Does Medicare Cover Preventive Services?

Medicare’s commitment to ensuring the health and wellness of its beneficiaries goes beyond providing coverage for medical treatments. Since the implementation of the Affordable Care Act (ACA) in 2011, Medicare has expanded its reach to offer an array of preventive and wellness services without any deductibles, copayments, or coinsurance charges.

Preventative services offer a range of offerings, including examinations, vaccinations, laboratory tests and screenings. Additionally, these services encompass health monitoring programs, along with counseling and educational resources designed to empower you in maintaining your personal well-being. This move marks a significant step toward promoting proactive healthcare among individuals aged 65 and older, as well as certain younger individuals with disabilities.

Qualifying for Free Preventive Screenings

Eligibility for these complimentary preventive screenings is primarily determined based on factors such as age, health risk indicators, and specific timeframes defined by Medicare. However, it’s important to note that these services are only provided by healthcare providers who accept assignment. This means that these providers acknowledge the Medicare-approved payment as the full amount. For each of these services, Medicare maintains a comprehensive list of detailed requirements, ensuring that beneficiaries can easily access the care they need.

Managing Your Preventive Services

Keeping track of your preventive services and screenings has been made more convenient with the integration of online Medicare accounts. Through these accounts, you can easily monitor the preventive services you’ve utilized in the past and access a schedule of Medicare-covered tests and screenings that you may be eligible for in the upcoming two years.

Medicare’s Covered Preventive Services

In 2023, Medicare covers an extensive range of approximately two dozen preventive services at no cost to you. While most of these services cater to individuals aged 65 or older, it’s worth noting that a significant portion of Social Security Disability Insurance (SSDI) recipients also qualify for Medicare after a 24-month waiting period following their eligibility for disability benefits.

Here are some of the preventive services covered by Medicare:

• Abdominal Aortic Aneurysm Screening: Those who are at risk of an aortic aneurysm may receive a one-time ultrasound screening.
• Alcohol Misuse Screenings: Medicare covers one alcohol misuse screening per year for adults and pregnant woman who use alcohol but don’t meet the criteria for alcohol dependency. If your doctor determines you’re misusing alcohol, you can get up to four counseling sessions per year.
• Bone Mass Measurements: Medicare covers bone mass measurements if you’re in high-risk categories, including those with or at risk of osteoporosis, vertebral abnormalities, receiving steroid treatments or has hyperparathyroidism. Bone mass measurement tests occur once every 24 months.
• Breast Cancer Screening: Women aged 40 and above can receive a free mammogram once every 13 months. Medicare also covers one baseline mammogram for women between 35-39.
• Cardiovascular Behavioral Therapy: Medicare helps beneficiaries determine their risk for cardiovascular disease. Once a year, beneficiaries get a cardiovascular disease risk reduction visit that includes screening for high blood pressure and diet counseling.
• Cardiovascular Disease Screenings: Medicare beneficiaries can receive a cardiovascular disease screening once every five years. This test checks your cholesterol, lipid and triglyceride levels.
• Cervical and Vaginal Cancer Screening: Medicare covers Pap tests and pelvic exams to check for cervical and vaginal cancers. These screenings are done once every 24 months, or once every 12 months for women who are at high risk.
• Colorectal Cancer Screenings: Medicare offers colorectal screening tests to find pre-cancerous and cancerous polyps in the colon. This screening is done every 1-10 years, depending on various health factors.
• COVID-19 Vaccines: COVID-19 vaccines (both Moderna and Pfizer) are available without cost-sharing.
• Depression Screenings: Medicare covers one depression screening per year.
• Diabetes Prevention and Screening: Medicare covers a blood screening test to check for diabetes in at-risk beneficiaries. Those with diabetes may participate in a yearlong diabetes prevention program and screenings.
• Flu Shots: Yearly influenza vaccinations.
• Hepatitis B and C Screenings: Medicare covers yearly Hepatitis B and C screenings and shots for those at medium or high risk.
• HIV Screening: Medicare covers yearly HIV screenings based on age and risk factors. Pregnant women can receive up to three HIV screenings during pregnancy.
• Lung Cancer Screening: Those aged 55-77 who don’t have signs or symptoms of lung cancer or are a current smoker/have quit smoking in the last 15 years can receive a free yearly screening for lung cancer.
• Nutrition Therapy Services: Those on dialysis, have kidney disease, a kidney transplant in the last 36 months or have diabetes receive medical nutrition therapy.
• Obesity Behavioral Therapy: If you have a body mass index (BMI) of 30 or more, you can receive an obesity screening and behavioral counseling.
• Pneumonia Vaccines: All Medicare beneficiaries can get up to three doses of the pneumococcal vaccine to help protect against different types of pneumonia.
• Prostate Cancer Screenings: Coverage for prostate cancer screenings begins the day after your 50^th birthday. A digital rectal exam and PSA blood test should be completed once every 12 months. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for the digital rectal exam. You pay nothing for the PSA blood test.
• Sexually Transmitted Infections Screening: Medicare covers sexually transmitted infection screenings for chlamydia, gonorrhea, syphilis, and Hepatitis B in those who are pregnant or at increased risk for sexually transmitted infections. A primary care doctor or provider must order the screening or refer the patient for behavioral counseling.
• Smoking Cessation Counseling: If you use tobacco, Medicare Part B covers up to eight smoking and tobacco-use cessation counseling sessions per year.
• Yearly Wellness Visit: Your doctor will provide a questionnaire, called a “Health Risk Assessment”. This assessment will help the doctor develop a personalized prevention plan to help you stay healthy. The visit will also include routine measurements, a cognitive assessment to look for signs of dementia and Alzheimer’s, advance care planning and more.
• Welcome to Medicare Visit: Medicare covers a “Welcome to Medicare” preventative visit within the first 12 months you have Medicare Part B. During this visit, the doctor will review your medical and social history, check height, weight, and blood pressure, perform a risk assessment and provide a written plan to determine additional preventive services. The visit may also include a conversation about creating advance directives.

Understanding the Scope of Free Services

It’s important to recognize that while many preventive services are provided without any associated costs, Medicare does impose certain limitations on the extent of these free services. Annual preventive and wellness visits are available free of charge, and additional specific services such as diabetes self-management training and glaucoma tests may also be offered. However, if a screening leads to further treatments or follow-up appointments, additional charges may apply.

Navigating Preventive Services with Medicare Advantage Plans

For those under Medicare Advantage plans, free preventive services are accessible through in-network providers. Beneficiaries must ensure they choose in-network providers to avoid potential charges.

Medicare’s dedication to proactive healthcare through free preventive services underscores its commitment to the well-being of its beneficiaries. This expansion of coverage empowers individuals to take a proactive approach to their health, paving the way for a healthier and more informed aging process. As you explore the myriad of preventive services available to you, remember that Medicare’s evolving commitment to your health continues to shape the landscape of healthcare for older adults across the nation.