Medicare & ACA/ObamaCare Preventative Care

Trump  Make America Healthy Again

Nearly half of the U.S. population is pre-diabetic or has type-2 diabetes. Every month, diabetes causes 13,000 new amputations, 5,000 new cases of kidney failure and up to 2,000 new cases of blindness in our country. In 1960, approximately 13 percent of American adults were obese. Now, more than 40 percent of Americans are obese, and more than 70 percent are either obese or overweight.

Even more shockingly, one-quarter of our teenagers today are pre-diabetic or have type-2 diabetes, and obesity is the leading medical reason that 71 percent of young Americans are disqualified from military service.  Learn More >>> The Hill 

#ACA / ObamaCare Preventative Care & Wellness Programs

Anthem Preventative Care

anthem preventative care

 

 

Resources & Links

  • A federal appeals court in Texas  on 6.21.2024 (read courts actual ruling)  found unconstitutional a key component of the Affordable Care Act that grants a health task force the effective authority to require that insurers both cover an array of preventive health interventions and screenings and refrain from imposing out-of-pocket costs for them. NBC News *
  • California law that requires all health plans regulated by the State of California to cover the same necessary preventive services at no cost to the patient, consumers enrolled in plans offered through Covered California will continue to have access to these critical health care services without disruption.  Covered CA Email dated 4.6.2023 * Joint Statement
  • FAQ finding doctors, labs and hospitals, when there’s confusion

 

All our plans are Guaranteed Issue with No Pre X Clause
Quote & Subsidy #Calculation
There is No charge for our complementary services

Guaranteed Issue - No Pre X Clause - Quote & Subsidy Calculation - No charge for our complementary services - If not in CA click here for Nationwide Quotes

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that explains everything about getting a quote

Full detailed explanation of how to use our quote engine video

Medicare Preventative Services 

Medicare #Preventative Services & Wellness Visit   Publication  # 10110

Medicare Preventative Services

 

 

Video's

you tube videos

 

See also programs that might be offered by Medi Gap or Medicare Advantage Carriers

#Medicare10050 and You  2025
Everything you want to know 

Steve's video on Medicare & You

***********

your medicare benefits # 101116

 

Nutrition & Weight

 #nutrition & weight control 

I lost 20 pounds and 4″ off my waist in 2011 and while my gut might be a little bigger… in the years since, at least I fit into the smaller clothes.  Here’s some of the tips and suggestions I found helpful.

 

Insurance Company Information

 

 

Food & Nutrition Calculators

The online dietary assessment provides information on your diet quality, related nutrition messages, and links to nutrient information. After providing a day’s worth of dietary information, you will receive an overall evaluation by comparing the amounts of food you ate to current nutritional guidance. To give you a better understanding of your diet over time, you can track what you eat up to a year.

Resources

Our other pages on Preventative & Wellness Benefits & Tips

Try this so your host or the waiter or host knows your full

Dining Etiquette Seminar – Eating Styles
See also Huff Post.com

Etiquette scholar.com 
dining I'm finished

Wellness and Prevention Programs from #Kaiser

 

Employers have an opportunity to improve the health of your employees every day. Making small changes to your workplace and company policies is a great way to start, and it’s where you can make the biggest impact. On these pages, you’ll find the tools and support to build a culture of health at work — and see how the right partner can help guide you along the way.

reduce absences caused by the flu set up on-site flu clinics. There’s a 6-week lead time to set up a clinic and clinics are available from mid-September to mid-December depending on your  location.

Benefits of Employee Wellness Programs for Small Business

6 Low-Cost Wellness Ideas for Small Businesses

More Kaiser Tools

 

Kaiser’s Website on why workforce health Matters

Kaiser's Website on why workforce health Matters

 

Mental Health

kaiser my strength
myStrength_for_Employers_Brochure
myStrength_Flyer_National
Calm_Promotional_Flyer

 

 

Controlling Presenteeism

 

It’s Monday morning, and all your employees are at their desks working—to some degree. Bill is having a mild asthma attack that’s making it hard for him to concentrate, Anne is dealing with depression, and Dana is still worn out from the flu. They’re at work, but not really all there. This is called “Presenteeism,” and we want to help you find a way to make sure your employees are at their best.

Quality Dividend CalculatorTM 2011, gives you a simple way to estimate how your choice of health plan will affect the productivity and absenteeism of your workforce.

When employees get higher quality care, they stay healthier, absenteeism drops, and productivity improves

Fewer Days Lost with Better Medical Coverage

Give yourself the winning edge with a customized online program from Kaiser Permanente in collaboration with Health Media®. You’ll get the clear steps and ongoing encouragement it takes to reach your health goals.

Presenteeism refers to attending work while ill. 

 
The development of interest in presenteeism, considers its various conceptualizations, and explains how presenteeism is typically measured.  Presenteeism has important implications for organizational theory and practice and the purchase of Employer Group Health Insurance.
 
Monday morning presenteeism

graph drain on productivity

why premiums are increasing

Insomnia – Proper Rest & Sleep

Get a Return on your Investment of your Health Insurance Premiums

 

Premiums are only 24 percent of your total health care costs. The other 76 percent are indirect costs associated with:

• Presenteeism—people showing up for work but not being as productive as they could be—63%

• Absenteeism and short-term disability—12%

• Long-term disability—1% For example, overweight and obese employees take more sick leave than nonobese employees and are twice as likely to have high-level absenteeism.

The average annual cost of medical expenses and absenteeism related to obesity can range from $460 to $2,500 per employee.

healthy.kaiserpermanente.org/flu 

Mammogram, Bone Density & Osteoporosis

#Mammogram coverage under Medicare

 

Breast cancer screening (mammograms)

Breast cancer is the most common non-skin cancer in women and the second leading cause of cancer death in women in the U. S. Every woman is at risk, and this risk increases with age. Breast cancer usually can be treated successfully when found early. Medicare covers screening mammograms and digital technologies to check for breast cancer before you or a doctor may be able to find it manually.

Who’s covered?

Women 40 and older are eligible for a screening mammogram every 12 months. Medicare also covers one baseline mammogram for women between 35–39.

How often is it covered?

Once every 12 months.

Your costs if you have Original Medicare

You pay nothing for the test if the doctor accepts assignment.

Am I at high risk for breast cancer?

Your risk of developing breast cancer increases if any of these are true:

• You had breast cancer in the past.

• You have a family history of breast cancer (like a mother, sister, daughter, or 2 or more close relatives who’ve had breast cancer).

• You had your first baby after age 30.

• You’ve never had a baby.

 

Other pages on our website dealing with cancer and how Insurance and Rx Prescription coverage might pay for it

 

 

Medicare Coverage of #Cancer Treatment # 11931 

coverage for cancer under Medicare

Preventative Care
Bone Density Osteoporosis 

Medicare covers bone mass measurements to see if you’re at risk for broken bones due to osteoporosis. Osteoporosis is a disease in which your bones become weak and brittle. In general, the lower your bone density, the higher your risk for a fracture.

Bone mass measurement results will help you and your doctor choose the best way to keep your bones strong..
 
Who’s covered?
 .
Bone mass measurements are covered for certain people with Medicare whose doctors say they’re at risk for osteoporosisand who have one of these medical conditions:.
 
• A woman whose doctor or health care provider says she’s estrogen-deficient and at risk for osteoporosis, based on her medical history and other findings
• A person with vertebral abnormalities as demonstrated by an X-ray
• A person getting (or expecting to get) steroid treatments
• A person with hyperparathyroidism
• A person taking an osteoporosis drug.
 
How often is it covered?
 .
Once every 24 months (more often if medically necessary).
.
Your costs if you have Original Medicare.
.
You pay nothing for this test if the doctor accepts assignment.  Publication 10110 
 
 
.
 
Costs if you have a Medicare Advantage Plan?
 
Just as an example – Blue Cross MediBlue Access PPO  EOC Evidence of Coverage
 
In network – No charge, but subject to the qualifying rules above. EOC Page 45
Out of Network – $1,250 annual deductible and you pay 40%

Vision 

How often are Eye exams covered?

Medicare doesn’t cover routine eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses. Medicare Part B (Medical Insurance) covers some preventive and diagnostic eye exams:

by an eye doctor who’s legally allowed to do the test in your state.

Who’s eligible?

All people with Part B who have diabetes are covered.

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount for the doctor’s services, and the Part B deductible applies. In a hospital outpatient setting, you pay a copayment.

Note

To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service. medicare.gov yearly-eye-exam

  • cms.gov/VisionServices_FactSheet
  • FAQs / Ask Us a Question
  • ICD billing codes
    • 92012 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
    • 92083 — extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees, or quantitative, automated threshold perimetry, Octopus programs G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2).
    • 92083 — extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees, or quantitative, automated threshold perimetry, Octopus programs G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2).

Dental For #Everyone,
has an excellent  website with full brochures, Instant online quoting and enrollment

Dental for everyone free quote

VSP Vision Enroll ONLINE

Child & Related Pages – Site Map 

Medi-Cal Share of Cost

If you are low income you might check out LIS – Low Income Subsidy – Extra Help to pay the Rx costs that are not covered.  LIS may also pay your Part D and Part B premiums and you might also qualify for Medi-Cal.

Part D Rx Low Income Subsidy – LIS – Extra Help

6 comments on “Preventative Care – Wellness Visit – Medicare

    • Vitamin D Assay Testing: Medical Necessity and Documentation Requirements

      82306-Vitamin D, 25 HYDROXY, includes fraction(s), if performed

      Vitamin D lab assay is only reimbursable under Medicare when it meets the indications under the applicable LCD and not as a routine screening according to 42 CFR 410.32(a) source

      § 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

      (a) Ordering diagnostic tests. Except as otherwise provided in this section, all diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests must be ordered by the physician who is treating the beneficiary, that is, the physician who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem. Tests not ordered by the physician who is treating the beneficiary are not reasonable and necessary (see § 411.15(k)(1) of this chapter).

      Our webpage on Medicare Appeals

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