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Top 5 Men’s Health Screenings Covered by Medicare Advantage

June is Men’s Health Month, and there’s no better time to think about ways to stay fit as you age. One important part of your health regimen should be preventive care — and one of the best ways to get it is through Medicare-covered screenings for men over 65. 

Worried about high costs from multiple appointments? That’s where a Medicare Advantage plan comes in handy. Your plan makes it easier for you to monitor your health by offering a wide range of screenings at no cost to you. Preventive screenings can help you catch, and treat, conditions before they become major health issues.

What to know about heart disease screenings

Heart disease is the leading cause of death in men, and the risk increases with age. Some conditions – like high cholesterol and high blood pressure (hypertension) — increase your risk of having cardiovascular disease (CV). If you catch these risk factors early, they can be managed or reversed to lower your risk of heart disease.

Because of the importance of heart health, Medicare pays for cardiovascular screening, which includes cholesterol tests every five years and annual blood pressure checks. Both tests can be taken at an annual physical or wellness checkup.

Your cholesterol screening is a bloodwork panel to check levels of total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and fat in your blood (triglycerides). If your results are abnormal, your doctor may recommend lifestyle changes or medication.

Your blood pressure is taken with a blood pressure cuff to see if you meet the guidelines, which are below 120/80 mm Hg. If your blood pressure is high, your doctor may also recommend lifestyle changes or medications. Checking your blood pressure regularly is a good way to manage hypertension; some Medicare Advantage plans cover blood pressure cuffs to track it from home with over-the-counter allowances.

Prostate cancer (PSA) tests

Prostate cancer occurs when abnormal cells in the prostate grow into a tumor. This is one of the most common types of cancer in men, but it often grows slowly and, when found early, is typically curable.

Talk to your doctor about whether you need a prostate exam. Some guidelines recommend them for men ages 50 through 69 who are at high risk for the condition. You may be at higher risk if you:

  • Have a close blood relative who had prostate cancer, especially if they had it before age 60,
  • Are African American,
  • Have symptoms like the urge to pee frequently, wake up often at night to pee, or have blood in your urine,
  • Smoke,
  • Are obese,
  • Or have been exposed to chemicals like arsenic or Agent Orange.

Medicare covers prostate cancer screenings, which include an annual digital rectal exam and PSA (prostate-specific antigen) test. During a digital rectal exam, your doctor checks for abnormalities like lumps or hard spots on the prostate. PSA bloodwork tells your doctor if you have high levels of prostate-specific antigen, which could signal you have prostate cancer.

Medicare Advantage will cover the annual bloodwork for the PSA test. You’re responsible for the digital rectal exam and doctor’s visit with your deductible or copay.

Diabetes screenings

About one-third of people 65 and older have diabetes, or high blood sugar. It’s important to catch diabetes early because, if left untreated, it can lead to complications including nerve damage, heart attack, stroke, and kidney failure.

The good news is that diabetes is treatable. A nutritious diet, regular exercise, and medications can all help reduce your blood sugar. Diabetes screenings are covered for $0 preventive care through Medicare if you have risk factors for the condition. You must have at least one of these risk factors for Medicare to pay for your diabetes screening:

  • High blood pressure,
  • High cholesterol and triglyceride levels,
  • Obesity,
  • Or high blood sugar.

It will also pay if you don’t have one of the above but are 65 or older and are either overweight or have a family history of diabetes. Medicare pays for up to two annual screenings and bloodwork that tests your plasma glucose or A1C.

Colorectal cancer screenings

Colorectal cancer screenings may be the most well-known of adult preventive care. For years, a colonoscopy was the only option for checking for polyps and other diseases in the rectum and colon. But now there are multiple, less invasive ways to screen for colorectal cancer. Medicare Part B covers all three: colonoscopies, stool DNA tests, and blood-based biomarker tests.

Colonoscopy – Medicare pays for colonoscopies every five years if you have an average risk of colon cancer. It will cover the screening every two years if you’re at high risk. Factors that increase your risk include:

  • Having an inflammatory bowel disease like Crohn’s or ulcerative colitis,
  • Previously having colorectal cancer,
  • Having a family history of the condition,
  • Or having a genetic condition like Lynch syndrome.

The test is paid for, but if your doctor finds and removes a polyp during the procedure, you pay 15% of the charge for that service, along with 15% of the facility fee if it’s performed in a location other than a hospital.

Stool DNA tests are less invasive tests, which check for blood and abnormal DNA in your stool that could signal the presence of polyps. Medicare pays for the at-home screening, recommended for people at average risk of colorectal cancer, every 12 months with a doctor’s referral.

Blood-based biomarker tests are the newest tests for colorectal cancer. Your doctor checks your blood for changes to your DNA that may signal colorectal cancer is present. Medicare pays for this screening once every three years for people who show no symptoms of colorectal cancer and who are at average risk of having the condition.

Abdominal aortic aneurysm (AAA) screenings

One screening that you may not have heard of before is for abdominal aortic aneurysms. An AAA screening is an ultrasound that checks for signs of an aneurysm (a weak, bulging spot) in the large blood vessel in your stomach. These screenings are important because this aneurysm grows slowly and often has no symptoms. If it ruptures, it can cause bleeding that frequently leads to death.

Medicare pays for a one-time ultrasound for men who are at risk for AAA and have a referral from their healthcare provider. You have a higher risk of the condition if you:

  • Are 65 or older,
  • Have ever smoked,
  • Or have a family history of AAA.

The roadmap: The annual wellness visit

Medicare’s annual wellness visit benefits for men include an appointment with your healthcare provider that is different from your yearly physical. An annual wellness visit comes at no cost to you after you’ve been covered by Medicare for more than 12 months. Unlike at a physical, your doctor will work with you during this visit to create a personalized prevention plan designed to keep you healthy as you age.

During this visit, your doctor may:

  • Take routine measurements like height and weight,
  • Review your prescriptions,
  • Offer health advice,
  • Discuss social needs that impact your health,
  • Perform a cognitive assessment to look for signs of dementia,
  • And provide a preventive screening schedule.

Preventive care becomes important as you age and have a higher risk for some health conditions. Your Medicare Advantage $0 preventive care benefits are designed to save you money, keep you active, and catch issues early to avoid higher healthcare costs down the road. Talk with a SmartMatch agent for details on what’s covered under your plan and other plans available in your area.

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