Fam Pract Manag. 2007;14(4):16
Kent Moore's article “What's New in Medicare Preventive Benefits” [February 2007] explains that the abdominal aortic aneurysm (AAA) screening benefit for patients age 65 to 75 who have smoked at least 100 cigarettes is available as part of the Welcome to Medicare physical. Isn't it true that patients have only six months from the time they get their Medicare card to have the Welcome to Medicare physical? If so, then this benefit seems limited to those patients between the ages of 65 and 65½. Even then, the screening is available only if we see the patient for a Welcome to Medicare physical and order it at that time. Is this benefit not available for patients who are older than 65½? Is it really only available at the time we see a patient for a Welcome to Medicare physical? I find it limiting and contradictory that Medicare would not provide coverage for AAA screenings for the many people who fall into the high-risk categories listed in the article but never had or wanted the Welcome to Medicare visit.
Medicare coverage of AAA screenings is effective for services furnished on or after Jan. 1, 2007, for qualified beneficiaries who meet the following criteria:
They receive a referral for an ultrasound screening as a result of an initial preventive physical exam [also known as the Welcome to Medicare physical].
They receive an ultrasound screening from a provider or supplier who is authorized to provide covered diagnostic services.
They have not been previously furnished an ultrasound screening under the Medicare program.
They are included in at least one of the following risk categories:
Those with a family history of AAA;
Men age 65 to 75 who have smoked at least 100 cigarettes in their lifetime;
Beneficiaries who manifest other risk factors in a beneficiary category recommended for AAA screening by the United States Preventive Services Task Force.
So you are correct, in a sense, that only Medicare beneficiaries who have had a Welcome to Medicare physical and received a referral for the AAA screening as a result of that exam are eligible for the AAA screening (as long as they also meet the other coverage criteria). The rules do not say that the AAA screening must occur in the same time period as the Welcome to Medicare physical, so, theoretically, the AAA screening could be covered after a beneficiary's first six months of eligibility, as long as the screening resulted from a referral at the Welcome to Medicare physical.
I understand your feeling that this policy is overly restrictive. Unfortunately, in this case Medicare policy is dictated by the law that created the benefit (section 5112 of the Deficit Reduction Act of 2005). As such, it would require an act of Congress to change it. I encourage you to share your perspective with your Congressional representatives, which you can do through “Speak Out,” the AAFP's Legislative Action Center, online at http://capitol.aafp.org/.