Medicare Preventive Services
Medicare covers a range of wellness and preventive services for free to help keep you healthy. Some preventive services include exams, shots, lab tests and screenings. You can get a free “Welcome to Medicare” checkup along with annual wellness visits to help prevent disease and disability.
Does Medicare Cover Preventive Services?
Medicare covers a variety of preventive services at no cost to you in order to detect and monitor your health as you age.
Some popular Medicare-covered preventive services include flu shots, mammograms, cancer screenings, diabetes screenings, STD testing and bone density testing.
- Original Medicare (Part A and Part B)
- You will not pay a deductible, copayment or coinsurance for most preventive services with Original Medicare (Part A and Part B). To avoid cost, you must visit a Medicare participating provider.
- Medicare Advantage
- Like Original Medicare beneficiaries, people with Medicare Advantage (Part C) plans will not pay a deductible, copayment or coinsurance for most preventive services. However, you may be charged if you visit an out-of-network provider.
Exams and Wellness Visits
When you first enroll in Medicare Part B, you are eligible to receive a free “Welcome to Medicare” checkup within the first 12 months of signing up.
This doctor visit is different from a standard physical exam. It is an opportunity for your doctor to assess your current wellness, understand your medical history and provide a roadmap for your future care.
It also includes height, weight and blood pressure measurements along with a simple vision test and referrals for screening services.
After your Welcome to Medicare visit, you can get an annual wellness exam every 12 months.
Yearly wellness exams let your doctor update your prevention plan and provide you with personalized health advice.
These annual exams also include a cognitive impairment assessment to check for signs of Alzheimer’s disease and dementia.
Shots and Vaccines
Medicare covers flu, pneumonia and Hepatitis B shots at no cost to you.
These illnesses can be deadly for people age 65 and older. This is especially true for people with chronic illnesses.
Simple preventive shots can protect you against these risks.
One flu shot is covered by Medicare each year.
Medicare also covers two different pneumococcal shots to protect you from different strains of a bacteria that can cause pneumonia.
According to the Centers for Disease Control, getting pneumococcal shots prevents 75 percent of adults 65 years and older from developing invasive pneumococcal disease. It also protects 45 percent of older adults against pneumococcal pneumonia.
Most people only need a single shot once in their lifetime. A different, second shot, is covered 11 months after the first shot.
Finally, Medicare covers Hepatitis B shots for people at medium or high risk for the disease. Check with your doctor to see if you qualify for a free Hepatitis B shot.
Lab Tests and Screenings
Screenings to detect disease are typically considered preventive if you’ve had no prior related symptoms.
In some cases, Medicare will only cover screenings if you have certain risk factors.
Medicare also covers medically necessary clinical diagnostic laboratory tests, if ordered by your doctor or practitioner. These lab tests help your doctor diagnose or rule out a potential illness or condition.
Medicare covers screenings for many conditions that affect seniors, including diabetes, cardiovascular disease and different types of cancer.
- Cardiovascular disease
- Abdominal aortic aneurysm
- Hepatitis B
- Hepatitis C
- Sexually transmitted diseases
Cancer Screenings Covered by Medicare
Medicare covers some screening tests used to find cancer.
It’s important to talk to your doctor about any family history of cancer. This helps health care providers decide which screenings you might need.
- Breast Cancer
- One mammogram is fully covered by Medicare every 12 months for all women age 40 and older. Medicare also covers a clinical breast exam once every 24 months.
- Cervical and Vaginal Cancer
- Women who are considered low risk for cervical or vaginal cancers can receive a Pap test and pelvic exam at no cost once every two years. You can get these screenings once a year if you’re at a heightened risk for developing cervical or vaginal cancer.
- Colorectal Cancer
- Medicare covers five different screening tools and tests used to detect colon cancer, including multitarget stool DNA tests, barium enemas, colonoscopies, fecal occult blood tests and flexible sigmoidoscopies. How often you can receive these services at no cost varies, but Medicare covers all expenses if your doctor accepts assignment.
- Lung Cancer
- Medicare Part B covers lung cancer screenings once a year if you meet several conditions. You must be between the ages of 55 to 77, have no signs or symptoms of lung cancer, currently smoke or quit smoking within the last 15 years and have a written order from your doctor.
- Prostate Cancer
- Medicare covers prostate-specific antigen (PSA) blood tests once a year for men over 50. You pay nothing for this test. Digital rectal exams will cost you a 20 percent copayment, and your Part B deductible applies.
Other Screening and Counseling Services
Along with disease and cancer screenings, Medicare provides programs for health monitoring, counseling and education.
These programs and services can help you identify negative behaviors and receive support to form healthier habits.
- Alcohol misuse screenings and counseling
- Depression screenings
- Diabetes self-management training
- Nutrition therapy services
- Obesity screenings and counseling
- Tobacco use cessation counseling
For example, smokers can receive up to eight tobacco-use cessation counseling visits every year.
Another service provides behavioral therapy sessions to overweight Medicare patients with a body mass index of 30 or higher.
Obesity behavioral therapy includes a dietary assessment and counseling to help you lose weight using a program focused on diet and exercise.
8 Cited Research Articles
- Centers for Disease Control. (2019, November 21). Pneumococcal Vaccination: What Everyone Should Know. Retrieved from https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html
- American Cancer Society. (2019, May 13). Medicare Coverage for Cancer Prevention and Early Detection. Retrieved from https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/government-funded-programs/medicare-medicaid/medicare-coverage-for-cancer-prevention-and-early-detection.html
- AARP. (n.d.). What is the “Welcome to Medicare” checkup? Retrieved from https://www.aarp.org/health/medicare-qa-tool/whats-a-medicare-wellness-visit/
- Barry, P. (n.d.). Can Medicare Help Me Lose Weight? Retrieved from https://www.aarp.org/health/medicare-insurance/info-03-2012/medicare-weight-loss-counseling-99.html
- Centers for Medicare & Medicaid Services. (n.d.). Your Guide to Medicare Preventive Services. Retrieved from https://www.medicare.gov/Pubs/pdf/10110-Medicare-Preventive-Services.pdf
- Medicare.gov. (n.d.). Diagnostic Laboratory Tests. Retrieved from https://www.medicare.gov/coverage/diagnostic-laboratory-tests
- Medicare.gov. (n.d.) Preventive screening services. Retrieved from https://www.medicare.gov/coverage/preventive-screening-services
- Medicare.gov. (n.d.) Yearly “Wellness” visits. Retrieved from https://www.medicare.gov/coverage/yearly-wellness-visits