Medicare Dads: Use Your Men-Focused Benefits

Men – founders of our country, pillars of the community, and the cornerstone of the family. The person everyone relies on for, well, pretty much everything.

They spend their whole lives providing for and protecting their fortune and family, but when it comes to taking care of themselves, they’re missing the mark.

Is it any wonder that:

• Men's life expectancy in the United States is more than 10% lower than women's.
• Over the last 30 years, the mortality rate has increased more for men than for women in every age category.
• Men suffer higher rates of death and serious illness than women for most of their adult lives. (Web MD)

Plus, a study by the Centers for Disease Control and Prevention (CDC), shows:

• Women are 33% more likely to visit a doctor than men.
• The rate of doctor visits for annual examinations and preventive services was actually 100% higher for women than for men.

These statistics are staggering!

It’s time for men to take hold of their health and understand the importance of prevention.

That’s why there’s a National Men’s Health Week devoted to bringing awareness to preventive health care.

What is National Men’s Health Week?

Each year, the week leading up to Father’s Day focuses on raising health awareness for men. 

In 2020, National Men’s Health Awareness Week is June 15-21st. This week is crucial to men's well-being, given they don’t typically go to the doctor when they’re sick, much less when they aren’t.

So, if you're a man – or have men in your life that you love – this information is for you.

Let's take a look at preventative screenings and tests covered by Medicare. Also, with the presence of COVID-19, staying healthy has taken on an even greater meaning. Even though our country is beginning to open back up, we still need to be careful and take care of ourselves.

According to the CDC, most chronic diseases can be prevented, or slowed, by making healthy choices like:

• Eating well
• Being physically active
• Avoiding tobacco and vaping products
• Limiting alcohol
• And now with the concern over COVID-19, practicing social distancing

The Importance of Preventative Care

Denis Parsons Burkitt, a famous surgeon who made significant health advances in the ’70s and ’80s, said, “Diseases can rarely be eliminated through early diagnosis or good treatment, but prevention can eliminate disease.”

Even 50 years ago, doctors knew prevention was essential. That’s not to say early diagnosis and proper treatment aren’t important, but prevention is key.

Along with healthy lifestyle choices, getting regular checkups, including preventative screening, tests, and vaccines will:

• Help you stay healthy
• Allow you to get prompt treatment if necessary
• Save your money by catching diseases in their early stages

Further reading: 

• ‍Here's A List of Free Preventative Screenings, Tests, and Shots from Medicare‍
• Staying Healthy After 60: How to Nourish Your Mind, Body, and Soul

Medicare and Preventative Services

Medicare Part B, which you have through Original Medicare or Medicare Advantage, covers many screenings, vaccines, and counseling. 

Original Medicare and Medicare Advantage pay 100% of the costs for covered preventative healthcare as long as you:

• Meet the eligibility requirements for the preventative service
• See a participating provider (one that accepts the assignment) for Original Medicare
• See an in-network provider for Medicare Advantage

Note: Neither Original Medicare nor Medicare Advantage can charge you a deductible, copayment, or coinsurance for these covered services. They’re free!

Related article: What is Medicare Advantage?

What Benefits Does Medicare Offer Men?

It’s pretty difficult to spend the day on the golf course, land that big catch, or explore the Rocky Mountains if you’re recovering from a heart attack or battling diabetes. 

Taking a small amount of time each year for a little health prevention can give you all the time in the world to do the things you love. 

Let’s look at some free preventative measures Medicare has to offer.

1. Welcome to Medicare Exam 

The Welcome to Medicare Exam is a one-time appointment with your doctor, but you must schedule it within the first year of having Part B coverage.

Although this visit isn’t a full-blown exam, it does establish a baseline with your physician for future exams.

What to Expect

During a Welcome to Medicare Exam, your provider will:

• Check your height, weight, blood pressure, body mass index (BMI), and vision
• Review your medical and social history
• Check for depression or other mental health conditions
• Make sure you can function safely in your home
• Provide you with education, counseling, and referrals related to your risk factors and other health needs
• Give you a checklist or written plan with information about other preventive services you may need

Costs with Medicare

The Welcome to Medicare visit is covered 100% by Medicare Part B.

Related reading: 8 Easy Health and Finance Resolutions for Seniors in the New Year

2. Prostate Cancer Screening

Prostate cancer screening tests look for possible signs of cancer.

Here’s a few facts about prostate cancer:

• It’s the most common type of cancer among men. 
• It tends to affect men 65 or older.
• It usually grows slowly. 
• It’s not necessarily fatal.
• More than 90% of prostate cancer cases are found in the early stages.
• It has one of the highest curability rates of all types of cancer. 

Eligibility

Medicare Part B covers one prostate screening each year for men over 50.

This screening includes:

• A digital rectal exam (DRE)
• A prostate-specific antigen (PSA) blood test

What to Expect

A PSA test is a simple blood test that looks for elevated PSA levels, a protein made by cells in the prostate. If your PSA levels are high, it could be an indicator of cancer, and your doctor might require you to have further testing.

During a DRE, the doctor will feel for any lumps or problematic areas in your rectum that could indicate cancer. This exam can be uncomfortable but usually isn’t painful, and it only takes a few minutes.

According to The American Cancer Society, a DRE isn’t as effective in detecting prostate cancer as a PSA test, but it can be helpful in certain situations.

Costs with Medicare

Medicare Part B covers 100% of the PSA test and 80% of the DRE test. You will have to pay a 20% coinsurance and the $198 Part B deductible. If you have a Medicare Supplement, the coinsurance and deductible may be fully covered.

3. Colorectal Cancer Screening

Colorectal cancer screenings detect conditions in the colon or rectum that could become cancerous.

Colorectal cancer is the third leading cause of cancer deaths in the United States.

According to WebMD, men have a 1 in 22 chance (4.2% of men) in developing colorectal cancer.

Your risk of developing colorectal cancer increases if:

• Someone in your family has had colorectal cancer.
• You’ve already had one cancer removed.
• You’ve had a condition such as Chron’s disease or ulcerative colitis.

Other general risk factors include:

• You’re over 50
• You drink two or more alcoholic drinks per day
• You’re obese
• You smoke
• You have type 2 diabetes
• You’re consuming a high-fat diet with the majority of fats coming from meat

Eligibility

Medicare Part B covers four different colorectal cancer screenings, and each one has eligibility requirements:

1. Fecal occult blood test – once a year if you’re over 50
2. Flexible sigmoidoscopy – once every four years, you’re over 50 and at high risk, or once every ten years after a colonoscopy if you’re over 50 and not at high risk
3. Colonoscopy – once every two years if you’re at high risk, or once every ten years if you’re not at high risk (but not within 48 months of a flexible sigmoidoscopy) Note: You don’t have to be over 50 to be eligible for a colonoscopy.
4. Barium enema – once every two years if you’re over 50 and at high risk, or once every four years if you’re over 50 and not at high risk (but not within 48 months of a flexible sigmoidoscopy)

What to Expect

The Center for Disease Control and Prevention and The Mayo Clinic explain how each of these screening tests works. 

Aside from the blood test, colorectal testing isn’t the most pleasant experience, but overall, it isn’t painful. Uncomfortable, maybe, but not unbearable. Thank goodness these tests are only needed every few years.

The Fecal Occult Blood Test looks for blood in the stool. Once a year, you’ll gather a small stool sample with a stick or brush that comes in a test kit you get from your doctor. Once returned, the stool samples are checked for blood. 

For the Flexible Sigmoidoscopy Test, the doctor uses a short, thin, flexible, and lighted tube to check for polyps or cancer. The doctor looks at the rectum and the lower third of the colon.

A Colonoscopy is similar to a flexible sigmoidoscopy, except the doctor uses the tube to check for polyps or cancer inside the rectum and the entire colon. 

If the doctor finds polyps or some cancers, he can remove them right then.

A Colonoscopy can be used as a follow-up test if they find something unusual during one of the other screening tests.

For a Barium Enema or Color X-ray, your doctor will use barium to coat the colon's lining. 

This coating allows the X-ray to show a clear silhouette of your colon so your doctor can look for abnormalities. 

Costs with Medicare

Medicare Part B pays for 100% of the costs of a Fecal Occult Blood Test, a Flexible Sigmoidoscopy, and a Colonoscopy.

Part B only covers 80% of the Medicare-approved amount for a Barium Enema, so you’ll have to pay a 20% coinsurance and the Part B deductible of $198. Again, if you have a Medicare Supplement, you very likely won't have any costs.

If you have Medicare Advantage, contact your provider to see your costs for a Barium Enema.

4. Cardiovascular (Heart) Disease Screening

Cardiovascular or heart disease screening is a blood test that checks for unhealthy levels of cholesterol, lipids, and triglycerides that can lead to things like heart attacks or strokes.

Heart disease is the No. 1 killer of men in the United States, and even if you don’t show symptoms, you can still be at risk.

Risk factors of heart disease include:

• Smoking
• Lack of exercise
• Poor diet
• Obesity
• High blood pressure
• High LDL or low HDL cholesterol levels
• Family history of heart disease or other cardiovascular diseases
• Age

While you can’t do much about your age or family history, you can control the other risk factors by eating a healthy diet and exercising. 

An article by John Hopkins Health explains that aerobic exercises and resistance (strength) training are essential activities for heart health. 

Aerobic Exercises

Aerobic activity increases your blood circulation, which in turn lowers your blood pressure. 

Activities such as brisk walking, swimming, cycling, or playing tennis at least 30 minutes five times a week could be a real boost to your health.

Resistance or Strength Training

Resistance training helps reduce fat and increases lean muscle mass. 

You can use free weights, weight machines, bands, or even your body weight to create resistance and build muscle. This training should be done on nonconsecutive days at least two days a week.

We need to emphasize the importance of being safe when doing resistance training. Without the proper knowledge, you can do more harm than good. 

Look into classes at your local gym or YMCA or even exercise videos like Strength Training for Seniors and Beginners.

Interesting fact: When you combine aerobic exercise and resistance training, it may help raise HDL (good) cholesterol and lower LDL (bad) cholesterol. 

Eligibility

You’re eligible for a heart disease screening every five years, even if you don’t have any signs of heart trouble.

If your doctor doesn’t offer you this blood test, request it! With heart disease being the “silent killer,” you don’t want to become a statistic when it can be detected and prevented.

What to Expect

Since heart conditions don’t always come with warning signs, your doctor will check you for all the risk areas during your screening.

You can expect him to weigh you, take your blood pressure, and talk to you about your family history and your current lifestyle.

Your doctor will then order blood work to test your cholesterol, lipid, and triglyceride levels. 

Costs with Medicare

This test is free to you since Medicare Part B covers 100% of this cost.

Further reading: Heart Failure: Warning Signs, Stages, and What Really Happens to Our Body

5. Diabetes Screening 

Diabetes screenings can help detect, treat, and manage diabetes. 

According to the American Diabetes Association, 13.8-17% of men in the United States have diabetes. 

Anyone can get diabetes, but there are some symptoms unique to men:

• Erectile dysfunction (ED) – up to 75% of men with diabetes have trouble achieving or maintaining an erection. 
• Genital thrush – a fungal yeast infection where excess sugar in the blood is passed in the urine.
• Reduced muscle mass – over time, high blood sugar levels can cause the body to break down muscle and fat for energy, which is more common in men with type 1 diabetes.

Other symptoms that can show up in anyone are: 

• Increased thirst and hunger
• Tiredness
• Blurry vision
• Passing more urine, and going more often, even at night
• In type 2 diabetes, sores or cuts that do not heal
• In type 1 diabetes, excessive weight loss before diagnosis.

Eligibility

Medicare covers diabetes screenings, a fasting blood glucose test, and a post glucose challenge test once a year if you have one of the following risk factors:

• High blood pressure (hypertension)
• History of high blood sugar
• History of abnormal cholesterol levels (dyslipidemia)
• Obesity

Medicare also covers an annual diabetes screening if you have at least two of the following:

• You're age 65+
• You're overweight
• Your family has a history of diabetes
• Your family has a history of diabetes during pregnancy (gestational diabetes), or you have had a baby weighing nine or more pounds

If you have pre-diabetes (high blood-sugar levels that aren’t high enough to be classified as diabetes), Medicare will cover two screening tests each year.

What to Expect

Before a fasting blood glucose test, you can’t eat or drink anything but water for eight hours.

More than likely, your physician will draw blood through a finger prick, but they may need to draw blood through a vein, depending on what tests your doctor orders.

Either way, you should only feel a small stick, but nothing excruciating.

The post glucose challenge test has more steps than the fasting blood glucose test.

You’ll still have to fast for eight hours before having your blood tested. You’ll then drink 8 oz. of a glucose solution and wait to have your blood tested again. The doctor will give you more specific directions for this test based on what he needs to see.

Costs with Medicare

Medicare Part B covers 100% of the costs for these screening tests.

6. Shots and Vaccines

Being vaccinated for illnesses – such as the flu, pneumonia, and Hepatitis B – is an easy way to stay healthy. 

Flu Shots

Flu seasons vary in severity from year to year, but those 65 and older continue to be at the greatest risk. 

A flu shot protects you from contracting and spreading the flu.

Pneumococcal Shots

Infection from pneumonia targets the lungs and can cause you to run a fever and have a hard time breathing.

The CDC reports that approximately 90% of flu and pneumonia-related deaths and 50-70% of flu and pneumonia-related hospitalizations occur among people in this age group.

These shots aren’t fool-proof, but they are proven to help. 

One thing’s for sure: if you don’t get the shot, there’s no way it can help. You have nothing to lose and a lot to gain, especially if it keeps you out of the hospital.

Hepatitis B Shots

Hepatitis B is a virus that attacks the liver and can cause chronic liver disease. The Hepatitis B shot is considered the best way to prevent getting this disease.

Eligibility

Flu Shots: If you have Medicare Part B, you can get one free flu shot per flu season.

Pneumococcal Shots: The pneumococcal shots help prevent pneumococcal infections like certain types of pneumonia. Part B covers two pneumococcal shots per year that protect against different strains of the bacteria. It covers the first shot at any time and a second shot if it's given one year (or later) after the first shot.

Hepatitis B Shots: Medicare will cover the Hepatitis B shot if you’re at medium or high risk of developing it. You’re considered at risk if you:

• Have End-Stage Renal Disease (ESRD)
• Have hemophilia
• You're a healthcare worker and have frequent contact with blood or bodily fluids.
• Live with someone that has Hepatitis B.
• Have diabetes

Cost with Medicare

As long as you meet the eligibility requirements (if there are any), you can receive these vaccines free – they’re covered 100% by Medicare.

Note:  If you’ve been exposed to a dangerous virus or disease such as tetanus or rabies, Medicare will pay 100% for the vaccine.

Conclusion

Men: it’s time to take a stand on preventative healthcare.

Going to the doctor may not be the highlight of your day, especially when you feel nothing's wrong. But taking a little time here and there to make sure you’re in great shape is worth it!

As a husband, father, son, and friend, you’re essential and worth every ounce of prevention, but you have to take the initiative. If not for yourself, for those that think you're pretty impressive!