Nov. 25, 2004

AMARILLO – A classic New Year's resolution is to work on getting healthier. This New Year, maybe Medicare can help.

Beginning in 2005, new Medicare beneficiaries will be able to access a broader range of preventive care procedures, including some for heart disease and diabetes, according to Health and Human Services Secretary Tommy G. Thompson.

These changes, in fact, have been planned for a while.

"These are changes that went into effect with the Medicare Prescription Drug Improvement and Modernization Act of 2003," said Andrew B. Crocker, Texas Cooperative Extension program specialist in gerontology and health.

With new benefits comes a new name – "Medicare Advantage," which was previously known as Medicare + Choice or Medicare Part C, Crocker said.

Medicare was originally available in two parts, Crocker explained:

- Medicare Part A covers inpatient care for hospitals and skilled nursing facilities. Part A also helps cover hospice care and some home health care, he said.

"Most people don't pay monthly for Part A because they or their spouse paid into Medicare for at least 40 quarters."

- Medicare Part B helps cover doctor services and outpatient care. Part B also covers some other medical services that Part A does not, such as physical and occupational therapists when medically necessary, Crocker said.

"Part B coverage also covers the screening (programs) and shots that Medicare provides."

Coverage under Medicare Part B is optional, he said. Beneficiaries pay a monthly premium which can be deducted from Social Security checks if desired.

"Together, these two parts comprise what is known as ‘Original Medicare'," Crocker said, which is the traditional fee-for-service Medicare plan available nationwide.

"You can see any doctor or provider without a referral as long as he or she accepts Medicare."

The new Medicare Advantage Plans require beneficiaries to be enrolled in both Part A and Part B.

"You may pay lower co-payments and get extra benefits, but you are more limited as to choice in health provider," Crocker said. "Medicare Advantage Plans are structured to work more like an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). You have a primary physician and are referred to other health providers (when needed)."

In addition to covering more preventive medical procedures, this new plan is designed to offer new enrollees more access to health education services too. Some of these services provide information on healthful diets, proper exercise and quitting smoking.

Medicare beneficiaries who enroll after Jan. 1, 2005, will receive a "Welcome to Medicare" physical examination, Crocker said.

"New enrollees in Medicare Part B will receive a one-time physical examination to document height, weight, blood pressure, baseline EKG and some education and counseling," he said.

"Existing Part B beneficiaries do not receive this benefit – just those enrolling after Jan. 1, 2005."

Added to that will be the availability of new tests including cardiovascular blood work to check for lipids, cholesterol and triglycerides, and a fasting plasma glucose test for diabetes screening, he said.

Those already enrolled in Medicare Part B have access to medical procedures such as bone mass measurements, colorectal cancer screenings, diabetes training, mammograms, Pap tests and pelvic exams, prostrate cancer screenings and vaccinations for flu, pneumonia and hepatitis B, Crocker said.

For more information on Medicare and its new options, visit the Web at http://www.medicare.gov/