Notice of New Preventive Services Covered Under Medicare
Effective January 1, 2012, Medicare will begin to cover the services listed below at zero cost sharing.
For more information, please contact KelseyCare Advantage at 713-442-CARE (2273) or toll-free 866-535-8343 (TTY/TDD 866-302-9336), 8 a.m. to 5 p.m., Monday through Friday.
| Services That Are Covered for You |
What You Must Pay When You Get These Services |
| Intensive Behavioral Therapy for Obesity |
The following services are covered at zero cost sharing:
- Screening for obesity in adults using measurement of BMI
- Dietary (nutritional) assessment
- Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high-intensity interventions on diet and exercise For Medicare beneficiaries with obesity, whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting, Medicare covers:
• One face-to-face visit every week for the first month;
• One face-to-face visit every other week for months 2-6;
• One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement as discussed below.
At the six month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed. To be eligible for additional face-to-face visits occurring once a month for an additional six months, beneficiaries must have achieved a reduction in weight of at least 3kg (6.6 lbs) over the course of the first six months of intensive therapy. |
| Intensive Behavioral Therapy for Cardiovascular Disease |
Medicare covers intensive behavioral therapy for cardiovascular disease (CVD), which consists of the following three components:
• Encouraging aspirin use for the primary prevention of CVD when the benefits outweigh the risks for men age 45-79 years and women 55-79 years;
• Screening for high blood pressure in adults age 18 years and older; and
• Intensive behavioral counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age, and other known risk factors for cardiovascular- and diet-related chronic disease. Medicare covers one, face-to-face CVD risk reduction visit per year for Medicare beneficiaries when counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting.
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| Screening for Depression in Adults |
Medicare will cover annual alcohol screening and up to four, brief face-to-face behavioral counseling in primary care settings to reduce alcohol misuse. |
| Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling to Prevent Sexually Transmitted Infections (STIs) |
Medicare will cover up to 2 individual 20 to 30 minute, face to face counseling sessions annually for high intensity behavioral counseling to prevent STIs for all sexually active members at increase risk for STIs. High or increase risk individual behavior includes any of the following:
• Multiple sex partners • Using barrier protection inconsistently
• Have sex under the influence of alcohol or drugs
• Having sex in exchange for money
• Having an STI within the past year
• IV drug use (for Hepatitis B only)
• Men having sex with men In addition to individual risk factors, community social factors such as high prevalence of STIs in the community will be considered in determining high/increase risk.
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