What women should know about Medicare coverage for health screenings and tests

As women age, our risk for certain chronic diseases increases. We can thank the aging process itself and the loss of the protective effects of estrogen after menopause. Older women are more likely to suffer from diseases such as osteoporosis, which can cause brittle bones. The likelihood of heart disease increases, as does the likelihood of developing dementia, in part because women tend to live longer than men and the risk increases with age.

Diagnosing some conditions is more difficult, as the frequency, appearance, and long-term effects of many diseases often appear differently in women than in men. It’s a key reason not to neglect regular health exams and wellness visits, since staying healthier through preventative care and screenings can ease the health challenges of aging.

Wellness Exams Essential for Older Women

Medicare pays for annual preventive care with no copay. This is especially relevant for women, who accounted for more than half (55%) of all Medicare beneficiaries in 2021. Nearly 1 in 8 (12%) were age 85 or older; many had functional difficulties, according to a KFF analysis. That included difficulty walking, bathing, vision loss or other problems that significantly affected their quality of life. People aged 85 and older tend to have five or more chronic diseases, which can become more complicated to manage with age.

Women know to focus on their health, says Alina Salganicoff, KFF women’s health policy director. But “sometimes the system is not prepared for women to take care of themselves, because they have competing demands, such as work or family care responsibilities.” This often creates limited time periods for women to prioritize themselves.

And, if women don’t have access to a primary care provider or receive regular care, they may skip important preventative measures like mammograms, she says.

“Having coverage is the first step, but many other factors affect whether women get the services they need,” Salganicoff says. That includes your relationships with your doctors, your own prior experiences, access to care, fears about conditions like dementia or cancer, or social supports like transportation, mobility, or cognitive issues, or having someone to support you. accompany

That first wellness visit is likely key to everything else in managing an older patient, according to Segen Chase, an internal medicine physician in private practice in Manhattan, Kansas. About 35% of the patients at her clinic are Medicare beneficiaries, including many who live in a nearby retirement community.

“It is very important that we do everything we can to have them visit and work with the practice’s wellness coordinator to complete all necessary assessments,” said Chase, who is part of American Medical Women’s WEL leadership training program.

Wellness exams include annual monitoring of numerous physical and behavioral markers such as vision, hearing, fall risk, sexual health, nutrition, alcohol and tobacco use, as well as psychosocial risks such as depression, stress, loneliness or social isolation, pain and fatigue. Patients also undergo cognitive testing, which can reveal subtle changes in brain health.

Wellness exams can also include questions about someone’s living situation, because they help us determine if they might need additional help at home, Chase says. “That also gives us the opportunity to discuss advance care planning, when they are not in a crisis situation.” Medicare pays for this as part of the annual Part B wellness visit.

According to KFF analysis, women with Medicare generally experience higher rates of certain health conditions compared to men. Urinary incontinence (37% vs. 18%), depression (31% vs. 21%), osteoporosis (29% vs. 7%), and lung disease (20% vs. 16%) were more common among women than among men. Women are also more likely than men to live alone. More than one-third of all women with Medicare (36%) live alone and more than half of those over age 85 live alone. This can increase the chances of loneliness and social isolation, which are linked to an increased risk of depression, dementia and stroke, according to the American Medical Association.

The wellness visit can help uncover some of the hidden problems, and together, the doctor and patient can create a care plan to manage these and other chronic conditions, Chase says.

What preventive women’s health services does Medicare cover?

Medicare Part B covers a variety of preventive services that benefit women’s health, including:

There are no copays, deductibles, or coinsurance charges for these and other covered exams, although other criteria may apply, according to the Medicare Rights Center. Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) will even help pay for an injectable osteoporosis medication and visits from a home health nurse to inject the medication if you are eligible.

This partial list of screenings covered by Medicare may seem daunting, which is why it’s so important for women to talk to their doctors and discuss their health history, risk factors, and priorities, according to Salganicoff. “It’s a complicated program and can be difficult for people to navigate,” she says.

These shouldn’t be one-off conversations either, Chase says. As we age, priorities and what is realistic for a person to achieve can change. Therefore, continuous dialogue is key to maintaining health.

We know that certain conditions manifest differently in women, so “a lot of medicine comes back to communication, maintaining the sanctity of the relationship while honoring their independence and finding out what is most important to that person.” “, says. Chase finds these conversations help women open up more about their physical and emotional challenges, especially those who are caregivers. “They are often exhausted but don’t want to admit it.”

Providing women with clear, simple information so they can learn about all of their Medicare benefits and receive the support they need to obtain preventive care and other needed services can go a long way toward keeping women healthy well into old age.

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