Does Medicare Cover Preventive Care?

does medicare cover preventive careOne of the questions we get most often is whether Medicare itself covers preventive care. It is a complex question, as there are many types of “preventive” care. The short answer is “yes”.

The Medicare coverage of preventive care was revised in 2011. Medicare now covers more preventive care services than it ever has. Below, we have outlined the majority of the preventive care services that Medicare offers:

Initial and Subequent Annual Visits

  • “Welcome to Medicare” visit: This is a one-time visit with a physician or other medical provider. This visit must occur within the first 12 months that you are enrolled in Medicare. This visit is designed to “map out” your specific, customized preventive care needs.
  • Annual wellness visits: The annual wellness visit is a yearly visit once you are on Medicare. This is completed with your primary care doctor, and it is designed to create/update your annual preventive care needs. It is tailored to your specific health, risk factors, family history, etc.

Specific Preventive Services 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)

Specific Preventive Care Services Covered at 80% by Medicare Part B

  • 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 – NOTE: Test strips and other diabetic supplies are covered under Medicare Part B at 80% as well

Overall, Medicare is now covering more preventive care services than they have in the past. It is up to you, the Medicare beneficiary, to be apprised of what will/will not be covered under Medicare. Keep in mind that all preventive care covered by Medicare at 80% is also subject to the Part B deductible (currently $166/year). If you have a Medigap plan, your plan will pay the remaining 20% coinsurance and, with some plans, the Part B deductible as well.

Medicare has published a booklet that goes into great detail about the types of preventive care that Medicare covers. You can request a copy of the book by calling 1-800-MEDICARE or view an online copy of the booklet here: Medicare’s Coverage of Preventive Care.

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