Doctor talks Medicare, checkups

Roosevelt General Hospital officials said they have received a lot of questions about wellness checks from Medicare patients. Dr. Erika Garcia, who practices family medicine at RGH, answered questions about Medicare and routine checkups.

What is a wellness check as described by Medicare and who should be getting one?

Routine preventative visits are advantageous for patients of all ages because healthcare providers can help identify any potential disease such as diabetes, high blood pressure and even cancer. The preventative visits are free of charge with insurance carriers but there may be a co-pay for some of the preventative services. Moreover, on Aug. 1, through the Affordable Care Act, all new private health plans and Medicare must cover certain preventive services such as mammograms, pap smears and colonoscopies without charging a deductible, co-pay or coinsurance. Also, the following women's preventive services will be covered without cost: well-woman visits, support for breast-feeding equipment, contraception and domestic violence screening.

It is important for Medicare members to know that traditional Medicare doesn't cover routine dental care, eyeglasses, hearing aids or custodial long-term care. It generally won't cover healthcare they receive while traveling outside the U.S.

How often should patients schedule wellness visits?

Routine preventative physical exams can be done every year or every two to three years depending on each individual's health risks. There are different recommendations on how often exams and tests should be done, therefore it is important for patients to discuss this with their provider.

What are the advantages of being screened regularly?

Having free preventative visits at regular intervals can help catch a disease on time and can alleviate many stressors by decreasing the amount of doctor visits and many out of pocket expenses for medications and supplies.

What typically goes on during a preventative exam and what are providers looking for?

During a routine preventative physical exam the health care provider will record and evaluate the patient's medical and family history, current health conditions, and prescriptions. Then a physical exam is done including blood pressure, vision, weight and height to get a baseline for the patient's care. The provider will also make sure the patient is up-to-date with preventive screenings and services, such as cancer screenings and vaccines. Tests will also be ordered as well as referrals, depending on the patient's general health and medical history.

Traditional Medicare offers two types of preventative visits, "Welcome to Medicare" and "Annual Wellness Exam," both of these are free of charge to Medicare members. The "Welcome to Medicare" can be done within the first 12 months of getting Medicare coverage. Then, after having Medicare for 12 months, patients qualify to get a yearly "Wellness Visit." The difference between these exams and the routine preventative physical exam mentioned above is that there is typically no head to toe physical exam unless the provider sees it necessary. There may only be a review of the patient's health along with education and counseling about preventive services that can be ordered or done at a different appointment.

Approximately how many people in Roosevelt County are or should be getting preventative exams?

There is still a large percentage of the Roosevelt County population that does not get routine preventative exams. Now with the new Affordable Care Act, this should encourage people to do so.