Medicare-Covered Preventative Care

Medicare is committed to helping you take care of your own health and an easy way to do this is to take advantage of disease prevention and early detection services. Medicare’s expanded benefits offer preventive care services, an annual wellness visit, and cancer screenings, all without a dollar out-of-pocket cost.

Initial and Annual Wellness Visits

Within the first 12 months after enrolling in Medicare Part B, you are entitled to a one-time “Welcome to Medicare” preventive visit. This visit includes a review of your medical history, education and training on preventive services, shots, screenings, and referrals. It may also include:

  • Height, weight, and blood pressure measurements
  • Body mass index calculation
  • Vision test
  • Risk review for depression and personal safety level
  • Advance directive counseling
  • Presentation of a list of necessary screenings, shots, and other preventive services needed

Once you’ve had Medicare Part B for more than 12 months, you are entitled to an annual “Wellness” visit to develop a personalized prevention plan based on your current health and risk factors. During this visit, you will be asked to fill out a Health Risk Assessment and based on the answers, your doctor can develop a plan to assist you in staying healthy.

This visit is covered by Medicare Part B once every 12 months. There is no charge to you for either the Welcome to Medicare preventive visit or the annual Wellness visit if your doctor accepts Medicare assignment and the Medicare Part B deductible doesn’t apply.

Diabetes Screenings

Twice each year you may be eligible for diabetes screenings. Medicare Part B covers labs if any of the following risk factors apply to you:

  • You have high blood pressure (hypertension)
  • You have an abnormal cholesterol and triglyceride levels
  • You are overweight
  • You have high blood sugar (glucose)

Medicare Part B will also cover these tests if you have 2 or more of these risk factors:

  • You are 65 or older
  • You are overweight
  • You have a family history of diabetes (parents or siblings)
  • You have a history of diabetes during pregnancy (gestational diabetes) or delivery of a baby weighing more than 9 pounds

These tests are covered at no charge to you.

Bone Mass Measurements

Medicare Part B will cover a bone mass (bone density) test once every 2 years (more frequently if medically necessary) for people who are at risk for osteoporosis and meet the following criteria:

  • A woman who is estrogen deficient, as determined by her doctor, and is at risk for osteoporosis based on her medical history and other findings.
  • A person whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures
  • A person taking prednisone or steroid-type drugs or one who is planning to begin this treatment
  • A person who has been diagnosed with primary hyperparathyroidism
  • A person who is being monitored to see if their osteoporosis drug therapy is working.

If your doctor or other qualified health provider accepts Medicare assignment, there is no charge for this screening.

Mammograms

Women 40 or older who are enrolled in Medicare Part B have coverage for a screening mammogram once ever 12 months and a diagnostic mammogram when medically necessary.

If your doctor or qualified health care provider accepts Medicare assignment, there is no charge for a screening mammogram. For a diagnostic mammogram, the 20% coinsurance of the Medicare-approved amount and the Part B deductible apply.

Glaucoma Tests

If you are at high risk for glaucoma, Medicare Part B will pay for a glaucoma test once every 12 months. The test must be performed (or supervised) by an eye doctor who is legally allowed to to this test in your state. You are considered to be at high risk if:

  • You have diabetes
  • You have a family history of glaucoma
  • You are African American and 50 or older
  • You are Hispanic American and 65 or older

You will be responsible for coinsurance of 20% of the Medicare-approved amount and the Medicare Part B deductible applies. If the testing is performed in a hospital outpatient setting, you will also pay a copayment.

Lung Cancer Screening

Medicare Part B covers a lung cancer screening with Low Dose Computed Tomography (LDCT)[glossary/] once per year if:

  • You’re between the ages of 55 – 77
  • You’re asymptomatic
  • You’re either currently a smoker or have quit smoking within the last 15 years
  • You have a tobacco smoking history of at least 30 “[glossary]pack years“
  • You get a written order from your doctor or qualified non-physician practitioner

If your doctor or other qualified primary care practitioner accepts Medicare assignment, you pay nothing for this service.

Other Covered Preventive and Screening Services

The following comprise a list of covered preventive services and screenings covered by Medicare. or, if more convenient, you can type your test, item, or service here and find if it is covered.

  • Abdominal aortic aneurysm screening
  • Alcohol misuse screenings and counseling
  • Bone mass measurements (bone density)
  • Cardiovascular disease screenings
  • Cardiovascular disease behavioral therapy
  • Cervical and vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screenings
  • Diabetes screenings
  • Diabetes self-management training
  • Glaucoma tests
  • Hepatitis C screening test
  • HIV screening
  • Lung cancer screening
  • Mammogram screening
  • Nutrition therapy services
  • Obesity screenings and counseling
  • One-time “Welcome to Medicare” preventive visit
  • Prostate cancer screening
  • Sexually transmitted infections screening and counseling
  • Shots
    • Flu Shots
    • Hepatitis B Shots
    • Pneumococcal Shots
  • Tobacco use cessation counseling
  • Yearly “Wellness” visit

 

Service Who is Covered Frequency Beneficiary Pays

Welcome to Medicare and Annual Wellness Visits

All Medicare recipients with Part B
  • Once in a lifetime for the Welcome to Medicare Visit
  • Annually for the Annual Wellness Visit
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.*

  • Copayment or coinsurance waived
  • Part B deductible waived

*If an EKG is involved, or if your doctor performs additional tests or services that aren’t covered under the preventive benefits:

  • Copayment or coinsurance applies
  • Part B deductible applies

Abdominal Aortic Aneurysm Screening

Medicare recipients with Part B to whom one of the following risk factors applies:

  • A family history of abdominal aortic aneurysms
  • The recipient is a man who has smoked at least 100 cigarettes in his lifetime and is between 65 and 75
  • Once in a lifetime – A referral from the treating doctor is required
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Alcohol Misuse Screening and Counseling

Medicare Recipients with Part B who screen positive for are eligible for counseling if:

  • They are competent and alert at the time of counseling
  • Counseling is by a qualified primary care physician or other primary care practitioners in a primary care facility
  • Annually for the alcohol misuse screening
  • Brief (15 minute) behavioral counseling for alcohol misuse 4 times per year
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Bone Mass Measurements (Bone Density)

Medicare recipients with Part B to whom one of the following applies:

  • Estrogen-deficient women at clinical risk for osteoporosis (as determined by their physician)
  • Patients receiving or to receive glucocorticoid therapy for more than three months
  • Patients with abnormalities of the vertebrae
  • Patients being monitored to assess response to FDA-approved osteoporosis drug therapy
  • Patients with primary hyperparathyroidism
  • Every 2 years
  • More frequently if deemed medically necessary
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Cardiovascular Disease Screening Tests

Lipid Panel which must include:

  • Cholesterol, serum, total
  • Lipoprotein, direct measurement, high-density cholesterol (HDL)
  • Triglycerides
All Medicare recipients with Part B without apparent signs or symptoms of cardiovascular disease
  • Once every 5 years when ordered by a doctor
If the doctor or qualified healthcare provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Cardiovascular Disease Behavioral Therapy

  • Discussion with treating physician regarding aspirin therapy and nutritional counseling
  • May include a blood pressure check
All Medicare recipients with Part B
  • Annually
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.
• Copayment or coinsurance waived
• Part B deductible waived

Cardiovascular Disease Intensive Behavioral Therapy

All Medicare recipients with Part B are eligible if they are:

  • Competent and alert at the time counseling is provided
  • Counseled by a qualified primary care physician or other primary care practitioner in a primary care setting
  • Annually
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Cervical Cancer with Human Papillomavirus (PVA) Screening Tests

• Pap test
• Pelvic exam
• Clinical breast exam

All female Medicare recipients with Part B
  • Once every 24 months for all women
  • Once every 12 months if the patient is at high risk for cervical or vaginal cancer, or if you’re of childbearing age and have had an abnormal Pap test in the last 36 months
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Colorectal Cancer Screening

For colorectal cancer screening using the Cologuard test
All Medicare beneficiaries to whom all the following apply:

  • Are 50 – 85 years of age
  • Are asymptomatic
  • Are at average risk of developing colorectal cancer

For screening colonoscopies, FOBTs, flexible sigmoidoscopies, and barium enemas

  • All Medicare beneficiaries to whom at least one of the following apply:
  • Aged 50 and older who are at normal risk of developing colorectal cancer
  • High risk for developing colorectal cancer as defined in the Code of Federal Regulations at 42 CFR 410.37(a)(3)

(For coverage of screening colonoscopies, there is no age limitation)

  • Cologuard Multitarget Stool DNA (sDNA) Test: once every 3 years
  • Screening Fecal Occult Blood Test (FOBT): every year
  • Screening flexible sigmoidoscopy: once every 4 years (unless a screening colonoscopy has been performed and then Medicare may cover a screening flexible sigmoidoscopy only after at least 119 months)
  • Screening colonoscopy: every 10 years (unless a screening flexible sigmoidoscopy has been performed and then Medicare may cover a screening colonoscopy only after 47 months) or every 2 years if the patient is at high risk.
  • Screening barium enema (as an alternative to covered screening flexible sigmoidoscopy): once every 4 years if the patient is 50 or over and once every 2 years if at high risk for colorectal cancer
For all services except the barium enema:

  • Copayment or coinsurance waived
  • Part B deductible waived

If during a screening colonoscopy or screening flexible sigmoidoscopy a biopsy is done or if a lesion or growth is removed, you may have to pay a copayment or coinsurance but the Part B deductible is waived.

For the barium enema:

  • Copayment or coinsurance applies
  • Part B deductible waived

Counseling to Prevent Tobacco Use

Either hospitalized or outpatient Medicare beneficiaries to whom all the following apply:

  • Use tobacco
  • Are competent and alert during counseling
  • Are counseled by a qualified physician or other Medicare-approved practitioner
  • A total of 8 sessions annually which may include 2 sets of up to 4 intermediate or intensive sessions
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Depression Screening

All Medicare recipients with Part B are covered as long as the screening is furnished in a primary care setting that has staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up.
  • Annually
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Diabetes Screening

Medicare recipients with Part B exhibiting any of the following risk factors:

  • High blood pressure
  • Abnormal cholesterol and triglyceride levels
  • Obesity
  • High blood sugar

OR

Medicare recipients with Part B exhibiting 2 or more of the following risk factors:

  • 65 or older
  • Obesity
  • Family history of diabetes in parents or siblings
  • Gestational diabetes or delivery of a baby weighing 9 pounds or more
  • For Medicare recipients with Part B who have already been diagnosed with pre-diabetes, two screening tests annually are available.
  • For those previously tested but not diagnosed with prediabetes, one screening annually is available
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Diabetes Self-Management Training

Available to Medicare recipients with Part B to whom all apply:

  • Those who are diagnosed with diabetes
  • Those who receive an order for such training from their physician or qualified non-physician practitioner
  • Initial Year: Up to 10 hours of training within the first 12-month period (1 hour of individual training and 9 hours of group training)
  • Following Years: Up to 2 hours each year following the initial 12-month period
Copayment/coinsurance applies
Part B deductible applies

Glaucoma Screening

Available to Medicare recipients with Part B with a written order from their doctor to whom one of the following applies:

  • Have diabetes mellitus
  • Have a family history of glaucoma
  • African-American aged 50 or older
  • Hispanic-American aged 65 or older
  • Annually
Copayment/coinsurance applies
Part B deductible applies

Hepatitis B Virus (HBV) Vaccine and Administration

Medicare recipients with Part B who are at intermediate or high risk for contracting hepatitis B

(Medicare recipients with Part B are not eligible for this benefit if they are currently positive for hepatitis B antibodies.)

  • Scheduled doses as required
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Hepatitis C Virus (HCV) Screening

Medicare recipients with Part B who have the test ordered by a primary care doctor or practitioner and to whom one of the following conditions applies:

  • High risk for HCV infection due to illicit injection drug use
  • Born between 1945 and 1965
  • Received blood transfusion before 1992
  • Medicare recipients with Part B born between 1945 and 1965 who are not considered high risk are eligible for one screening during their lifetime.
  • High-risk Medicare recipients with Part B with continued illicit injection drug use since the prior negative screening may be tested annually.
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Human Immunodeficiency Virus (HIV) Screening

Medicare recipients with Part B who ask for the test and are at increased risk for HIV infection or pregnant women Medicare recipients with Part B from 15 to 65 may be screened annually without regard to perceived risk.

Medicare recipients with Part B under 15 or over 65 who are at increased risk for HIV infection may be screened annually.

Medicare recipients with Part B who are pregnant may be screened three times during pregnancy:

  • When diagnosed with pregnancy
  • During the third trimester
  • During labor, if ordered by the woman’s doctor
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Influenza Virus Vaccine and Administration

All Medicare recipients with Part B
  • Once per influenza season
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Lung Cancer Screening

Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography (LDCT)

Medicare recipients with Part B for whom all the following are true:

  • 55 – 77 years of age
  • Must have no symptoms of lung cancer
  • 30 pack-year history of smoking tobacco (1 pack-year = smoking 1 pack of 20 cigarettes per day for one year)
  • Must be a current smoker or one who has quit within the last 15 years
  • Must have received a written order for lung cancer screening with LDCT
Annually

  • First year: recipients must receive counseling prior to the first LDCT screening
  • Following years: recipients must receive a written order provided by a physician or non-physician provider
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Mammography (Screening)

All female Medicare recipients with Part B who are 35 and older
  • Age 35 – 39: One baseline screening
  • Age 40 and older: Annually
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Mammography (Diagnostic)

All female Medicare recipients with Part B who are 40 and older
  • When medically necessary
  • Copayment or coinsurance applies
  • Part B Part B deductible applies

Medical Nutrition Therapy

Medicare recipients with Part B for whom all the following are true:

  • They have received a referral from their treating physician
  • They have been diagnosed with diabetes or renal disease, or they have received a kidney transplant within the last three years
  • They are provided the service by a registered dietitian or nutrition professional
  • First year: 3 hours of one-on-one counseling
  • Following years: 2 hours
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Obesity Screening & Counseling

Medicare recipients with Part B for whom all the following are true:

  • Body Mass Index (BMI) > 30 kg / meter squared
  • They are competent at the time of counseling
  • They are counseled by a qualified primary care physician or other primary-care practitioner in a primary care setting
  • Month 1:  One face-to-face visit every week
  • Months 2 – 6:  One face-to-face visit every other week
  • Months 7 – 12:  One face-to-face visit every other month (if certain requirements are met)
  • At the 6-month visit, the doctor must reassess the level of obesity and determine what additional weight loss must be attained.
  • The Medicare recipient must have lost at least 3 kg to be eligible for additional face-to-face visits occurring once per month for an additional 6 months.
  • If the Medicare recipient has not lost at least 3 kg during the first 6 months, the doctor must reassess the patient’s readiness to modify their behavior as well as refigure their BMI.
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Pneumococcal Vaccine and Administration

All Medicare recipients with Part B
  • An initial pneumococcal vaccine to any Medicare recipient who has never received the vaccine under Medicare Part B
  • One year later, the recipient may receive a different, second pneumococcal vaccine
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived

Prostate Cancer Screening

All male Medicare recipients with Part B of 50 years plus one day, or older
  • Annually
For a digital rectal exam:

  • Copayment or coinsurance applies
  • Part B deductible applies

For a Prostate Specific Antigen Test (PSA)

  • Copayment or coinsurance waived
  • Part B deductible waived

Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling to Prevent STIs

Medicare recipients with Part B for whom all the following are true:

  • Sexually active adolescents and adults at increased risk for STIs
  • Those who are referred for this service by a primary care provider and whose service is provided by a primary care provider in a primary care setting

Behavioral counseling conducted in an inpatient setting, like a skilled nursing facility, won’t be covered as a preventive service

  • One annual occurrence of screening for chlamydia, gonorrhea, and syphilis in women at increased risk who are not pregnant
  • One annual occurrence of screening for syphilis in men at increased risk
  • Up to two occurrences per pregnancy of screening for chlamydia and gonorrhea in pregnant women who are at increased risk for STIs and continued increased risk for the second screening
  • One occurrence per pregnancy of screening for syphilis in pregnant women; up to two additional occurrences in the third trimester and at delivery if at continued increased risk for STIs
  • One occurrence per pregnancy of screening for hepatitis B in pregnant women; one additional occurrence at delivery if at continued increased risk for STIs
  • Up to two 20–30 minute, face-to-face HIBC sessions annually
If the doctor or qualified health care provider accepts assignment, there is no cost for this service.

  • Copayment or coinsurance waived
  • Part B deductible waived