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Your Medicare support system: What a doctor says about the best way to manage your health with Medicare

Brook Showell By Brooke Showell

Managing your health may seem like an overwhelming task, but it begins with small steps: an appointment for an annual physical, a flu shot or other simple preventive measures. The good news is that many Medicare members have preventive benefits included with their plan.

Even better? You don’t have to navigate these benefits on your own — your physician can be a valuable source of guidance and support. To learn more, we spoke with John Moore, DO, an Aetna medical director and senior health specialist, about the best ways to take advantage of Medicare’s preventive health care benefits, and the key role your primary care physician can play in managing your health.

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Is there one preventive care benefit you think everyone should take advantage of?

Dr. Moore: When it comes to preventive care, put an annual physical at the top of your to-do list. It’s covered under all Medicare Part B and Medicare Advantage plans, so you should definitely take advantage of it. This yearly visit often begins with a one-on-one conversation that gives your physician a better overview of your medical history. Think of it as your time to address any and all concerns.

The physical also includes a health risk assessment, which generally takes the form of a questionnaire that you complete before or during the visit. You’ll be asked about your health status, injury risks, behavioral risks and urgent health needs. The answers to these questions will help your doctor decide on the type of additional preventive care you might need.

Some seniors have chronic problems and see their doctor for things like heart failure or diabetes. But they don’t really ever do a physical, and they think the doctor has everything managed. That’s a false sense of security. In a physical, your doctor will look at everything, make sure all the screening tests are done and your vaccinations are up to date. They’ll also review your current medications, get updated blood work and then refer you for any further care you may need.

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How can your doctor help you use Medicare benefits to prevent serious health issues?

Dr. Moore: Heart disease, cancer and chronic lower respiratory disease are the leading causes of death for people age 65 and over. Your doctor will screen for these three conditions during your annual physical.

Patients 65 and older should also schedule a few follow-up tests covered by their benefits. One is a colonoscopy to screen for colon cancer, which is covered once every 120 months or once every 24 months if you’re high risk. Or there’s a new alternative, known as stool DNA testing. This alternative is now covered in place of a colonoscopy and should be repeated every three years for patients at average risk.

It’s also advised that women get a mammogram to screen for breast cancer, which is covered once every 12 months. These are covered by all Medicare Part B and Medicare Advantage plans. And your primary care doctor can often help you get these screenings scheduled.

How can your doctor help you navigate other Medicare benefits included in your plan?

Dr. Moore: Your physician can help guide you toward the programs and specialists that are appropriate for you. Many plans, including Medicare Advantage plans, cover visits to specialists. A good primary care physician can recommend specialists who are covered by your plan. If you have several medical conditions that require you to visit multiple specialists at once, your doctor can also help you determine which specialist to see, and the order in which to see them.

What about those times when you just have a question about your health?

Dr. Moore: Sometimes you forget to ask your primary care physician about something or just want some additional information. With many Aetna Medicare Advantage plans, you have access to the Medicare Nurse Hotline, which connects you with registered nurses, 24/7. They’ll help you understand symptoms and manage chronic conditions; learn about treatment options provided by your doctor; and decide whether to visit a doctor or urgent care center.

I think this hotline gives patients some independence and a sense of security in better understanding their health. It may be a one-time call, or it may lead to you getting help with a variety of issues. The point is that this benefit gets you help when you need it, which can prevent further complications down the road.

How important is exercise to overall health, and where do Medicare Advantage benefits fit in?

Dr. Moore: Seniors absolutely need physical activity because it provides so many benefits to help maintain and even improve mental, emotional and physical health. Regular activity is particularly good for your joints and muscles, strength and cardiovascular health. Exercise also helps stave off obesity and prevent osteoporosis in both women and men. It’s even good for your libido.

Many Medicare Advantage plans offer gym memberships through a program called SilverSneakers®. Taking advantage of the gym also provides an outlet for socialization, which can spark new friendships and protect against isolation and depression.

What if you’ve been diagnosed with a chronic condition? Can Medicare Advantage benefits assist with that as well?

Dr. Moore: Check with your Medicare Advantage plan to see if they provide counseling for chronic conditions. At Aetna, for example, members of many Aetna Medicare Advantage plans will have access to our disease management program, which helps members understand their health conditions and follow their doctor’s treatment plan. Heart failure, asthma, stroke, hyperlipidemia, hypertension, kidney disease and diabetes are some of the more common issues seniors face and are among the conditions we address.

Let’s say someone has diabetes and is controlling it fairly well. But perhaps they want more information about it. The program takes a more holistic approach to helping members understand everything they should be doing. That could include eye exams, foot exams, blood tests for lipids and renal function, stress testing and even maintaining skin health.

We work one on one with members to answer their questions about all of these things. For example, an Aetna case manager will engage a patient on the phone, and in some parts of the country, meet with patients face to face. They help keep members healthy in the long term by providing information about everything from how exercise can help control a diabetic’s blood sugar, to helping people find discounts for medications, to setting up transportation to medical appointments so members can better manage their conditions. 

Medications can be a big part of managing a chronic condition. How can Medicare Advantage benefits help when it comes to filling prescription medications?

Dr. Moore: The best person to speak with about prescription medications is your primary care doctor. But once you get your prescription, it’s important to remember that your Medicare benefits can help you follow your doctor’s advice on how often you should take your medications.

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For example, home delivery service for prescription drugs is a common Medicare benefit that helps ensure people take their medicine as prescribed. Home delivery typically allows for up to a 90-day supply of most medications, and patients tend to consistently take their medications better when they have a 90-day supply rather than a 30-day supply. Mail order helps promotes a patient’s independence, too. Some Medicare recipients may depend on family or neighbors to pick up their medication because they can’t drive or don’t want to travel to the pharmacy. This service helps with that.

How can using these Medicare benefits positively impact your overall health?

Dr. Moore: A Medicare recipient who is retired or almost retired wants to enjoy their golden years. My advice? Take complete advantage of all the benefits available to you through your Medicare plan. There’s free education, free advice and programs at no extra cost to proactively keep you healthy.

About the author

Brooke Showell is a writer and editor whose health, fitness and psychology stories have appeared in Self, Health, Woman’s Day and Redbook. She’s very into the idea of fitness travel and plans to one day take her yoga practice to the beach.

Also, no matter what Medicare plan you have, see your primary care doctor and follow through with the appropriate preventive care testing. This can help you catch serious conditions early, when they can be easily treated. And never, ever be afraid to reach out to your physician about how to use your benefits. After all, our job is to help keep you well.