What Are Medicare Preventive Services

Medicare Preventive Services, are meant to help keep you healthy and prevent future health issues from arising.  The services offered and the timeline for testing is set by your current health and risk category. Here are some details on the preventive health services offered by Medicare.  You can also call us for questions at 844-528-8688 anytime.

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Medicare isn’t just about providing you with affordable access to healthcare for emergencies or long term medical treatments. It’s also here to help keep you healthy and prevent future health issues from arising.

While keeping a healthy weight, eating well, exercising, and avoiding smoking are some of the best ways to maintain your health, Medicare Preventive Services add an extra layer of protection by ensuring that you don’t give up on necessary medical appointments just because you’ve got a new form of insurance. Preventative services include lab tests, screenings, shots, and exams, as well as various programs that will monitor your health, and teach you how to stay healthy. They are meant to help catch major health problems before they progress, or even prevent them altogether

Difference Between Diagnostic Services and Preventive Screenings

Beyond simple wellness visits, Medicare Preventive Services also include screenings and diagnostic services. The difference is pretty simple:

Preventative screenings are usually to detect issues before the patient shows any symptoms of a disease. Medicare usually covers most preventive care for free, but there are cases in which Medicare will only cover the tests if the patient has certain risk factors.Diagnostic services are meant to address already existing symptoms or conditions and usually require you to pay a deductible, copay or coinsurance


What Preventive Services Does Medicare Cover

Your doctor or health care provider might ask you to take certain tests or other services to assess your health and determine further treatment or care. Thankfully, Medicare Preventive Services can help in a variety of ways.  The Medicare preventive services publication HERE.

Medicare Preventive Services Covered Annually

The following services will usually be covered once per year for everyone on Medicare:

  • Cardiovascular disease (behavioral therapy)
  • Depression screening
  • Flu shots (covered once per flu season)
  • HIV screening (coverage increases to 3 tests during pregnancy)
  • Mammogram screening (for women ages 35-39, only a one time baseline appointment is covered; ages 40+ are covered annually)
  • Prostate cancer screening (covered for men who are over 50).
  •  Wellness visit (only covered for those who have been part of Medicare Part B for more than 12 months)

Preventive Services That Require Qualifying Criteria

There are also certain kinds of screenings which are covered but only when the patient belongs to a high-risk group or meets certain criteria.

  • Lung cancer screenings are covered for patients who meet all of the following criteria:
    • Age 55 – 77
    • Current smoker or quit within the last 15 years
    • Have a smoking history of at least one pack a day for 30 years
    • Have written consent from your physician
  • Glaucoma tests are available for those who are at a high risk for this condition.
  • Pap tests, pelvic exams, and breast exams are covered every 24 months for most women. For women at high risk of related cancers, they’re covered yearly.
  • Bone mass measurement is covered every 24 months if you fall into an osteoporosis risk group.

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Medicare Preventive Services for Substance Abuse

There is special counseling and treatment available for those who want to quit smoking or control their alcohol use.

  • In the case of alcohol misuse, one screening is covered per year to identify if you misuse alcohol, but are not dependent. For those that screen positive, Medicare will cover up to 4 face-to-face counseling session per year.
  •  For smoking cessation, Medicare coverage includes a maximum of 8 counseling sessions in a year. All people who use tobacco are covered.

Medicare Preventive Services For Certain Conditions

There are also other screenings for people at risk of certain health conditions, but the requirements are more specific, and usually require a doctor’s referral or counseling to schedule. These include the following:

  • Abdominal aortic aneurysm screening
  • Cardiovascular disease screening
  • Colorectal cancer screenings
  • Diabetes screenings and self-management training
  • Hepatitis B shots
  • Hepatitis C screenings
  • Medical nutritional therapy services
  • Obesity screening and counseling
  • Pneumococcal shots
  • Sexually transmitted infections counseling and screening

What Is The Welcome To Medicare Visit

The Welcome to Medicare Visit is a special sort of wellness visit that you can choose to receive as soon as you join Medicare. The visit will help you prepare for future appointments, and may help your doctor find certain health issues early on.

Medicare Part B will cover your Welcome to Medicare appointment, but you must visit within 12 months of your enrollment in part B.

In the preventive visit, your provider will assess your overall well-being by checking your weight, height, body mass index (BMI), vision, and blood pressure. The doctor will also review your social and medical history, as well as the potential for depression and other kinds of mental health conditions. Lastly, they’ll help determine any other preventive services you may need by assessing your risk factors. The Welcome to Medicare Visit is an important part of starting your preventive healthcare off on the right foot. It’s one appointment you don’t want to miss.

Preventative Services Covered by Medicare Advantage Plans?

Yes. All preventive care services are covered by Medicare, no matter if its a Medicare Advantage Plan or Original Medicare. You just have to meet the basic eligibility standards, and then you’ll have the right for these services.

How Does Medigap Work With Medicare Preventive Services?

Medicare Preventive Services are included in Original Medicare, so as long as you have Part B you are covered. However, as previously mentioned, certain diagnostic services may require a copay, coinsurance, or deductible.

If you have Medicare Supplemental Insurance, some or all of these out-of-pocket expenses will not be billed to you (according to your plan benefits).

Learn more about what procedures Medicare covers by visiting our frequently asked questions page.

Learn More About Medicare Preventive Services

Still have questions about how your Medicare Preventive Services work? Just give us a call at 844-528-8688 and we’ll be happy to help.

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