Comparison Between US Preventive Services Task Force Recommendations and Medicare Coverage

Evidence-based clinical preventive services have the potential to improve quality of life and prevent premature death for Medicare recipients. Through legislation, the secretary of the U.S. Department of Health and Human Services is authorized to cover Medicare for services strongly recommended, or recommended by the U.S. Preventive Services Task Force (USPSTF), a government-sponsored panel of experts. But how much do the USPSTF recommendations matchup with the preventive services covered by Medicare?

The researchers looked at two components of Medicare preventive care—preventive care coordination and the preventive service itself—for 15 services rated strongly recommended or recommended for adults 65 and older.

Among their findings, Medicare:

  • Reimbursed fully for 7 percent of services.
  • Reimbursed fully for the preventive coordination but not the service for 7 percent of services.
  • Reimbursed partially for both the coordination and the preventive service for 27 percent of services.
  • Reimbursed fully for the service or test but only partially for the coordination of obtaining the service for 60 percent of services.

Medicare reimburses for 44 percent of the16 preventive services USPSTF recommends against.

The authors recommend that Medicare “align itself with the USPSTF recommendations and usher in an era of improved quality of care through effective prevention.”