Medicare Preventive Services in 2011: A New Service and Changes in Cost Sharing

You need to start planning your 2011 preventive services now to take full advantage of changes to Medicare which have come about in the health reform legislation.

The most significant change in Part B will be the introduction of an annual “wellness exam” and the elimination of applying the annual deductible or paying coinsurance for many preventive services. If your provider accepts assignment for these services, you will pay nothing for them. But not all preventive services are included.

The new Annual Wellness Exam is a physical exam which includes a “comprehensive health risk assessment” and a “personalized prevention plan.” The personalized prevention plan takes into account the findings of the health risk assessment and include elements such as: a five- to ten-year screening schedule; a list of identified risk factors and conditions and a strategy to address them; health advice and referral to education and preventive counseling community-based interventions to address modifiable risk factors such as physical activity, smoking, and nutrition. No coinsurance or deductible will apply to this newly covered service.

You can get this exam once every 12 months, but not within first 12 months of Part B enrollment (which is the timeframe in which you can get the “Welcome to Medicare” physical exam). And, because is it very similar, you can‘t get it within 12 months of a “Welcome to Medicare” exam.

Most beneficiaries should immediately schedule one of these exams for 2011 with their physician, as, unless they meet either of the two exceptions above, the sooner they get it, the sooner they can get it in subsequent years. Plus my experience is that it often takes a good deal of time to schedule a physical, so call now for your first date in 2011.


These are the preventive services which, beginning in 2011, will not be subject to the Part B deductible or coinsurance:

“Welcome to Medicare” Physical Exam
Annual Wellness Exam
Abdominal Aortic Screening
Bone Mass Measurement
Flexible Sigmoidoscopy
Colonoscopy
Pelvic Exam and Clinical Breast Exam
Screening Mammogram
Tobacco Cessation Services
Medical Nutrition Therapy Services
Hepatitis B Shot

If you have not gotten these and you are otherwise eligible (the criteria are spelled out in Chapter 4 of Managing Your Medicare) you should take this opportunity to make an appointment in 2011 to get the service.


Note that these preventive services already had no cost sharing, and if you need them, get them right way, don’t wait ‘til 2011:

Cardiovascular Disease Screening (lab test)
Fecal Occult Blood Test (lab test)
Diabetes Screening (lab test)
HIV Screening (lab test)
Pap Smear (lab test)
PSA (lab test)
Flu Shot (including the “swine” flu (H1N1) shot)
Pneumococcal Pneumonia Shot

(Note that lab tests have to be assigned and are not subject to the deductible or coinsurance, but you may have to pay part of the cost of the visit to take the specimen or have the results interpreted.)


These preventive services will continue, in 2011 and beyond, to have the deductible and coinsurance apply, as before, so there is no sense in waiting to avail yourself of them:

Barium Enema
Glaucoma Screening
Digital Rectal Exam
Kidney Disease Education (KDE) Services