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April 28, 2020
Medicare Moms: Use Your Women-Focused Medicare Benefits

Medicare Moms: Use Your Women-Focused Medicare Benefits

The month of May hosts two essential events for women: Mother’s Day and National Women’s Health Week. Is it a coincidence that these two coincide each year? We don’t think so.

Women are constantly giving to others – we need to be reminded to take some time for ourselves. Put yourself first this month and make sure you’re taking advantage of the many women-focused Medicare benefits available to you.

Most screenings and preventive exams are paid for in full by Medicare, so you have nothing to lose!

What Is National Women’s Health Week?

National Women’s Health Week is all about raising awareness for women – there’s so much we can do to stay on top of our health (Centers for Medicare and Medicaid Services (CMS).

This week of health awareness, which lasts from Mother’s Day (May 10) through May 16, 2020, is a critical movement for women because we live longer than men and are the most vulnerable.

According to NCPSSM:

  • More than half of Medicare’s nearly 57 million recipients are women; for beneficiaries 85 and over, almost 70 percent are women.
  • Women live longer than men and are more likely to suffer from three or more chronic conditions including arthritis, hypertension, and osteoporosis.
  • More women than men suffer from physical limitations and cognitive impairments that limit their ability to live independently.
  • Women have lower incomes than men.

During the COVID-19 outbreak, this health observance week is even more important as we remind women across our country to take care of themselves. While we’ll be focusing on how Medicare can help you, taking care of yourself isn’t just about preventive screenings and tests.

The Office on Women’s Health encourages women to take care of body and mind by:

  • Staying connected to your healthcare provider, especially if you have any concerns about COVID-19
  • Maintaining a healthy weight
  • Staying active
  • Eating well-balanced meals and snacks
  • Taking care of your mental health by staying connected with family and friends
  • Managing stress – meditation can be a tremendous help
  • Practicing good sleeping habits – following a routine and aiming for 7 hours a night is a great start
  • Monitoring alcohol intake
  • Quitting smoking and vaping

We have several articles here at Medicare Allies that can help you reach many of these goals, so check them out when you’re done here!

What Medicare Benefits Does Medicare Offer Women?

Living a full, healthy life is the goal here, so instead of chasing diseases and ailments, let’s work to catch them early! Medicare helps women prevent health conditions by offering various screenings and preventative services.

The four most important screenings and services for women are:

  1. Screening mammograms
  2. Bone mass measurements
  3. Screening Pap Tests
  4. Screening Pelvic Exams

Let’s go through each service to get a better understanding of what it is, why it’s important, and what Medicare pays for.

1. Screening Mammograms

Mammograms are used to detect breast cancer and other abnormalities in the breast. According to the American College of Radiology, it’s the only test known to reduce breast cancer deaths.

It’s worth going to a facility that specializes in mammograms and does many mammograms each day (American Cancer Society). If you switch facilities, make sure you bring information about past mammograms, including dates, biopsies, and other breast treatments you’ve had before.

If you’re new to the annual mammogram, here are a couple of tips:

  • Don’t wear deodorant on the day of your exam. Some antiperspirants can show up on the X-ray as white spots.
  • Wear a skirt or pants instead of a dress. That way, you only have to remove your top and bra for the mammogram, not your whole outfit.

What to Expect

The actual mammogram requires you to be topless; the facility will give you a wrap to cover yourself. A technologist will position your breasts on the machine’s plate. A plastic upper plate is lowered to flatten your breasts for a few seconds while a picture is taken. You then change positions before the next picture is taken. Two views of each breast are taken for a screening mammogram.

A typical mammogram takes about 20 minutes, but the breast compression part only lasts a few seconds each time. Some women find the compression painful, so tell your technologist if you’re in pain.

Mammograms and Medicare

Medicare Part B, or your medical insurance, covers an annual screening mammogram and diagnostic mammograms more often if your healthcare provider says it’s medically necessary.

If you’re between ages 35-39 and on Medicare, you can have one baseline mammogram until you’re 40. Then, you’re covered for an annual mammogram.

The screening mammogram is free as long as your healthcare provider accepts Medicare (this is called “Medicare assignment”).

If you have breast symptoms or your doctor notices something on the screening mammogram, you’ll need a diagnostic mammogram. For a diagnostic mammogram, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. If you have a Medicare Supplement, you won’t have the 20% coinsurance.

According to CMS.gov’s Physician Fee Schedule tool, the average national cost of a diagnostic mammogram in an approved facility is $136.42 (assuming HCPCS Code 77065 is used). This cost can range depending on your specific location and the exact billing code your provider uses.

If you have a Medicare Advantage plan, check with your plan to find out your costs.

2. Bone Mass Measurements

Regular screening for bone mass measurements, or bone density, can help in the prevention of bone loss, or osteoporosis, which can lead to bone fractures and loss of mobility.

A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. The National Osteoporosis Foundation (NOF) recommends a bone density test of the hip and spine by a DXR (dual-energy x-ray absorptiometry) machine to diagnose osteoporosis.

A bone density test is performed on the hip and spine for the following reasons:

  • These bones have a greater chance of fracturing or breaking
  • They require long recovery periods
  • They cause severe pain
  • They can be debilitating
  • The bone density in the hip and spine are a good predictor of the likelihood of fractures or breaks in other bones

NOF recommends a bone density test for all women 65 and older. If you break a bone after age 50 or have any risk factors, it’s also recommended that you have bone density testing done.

A bone density test may also be necessary if you have any of the following:

  • an X-ray of your spine showing a break or bone loss in your spine
  • back pain with a possible break in your spine
  • height loss of ½ inch or more within one year
  • total height loss of 1½ inches from your original height

What to Expect

You’ll probably need a prescription or referral from your health care provider to have a bone density scan done. Be sure to take it with you to your appointment so they can send the results to your doctor.

A bone density test is non-invasive and painless, which means there are no needles or instruments placed into your skin or body.

You can remain fully dressed during a bone density scan. You just need to make sure there are no zippers, buttons, or metal snaps on your clothing around your waist or along your spine area.

The whole process only takes about 15 minutes. You will lie still on your back with your arms at your side and your lower legs and feet will be elevated on a soft block. The machine will move above your body and take images using very little radiation.

When the hip and spine density cannot be measured, as in the case of larger people weighing over 300 pounds, your provider will perform the same scan on the radius bone in the forearm, and do a peripheral bone density test of the heel or another bone.

Bone Mass Measurements and Medicare

Medicare Part B, your medical insurance, covers a bone mass measurement test once every 24 months (more often if deemed medically necessary) if you meet at least one of these conditions:

  • You’re a woman whose doctor determines you’re estrogen-deficient and at risk for osteoporosis, based on your medical history and other findings.
  • Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures.
  • You’re taking prednisone or steroid-type drugs or are planning to begin this treatment.
  • You’ve been diagnosed with primary hyperparathyroidism.
  • You’re being monitored to see if your osteoporosis drug therapy is working.

If your doctor accepts Medicare and you meet one of the conditions above, bone mass measurements are free.

Your doctor may request that you have additional screenings or other tests that your Medicare plan doesn’t cover. If this happens, you may have to pay for some or all of the services.

Ask questions about the tests your doctor is recommending, and check with Medicare to see what will and won't be covered.

If you have a Medicare Advantage plan, check with your plan to see what will be covered.

3. Screening Pap Tests and Screening Pelvic Exams

These two tests are lumped together because they work in unison to check for cervical and vaginal cancers. 

A Pap smear, also called a Pap test, checks for the presence of precancerous or cancerous cells on your cervix. About 69% of women have had a Pap test in the past 3 years (CDC). 

If you’re 65 or older, odds are you’ve have many Pap smears in your life. Current research recommends women get Pap smears every three years starting at age 21. However, women over 65 with a normal Pap smear history may be able to stop having the test in the future (Healthline).

WebMD explains women over 65 can stop getting screened if they’ve had at least three negative Pap tests in a row or two negative HPV tests in the last 10 years. Women with a history of a more advanced precancer diagnosis should continue screenings for at least 20 years.

Talk to your doctor about whether or not you need to continue Pap smear screenings.

A pelvic exam helps assess your gynecological health. The doctor is looking for ovarian cysts, STIs, uterine fibroids, or early-stage cancer. This is typically done at the same time as a Pap test, and the pelvic exam is recommended annually no matter your age.

What to Expect

While Pap tests can be uncomfortable, it’s very quick. Your doctor will ask you to undress for this exam, and a gown will be provided. A speculum is inserted to provide access to the cervix. The doctor then scrapes a small sample of cells from your cervix. Those cells are sent to a lab for testing.

Typically, at the same time, your doctor will do a pelvic exam. This also only lasts a few short minutes. The doctor checks your vulva, vagina, cervix, ovaries, uterus, rectum, and pelvis for any abnormalities.

The doctor will first do an external visual exam followed by an internal exam using a speculum, and at this time, your doctor may also do a Pap test. Once this is done, your doctor will likely do a physical exam by pressing on your abdomen and pelvis to check your uterus and ovaries.

While this can be an uncomfortable exam, your doctor should be explaining everything as she goes so that nothing is a surprise. Take deep breaths and remain calm.

Pap Tests, Pelvic Exams, and Medicare

Medicare Part B, your medical insurance, covers these screening tests once every 24 months. If you’re at high risk for cervical or vaginal cancer, or if you’re of child-bearing age and had an abnormal Pap test in the past 36 months, Medicare covers these screening tests once every 12 months.

If your doctor or healthcare provider accepts Medicare, the Pap smear and pelvic exam is free.

Staying Strong and Healthy

During the month of May, women are encouraged to connect with family and either begin or continue an effort to be healthy through preventative measures.

Along with the screenings that Medicare provides, it’s vital to stay physically active and eat a healthy diet.

Taking care of yourself, so you can live a long, active life is important to everyone who loves you. This May, make YOU a priority!

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