Guide to Medicare Preventive Services and Screenings
This article was updated on: 08/04/2017
As a result of the Affordable Care Act, also known as health reform, the government now covers a variety of Medicare preventive services and screenings for individuals enrolled in Medicare Part B. Often, these benefits are covered at no cost to the beneficiary.
Many individuals qualify for the Medicare program by turning 65 years of age. Others may qualify through disability or illnesses. When it comes to preventive services, it could be important for all beneficiaries to take advantage of these benefits to lead healthier and longer lives.
Preventive services covered by Medicare
Medicare covers a variety of preventive services and screenings to help beneficiaries stay healthy. Here is a list of Medicare preventive services covered by Medicare Part B:
- Abdominal aortic aneurysm screenings
- Alcohol misuse screenings and counseling
- Bone mass measurements
- Breast cancer screening and mammograms
- Cardiovascular disease screenings
- Cardiovascular disease behavioral therapy
- Cervical and vaginal cancer screenings
- Colorectal cancer screenings
- Depression screenings
- Diabetes screenings
- Diabetes self-management training
- Glaucoma tests
- Hepatitis C screening tests
- HIV screenings
- Lung cancer screenings
- Medical nutrition therapy services
- Obesity screenings and counseling
- Prostate cancer screenings
- Sexually transmitted infections screenings and counseling
- Shots, including flu shots, Hepatitis B shots, and pneumococcal shots
- Tobacco use cessation counseling
There are requirements around each type of preventive service regarding who is covered and how often coverage is provided. To learn more about the specifics for each type of service and screening, please refer to this government publication.
The “Welcome to Medicare” preventive visit
Additionally, Medicare will pay for a “Welcome to Medicare” preventive visit, which beneficiaries can take advantage of during the first 12 months that they have Medicare Part B (Medical Insurance) coverage. During this visit, your physician will review your medical and social history as related to your health care and provide more education and counseling about preventive services that you may need.
The yearly “Wellness” visit
Beneficiaries who have had Medicare Part B coverage for longer than 12 months are eligible for a yearly “wellness” visit every 12 months. During this visit, your physician will help develop or update your personalized plan for preventing diseases or disabilities based on current health and risk factors. A short questionnaire, also called a Health Risk Assessment, is a key component of this visit and was developed by years of medical research and insight from the Centers for Disease Control and Prevention. The answers to these questions will help the development of your personalized prevention plan.
Are Medicare preventive services free?
Generally, preventive services, screenings, and visits are free of charge as long as the doctor or other qualified health-care provider accepts Medicare assignment. This means that they will accept the Medicare-approved amount as full payment. Additionally, you will need to fall within the eligibility requirements and follow the requirements associated with each service. Medicare Part B (Medical Insurance) provides this coverage.
There are certain Medicare preventive services that do require payment of 20% of the Medicare-approved amount of the cost for service, after the annual Medicare Part B deductible has been paid. This includes diabetes self-management training, glaucoma tests, and digital rectal exams, to name a few.
Please note that any additional tests or services provided in the same visit may not be covered. If these additional services are not covered, you may be responsible for paying your Medicare Part B deductible and a coinsurance amount.
As I’ve explained, Medicare preventive services are provided under your Medicare Part B coverage; they’re also covered under Medicare Advantage plans. Many Medicare beneficiaries do enroll in Medicare Advantage plans; I can help you see if that could be a good idea for you. Here are some steps you could take now:
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- To take a look at available Medicare plan options at your convenience, use the Compare Plans buttons on this page.
- If you’re ready to discuss your Medicare plan needs now, call Medicare.com’s licensed insurance agents at 1-844-847-2659, TTY users 711; Monday through Friday, 8AM to 8PM ET.
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