovascular disease. During this visit, your doctor may discuss whether taking aspirin is appropriate for you, check your blood pressure, and give you tips to make sure you’re eating well.
If you have a body mass index of 30 or more, Medicare will cover intensive counseling to help you lose weight. This counseling may be covered if you get it in a primary-care setting, where it can be coordinated with your personalized prevention plan.
In 2013, Medicare also will cover screenings for chlamydia, gonorrhea, syphilis and Hepatitis B. These screenings are covered for people with Medicare who are pregnant and/or at increased risk for sexually transmitted infection. Medicare covers these tests once every 12 months or at certain times during pregnancy.
In addition, Medicare covers up to two high-intensity behavioral counseling sessions each year for sexually-active adults at increased risk for sexually transmitted infections. Medicare covers this counseling only in a primary-care setting. Counseling in an inpatient setting, like a skilled nursing facility, isn’t covered as a preventive service.
You pay nothing for any of the above services if your primary-care doctor or other qualified primary-care practitioner accepts Medicare’s payment amount.
Medicare now covers one depression screening per year, too. The screening must be done in a primary-care setting that can provide follow-up treatment and referrals. You pay nothing for this test if the doctor or other qualified provider accepts Medicare payment, but you generally have to pay 20 percent of the Medicare‑approved amount for the doctor’s visit.
Besides these services, Medicare covers a long list of preventive benefits — often at no cost to you — to help you stay healthy and detect disease in its most treatable stages.
Medicare-covered preventive services include tests and screenings for breast, prostate, cervical, and colon cancer; screenings for conditions that may trigger heart attack or stroke; checks for diabetes and glaucoma; and counseling to help you stop smoking.
You’re also entitled to a one-time “Welcome to Medicare” checkup during the first 12 months after you take Medicare Part B, and wellness visits with your doctor each year after that. These visits are free.
Shots to protect you against flu and pneumonia also are free.
The Affordable Care Act eliminated deductibles and co-pays for most Medicare preventive services in order to encourage people to use them more.
Please take advantage of them.
David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii and the Pacific Trust Territories.
You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).
Do you know someone who has been denied health insurance due to a pre-existing condition?
If so, they may be eligible for the Pre-Existing Condition Insurance Plan. Call toll free 1-866-717-5826 (TTY 1-866-561-1604) or visit pcip.gov and click on “find your state” to learn more.