5. Medicare Advantage Preventive Care

Medicare Advantage preventive care

By focusing on preventive care and wellness, we can work together to help you avoid illness and stay well. Our members receive preventive screenings and other valuable services, at no additional cost when using an in-network provider. Review your summary of benefits and coverage for network provider details.

Office visits

Welcome to Medicare visit

As soon as you enroll in Medicare Part B, you can schedule your welcome to Medicare visit. This visit is covered at no cost to you by Medicare.

During this visit, your primary care physician (PCP) will record your medical history, check your vision, and take your blood pressure. They'll also check your weight and height to measure your body mass index.

This visit is a great way to make sure you're current on important screenings and shots. You'll also talk with your provider about your family medical history and ways to manage your health.

Did you know?

When you are new to Medicare Advantage you can schedule your welcome to Medicare visit and an annual wellness visit.

  • Both visits are covered at no cost ($0) to you during your first year of enrollment.
  • The annual wellness visit and all PCP visits are covered at no cost ($0) to you.

Annual wellness visit

When you visit an in-network provider you'll pay no ($0) out-of-pocket costs for these preventive services and more. Review your summary of benefits and coverage for network provider details.

  • Breast cancer mammography screening
  • Colorectal cancer screening
  • Diabetes screenings, monitoring supplies, and self-management training

Annual physical

During this visit, your PCP will learn about you and your family's medical history. They'll perform a general health assessment with a hands-on examination of all body systems.

Transportation

We cover 24 one-way rides each year to medical appointments or to the local pharmacy. If you would like a ride to an upcoming appointment, call Member Services at 1-877-232-7566 weekdays 8 a.m. - 8 p.m, (year round) and weekends (Oct. 1 - March 31) or visit our extra benefits page to set up this service at no additional cost to you.

Telehealth

Telehealth can be used to assess your risk for certain health conditions. It may also be used for your annual preventive visit or for other appointments if you don't need lab work or vaccines. Telehealth annual preventive visits should be done using audio and visual technology (a smart phone or computer). Talk with your PCP and ask if a telehealth appointment is right for you. 

Other preventive services

All preventive services are listed in your Evidence of Coverage. See the Medical Benefits chart in Chapter 4, Section 2.1. You'll see an apple listed next to the preventive services in the benefits chart.

Non-preventive care

Non-preventive care is care given to manage chronic or acute (sudden) illness. These services will have out-of-pocket costs (copays). Examples include, but are not limited to:

  • Diagnostic tests and screenings: These are non-routine tests and screenings. For example, if something suspicious is found on your screening and your provider needs additional information, follow-up tests will not be considered as preventive care.
  • Specialist visits: Visits to a specialist (gastroenterologist, orthopedist, neurologist, podiatrist, etc.) for a particular problem are not covered as preventive care. 

Caregiving and burnout

Anyone can be a caregiver

According the AARP, over 50 million of us are caregivers during any given year. Many of these people don't even realize they are caregiving. 

Whether your job requires you to provide care, or you have a loved one in need, burnout is a very real risk. When you put your needs on holds for others it can be harmful to your:

  • Health
  • Relationships
  • State of mind

Take care of yourself. Give yourself a break! Use the following strategies a few hours a week to reduce the effects of compassion fatigue.

  • Maintain personal relationships
  • Prioritize leisure activities that give you enjoyment
  • Find ways to pamper yourself
  • Make yourself laugh
  • Ask for help

If you are feeling overburdened by caregiving, consider joining a support group such as the Family Caregiver Alliance.

In-home support from Papa Pals

Papa Pals can provide 120 hours per year of in-home or virtual assistance. They can help with light housework, organization, technology, and transportation. Call 1-888-840-1609 (TTY: 711), or visit our extra benefits page to enroll.

Caregiving and burnout resources

What is Medicare Advantage?

Medicare Advantage (MA) health plans, also called Part C plans, combine Original Medicare (Parts A and B) and often Part D into one plan with a network of providers. In addition to services covered by Original Medicare (Parts A and B), your MA plan may provide many other health care services at no additional cost to you. Visit our additional benefits page to see the added services we provide you at no additional cost.

Medicare Part A

Medicare Part A covers care at hospitals and other facilities. You typically pay a deductible, coinsurance, and copays.

Part A insurance covers things like:

  •  Inpatient hospital stays
  •  Skilled nursing care
  • Hospice care
  • Limited home health-care services

Medicare Part B

In general, Medicare Part B covers your outpatient (office-based) medical care.

Part B insurance covers things like:

  • Doctor visits
  • Outpatient care
  • Medical supplies
  • Some preventive services
  • Vaccines
  • Visit Medicare.gov for a list of preventive and screening services covered by Part B

Medicare Advantage Part D (MA-PD)

Medicare Part D covers most of your medications and some vaccinations. You may need to use your Part B coverage for prescriptions, vaccinations, and other pharmacy items.

Part D insurance covers things like:

Learn more about Medicare and Medicare insurance coverage at Medicare.gov.