Medicare Preventive Services and Health Care Reform

Last week the Obama administration announced which “preventive” services are to have no co-payments or deductibles applied under the recent health care reform legislation. You should note that this announcement does NOT apply to Medicare, but only to new insurance plans which are effective beginning in September.

Nonetheless, it gives us a good indication of exactly which services in Medicare will be wholly paid for by the Medicare program beginning next year, 2011. As you know, preventive services in Medicare currently have a hodgepodge of payment rules: some have neither any coinsurance nor a deductible, some have deductibles but no coinsurance, some have coinsurance and no deductibles, and some have both. (The details are in Chapter 4 of the book.) So what is good is first, that this hodgepodge will be simplified, and, second, that you will be incentivized to keep up with your preventive services as you won’t have to pay anything out-of-pocket for them. And as far as I can tell with the new law, this will be true whether you are in Original Medicare or in Medicare Advantage (Part C). The details on all this will be coming out in the fall as Medicare publishes the official regulations on preventive services.

And did you note that I used parentheses around “preventive” services? This is because some of the services so classified are, in my judgment, more “intervention” services than merely preventive ones. For example, the recently issued rules mandate “free” tobacco cessation services, that is, active counseling to get you to stop smoking, chewing or snuffing, and we can expect Medicare will do the same. So “stay tuned” to see exactly what Medicare will and won’t define as “preventive” services.