Medicare Preventive Services: What’s Free, What’s Not!
Dear Savvy Senior,
What types of preventive health screenings does Medicare completely cover, and which ones require a coinsurance fee? I’m due to get some preventive tests done, but I want to find out how much I’ll have to pay before I proceed.
Medicare covers a wide array of preventive services to help you stay healthy, but it’s important to know which services are totally covered, and which ones will generate some out-of-pocket costs.
Thanks to the Affordable Care Act, original Medicare now offers many of their preventive health services completely free to beneficiaries.
Preventive services include various exams, lab tests and screenings that help find health problems in their earliest stages when they’re easier to treat. They also include a number of vaccinations and programs for health monitoring, as well as counseling and education to help you take care of your own health.
Here’s a quick rundown of the different Medicare preventive services that won’t cost you a cent, along with the eligibility requirements you’ll need to meet to get them.
Wellness visits: All Medicare beneficiaries are eligible for two types of preventive wellness visits – one when you’re new to Medicare and one each year after that. But don’t confuse these with full physical examinations. These are prevention-focused visits that provide only an overview of your health and medical risk factors and serve as a baseline for future care.
Colorectal cancer screening: The fecal occult blood test, flexible sigmoidoscopy or colonoscopy are available to all beneficiaries age 50 or older.
Mammograms: All women with Medicare ages 40 and older can get a free breast cancer screening mammogram every year.
Pap tests and pelvic exams: These cervical and vaginal cancer screenings are available every two years, or once a year for those at high risk.
Prostate cancer screenings: Annual PSA blood tests are available to all male beneficiaries age 50 and older.
Cardiovascular screenings: Free blood test to check cholesterol, lipid and triglyceride levels are offered every five years to all Medicare recipients.
Diabetes: Screening available twice a year for those at risk.
Bone mass measurements: This osteoporosis test is available every two years to those at risk, or more often if medically necessary.
Abdominal aortic aneurysm screening: To check for bulging blood vessels, this test is available to men ages 65 to 75 who have ever smoked.
Vaccinations: An annual flu shot, a vaccination against pneumonia and the hepatitis B vaccine are free to all beneficiaries.
In addition, Medicare also offers free smoking cessation counseling; medical nutrition therapy to help beneficiaries with diabetes or kidney disease; depression screenings; alcohol screening and counseling; obesity screening and counseling; annual cardiovascular risk reduction visits; sexually transmitted infection screening and counseling; and HIV screenings.
Medicare also offers several other preventive services that require some out-of-pocket cost-sharing. With these tests, you’ll have to pay 20 percent of the cost of the service (Medicare picks up the other 80 percent), after you’ve met your $147 Part B yearly deductible. The services that fall under this category include digital rectal exams for prostate cancer, glaucoma tests, and diabetes self-management training services.
For detailed information on all Medicare preventive services see www.medicare.gov/share-the-health, or call Medicare at 800-633-4227 and ask them to mail you a free copy of Your Guide to Medicare’s Preventive Service (publication 10110).
If you have a Medicare Advantage plan, you’ll be happy to know that all Advantage plans are also now required to cover the same free preventive services as original Medicare.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.
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