Medicare Preventive Services: What's Free and What Isn't?

When we’re young we believe that we’re invincible, which makes it harder to admit as we age that our bodies naturally need more care. Normal aging affects the heart, bones and joints, so preventive care is key to avoiding aging that could be harmful to your health.

Medicare-eligible Americans who are signed up for Medicare Part B as part of Original Medicare or Medicare Advantage (Medicare Part C) can take advantage of the preventive services that are included. Preventive care can help save you from serious illnesses entirely or detect health conditions early enough to treat.

What are Medicare preventive services?

Preventive services include fully and partially covered screenings, vaccinations, and counseling services.

If your doctor accepts assignment, meaning your doctor agrees to accept Medicare’s fee for covered services, you can benefit from the many preventive care services that are available at no cost to you. Free preventive care services are readily available to adults age 50 or older, so it’s surprising to learn that less than 50 percent of adults age 65 and older are up to date on preventive services, according the Centers for Disease Control and Prevention. If your provider does not accept payment in full — or Medicare at all — you may pay for the services out of pocket.

Below is a breakdown of which Medicare preventive services are free and which aren’t.

Fully covered Medicare preventive services:

Screenings
 

• Abdominal Aortic Aneurysm Screening
  A one-time ultrasound is covered.
• Bone Mass Measurement
  One test every 24 months or more if medically necessary.
• Breast Cancer Screenings
  Annual screenings, including breast exams and mammograms, are covered.
• Cardiovascular Screenings
  Blood tests to check cholesterol, lipid and triglyceride levels every five years.
• Cervical and Vaginal Cancer Screenings
  Pap tests and pelvic exams once every 24 months or once every 12 months if at risk for cancer.
• Colorectal Cancer Screenings
  Sigmoidoscopy every 48 months or every 24 months if at high risk, screening every 120 months if not at high risk and fecal occult blood test every 12 months.
• Depression Screening
  One yearly screening with your primary care physician.
• Diabetes Screening
  Two fasting blood glucose tests are covered if you are at risk for diabetes.
• Hepatitis C Screening Test
  One test is covered. However, if you are at high risk, yearly screenings are covered.
• HIV Screening
  One test every 12 months is covered.
• Lung Cancer Screening
  One yearly screening is covered for current or former smokers.
• Obesity Screening
  The screening is covered for individuals whose body mass index (BMI) is 30 or more.
• Prostate Cancer Screenings
  One prostate specific antigen test is covered every 12 months.
• Sexually Transmitted Infections Screening
  Screenings for Hepatitis B, chlamydia, gonorrhea, and syphilis are covered once every 12 months.

Vaccinations
 

• Flu Shots
  One flu shot every flu season
• Pneumonia Shots
  One shot in a lifetime is typical, but a second shot is also covered one year later.
• Hepatitis B
  Three shots for full protection

Counseling
 

• Alcohol Misuse
  Four yearly sessions are covered.
• Cardiovascular Behavioral Therapy
  One yearly session with your primary care physician is covered.
• Medical Nutrition Therapy
  The first year includes three hours of therapy. Each year after that includes two hours of therapy.
• Obesity
  Behavioral counseling to help you lose weight is covered.
• Tobacco Use Cessation
  Eight sessions in 12 months are covered.

Partially covered Medicare preventive services:

Screenings
 

• Colorectal Cancer Screenings
  Barium enemas require you to pay 20 percent of the Medicare-approved amount for the service.
• Diagnostic Mammogram
  You will pay 20 percent of the Medicare-approved amount. However, this can be applied to your Part B deductible.
• Glaucoma Tests
  You will pay 20 percent of the Medicare-approved amount. However, this can be applied to your Part B deductible.
• Prostate Cancer Screenings
  Digital rectal exams require you to pay 20 percent of the Medicare-approved amount. However, this can be applied to your Part B deductible.

Counseling
 

• Diabetes Self-Management Training
  You will pay 20 percent of the Medicare-approved amount. However, this can be applied to your Part B deductible.

If a free service leads to other non-preventive services based on the results, you may have to pay. However, Medicare plans could help cover those costs. Not all Medicare beneficiaries are eligible for all Medicare preventive services. For example, mammograms are a free service to female Medicare beneficiaries only. You may want to check your Medicare policy if you have questions about which preventive services are covered.

Clifton Stubbs is a regional sales director for HealthMarkets and Excelsior Insurance Brokerage.