Preventative Care Covered by Medicare

Preventative Care Covered by Medicare

Preventive care is, without a doubt, a significant factor in your physical well-being. This is also true, maybe even more so, as you age. Fortunately, after years of having limited coverage of preventive care, Medicare does now cover more preventive care. The key for the Medicare beneficiary is being aware of these and taking advantage of them. Preventative Care Covered by Medicare

Annual Visits Covered by Medicare

“Welcome to Medicare” Visit – Each Medicare beneficiary is entitled to a “Welcome to Medicare” visit within their first 12 months of being on Medicare Part B. During this visit, your provider will help you map out your current health situation and any future follow-up or ongoing needs (What Does the Welcome to Medicare Visit Cover?). Make sure your provider knows that this is your “Welcome to Medicare” visit, as this is coded differently than the annual wellness check (see below) and can cause problems if not handled correctly.

Annual Wellness Check – After your initial visit, each Medicare beneficiary can also do an annual wellness visit. During this visit, which is completed with your primary care doctor, you will review any further preventive care needs as well as your current health concerns or questions.

Preventive Services That Medicare Covers at 100%

Now, Medicare covers many preventive care services at a 100% level, as long as they are deemed to be “medically necessary”. Keep in mind that what Medicare considers “medically necessary” is person-specific in some cases – it can be based on your past health history, family history and other medical variables. Here is a list of medical preventive services that are covered by Medicare Part B at 100%:

  • Abdominal Aortic Aneurysm (AAA) Screening: This is for at-risk beneficiaries. You are considered at-risk if you have a family history of AAA or are a tobacco user
  • Alcohol Misuse Screening and Counseling: This is designed to eliminate/reduce alcohol use for someone considered to be misusing alcohol by their primary physician
  • Bone Mass Measurements: Medicare covers a bone density measurement every two years for people at risk for osteoporosis. Those classified as at risk for purposes of this screening are: estrogen-deficient women, those with vertebral abnormalities, those taking steroid treatments, those with hyperparathyroidism, and those that take an osteoporosis drug
  • Cardiovascular Risk Reduction: ALL Medicare beneficiaries are eligible for this visit. Doctors should screen for blood pressure and provide behavioral counseling and diet-related tips
  • Colorectal Cancer Screening: Medicare covers this for people age 50 and over. This includes a fecal occult blood test, flexible sigmoidoscopy (once every 4 years), and/or colonoscopy (once every 10 years or once every two years for those that are high risk)
  • Depression Screenings: Covered annually for all Medicare beneficiaries and must be performed in a primary care setting
  • Diabetes Screening: This is covered by Medicare either once or twice a year, depending on your risk factors, current health and whether you have been diagnosed as pre-diabetic
  • HIV Screening: Medicare covers this annually for all beneficiaries
  • Heart Disease Screening: Medicare covers this once every five years to test for cholesterol, lipid, and triglyceride levels
  • Mammograms: All women (over age 40) are eligible for an annual screening
  • Medical Nutrition Therapy: Medicare covers medical nutrition therapy, which may include dietary counseling for those with certain chronic diseases or risk factors
  • Obesity Screening/Counseling: Medicare covers screening for those that are classified as obese to help you lose weight. The baseline used for this is a body mass index (BMI) or 30 or more.
  • Pap Smears/Pelvic Exams/Breast Exams: If you are considered low risk, Medicare covers this every two years. If you are considered high risk, Medicare covers one exam per year.
  • Prostate Cancer Screenings: Medicare covers a blood test for prostate cancer for all male beneficiaries once per year
  • Smoking Cessation: Medicare covers two counseling attempts at quitting smoking per year
  • Vaccines and Immunizations: Medicare covers flu shots (once/year), pneumonia shots (once/lifetime), hepatitis B, and shingles (covered through Part D with some cost-sharing)

Preventive Services That Medicare Covers at 80%

There are other preventive care services that Medicare covers at 80%. If you have a Medigap plan, your plan may pick up the remaining 20% depending on which plan you have. Here is a list of those preventive services:

  • Colorectal Cancer Screening: This applies to Barium enema once every 48 months (or once every 24 months for someone classified as high risk)
  • Glaucoma Screening: Medicare will cover this at 80% if you are at risk (family history, diabetes, etc)
  • Prostate Cancer Screening: Medicare covers the digital rectal exam once a year for all male beneficiaries over age 50
  • Diabetes Self-Management Training: Medicare covers up to 10 hours of training during your first year if you are at risk of complications of diabetes or have recently been diagnosed

Overall, Medicare is covering much more preventive care than it has in the past. It is up to each Medicare beneficiary, in conjunction with their medical providers, to stay on top of this. Make sure you take advantage of the preventive care options that you have at your disposal as a Medicare beneficiary. Preventative Care Covered by Medicare

Preventative Care Covered by Medicare

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about the author

Garrett Ball

Garrett is the founder/President of Secure Medicare Solutions, a leading, independent Medicare insurance agency. Since 2007, Garrett has worked with tens of thousands of people turning 65 or already on Medicare to understand, compare and choose Medicare insurance that fits their specific needs and situation.

His latest project is 65Medicare.org, an online hub for people just starting with Medicare, which is focused on distilling difficult Medicare questions into easy-to-understand resources.

Garrett resides in North Carolina with his lovely wife, Celeste, and three spirited children.

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