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Many Are Not Getting The Preventive Care They’re Entitled To

Who doesn’t think preventive health care is important?  Probably nobody if you ask this question abstractly.   But when it comes to getting it–well that’s a different matter.  Medicare stats show that too few people are getting preventive services even when they are free.  It’s darn difficult, it seems, to get people to take good care of themselves.

By mid-November, of the four million or so new beneficiaries who signed up for Medicare this year, only 3.6 percent had had their “Welcome to Medicare” exam.  Only 1.7 million of the more than 40 million seniors, most of whom were already on Medicare, had had their “Annual Wellness Visit.” A poor showing indeed given all the hoopla and hype surrounding the preventive benefits that health reform was supposed to bring to seniors.

To review:  All new Medicare beneficiaries are entitled to a free physical exam within the first twelve months that their medical, or Part B, coverage becomes effective.  It’s a one-time benefit, and Medicare says that seniors are told about the benefit when they sign up.   A Medicare spokesperson added that people, who become enrolled in Medicare as a result of receiving Social Security benefits, also automatically receive an enrollment package that discusses the “Welcome to Medicare” exam.  What about those haven’t yet taken their Social Security benefits or continue to work after they turn 65?   Apparently they’re on their own to find out.  Seniors are also entitled to an “Annual Wellness Visit”, designed to focus on delivering preventive health services.   The exam is free if the doctor accepts Medicare’s payment.  If the doctor orders tests and procedures not covered under the exam, the patient may incur some expense most likely covered by a Medigap policy or a Medicare Advantage plan.

Despite these free exams designed to catch illness early, barriers remain.  One is that doctors themselves don’t know the rules or disregard them.  A few weeks ago a 72-year-old New York City man on Medicare asked his long-time doctor for a pneumonia vaccination.  The doctor refused unless he paid him $300 up front.  This vaccination is considered the standard of care for people over age sixty-five and protects against some kinds of pneumonia, a potentially deadly disease.  That’s why Medicare covers it.

During a subsequent visit, the man again asked for the vaccine and advised the doctor that Medicare covered the injection.  This time the doctor said he had no vaccine available, and if he wanted the shot, he should go elsewhere.  It was too expensive to keep on hand, he said, because there was no demand from his patients.   Maybe that’s why he was trying to get his patient to pay out of pocket.  Or maybe his patients didn’t know they should have the shot.  But that raises another question:  why wasn’t he reminding his patients they needed the vaccination, which would prompt them to get it?

Let’s face it.  Patients themselves put off getting preventive care perhaps because they are afraid of what it might reveal.  Roadblocks like the man encountered make the task of getting the care that much harder.  It’s easy to blame Medicare for not reminding people more often about what it covers.  It’s easy to blame the docs for not delivering the right kind of care either for financial reasons or sloppy medical practice.

Patients themselves bear some responsibility too.  It’s important to read the Medicare Handbook, as dense as it may be, and it’s important to challenge your physicians when they don’t provide good care.  The New York man is reluctant to find a new doctor.   Why?  “Do you know how hard it is at this age to find a new doctor and start over?” he says.  You can’t change doctors as easily as you can go to another restaurant that pads the bill.  It’s the old trust factor in medicine.  We tend to trust even when we shouldn’t.

You can read Trudy Lieberman’s bio here.

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

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