Preventative Services

Medicare pays for many preventive services to keep you healthy. Preventive services can find health problems early and can keep you from getting certain diseases. Preventive services include exams, shots, lab tests, and screenings. They also include programs for health monitoring, counseling, and education to help you take care of your own health.

The Affordable Care Act makes many improvements to Medicare. If you have Original Medicare, you can get a yearly “Wellness” visit and many other covered preventive services.

Below is a list of preventive services that are covered by Medicare Part B. The costs will depend on whether your benefits are through Original Medicare or through a Medicare Advantage Plan (like an HMO or PPO).

  • Alcohol Misuse Screening & Counseling

    Who's covered?
    Adults with Medicare (including pregnant women) who use alcohol, but don't meet the medical criteria for alcohol dependency.
    How often is it covered?
    1 screening per year. Additional sessions available depending on situation.
    Your costs if you have Original Medicare
    Nothing, if qualified primary care doctor / practitioner accepts assignment.

  • Bone Mass Measurements

    Who's covered?
    Bone mass measurements are covered if medically necessary for certain people
    with Medicare whose doctors say they’re at risk for osteoporosis, and have one
    of these medical conditions:
    • A woman whose doctor or health care provider says she’s estrogen-deficient
    and at risk for osteoporosis, based on her medical history and other findings
    • A person with vertebral abnormalities as demonstrated by an X-ray
    • A person receiving steroid treatments
    • A person with hyperparathyroidism
    • A person taking an osteoporosis drug
    How often is it covered?
    Once every 24 months (more often if medically necessary).
    Your costs if you have original Medicare
    You pay nothing for this if your doctor accepts assignment.

  • Breast Cancer Screenings (Mammograms)

    Who's covered?
    Women 40 and older are eligible for a screening mammogram every 12
    months. Medicare also covers one baseline mammogram for women between
    35–39.
    How often is it covered
    Once every 12 months.
    Your costs if you have Original Medicare
    You pay nothing for the test if the doctor accepts assignment.
    Am I at high risk for breast cancer?
    Your risk of developing breast cancer increases if any of these
    are true:
    • You had breast cancer in the past.
    • You have a family history of breast cancer (like a mother, sister, daughter,
    or 2 or more close relatives who have had breast cancer).
    • You had your first baby after age 30.
    • You’ve never had a baby.

  • Cardiovascular Disease Screening

    Medicare covers cardiovascular disease screenings that check your cholesterol
    and other blood fat (lipid) levels. High levels of cholesterol can increase your
    risk for heart disease and stroke. These screenings will tell if you have high
    cholesterol.
    Who's covered?
    All people with Medicare.
    What's covered
    Tests for cholesterol, lipid, and triglyceride levels.
    How often is it covered
    Once every 5 years.
    Your costs if you have Original Medicare
    You pay nothing for this screening.

  • Cervical and Vaginal Cancer Screening

    Medicare covers Pap tests and pelvic exams to check for cervical and vaginal
    cancers. As part of the pelvic exam, Medicare also covers a clinical breast
    exam to check for breast cancer.
    Who's covered?
    All women with Medicare.
    How often is it covered
    Medicare covers these screening tests once every 24 months, or once every 12
    months for women at high risk, and for women of child-bearing age who have
    had an exam that indicated cancer or other abnormalities in the past 3 years.
    Your costs if you have Original Medicare
    You pay nothing for Pap test. You pay nothing for the pelvic exam (including
    a clinical breast exam) if the doctor accepts assignment.
    Am I at high risk for cervical cancer?
    Your risk for cervical cancer increases if any of these are true:
    • You’ve had an abnormal Pap test.
    • You’ve had cervical or vaginal cancer in the past.
    • You have a history of sexually transmitted disease (including HIV
    infection).
    • You began having sex before age 16.
    • You’ve had 5 or more sexual partners.
    • Your mother took DES (Diethylstilbestrol), a hormonal drug, when she
    was pregnant with you.

  • Colorectal Cancer Screening

    Medicare covers colorectal cancer screening tests to help find pre-cancerous polyps
    (growths in the colon) so they can be removed before they become cancerous
    and to help find colorectal cancer at an early stage when treatment works best.
    Treatment works best when colorectal cancer is found early.
    Who's covered?
    All people with Medicare 50 and older, but there’s no minimum age for having
    a screening colonoscopy.
    How often is it covered
    • Screening fecal occult blood test—Once every 12 months.
    • Screening flexible sigmoidoscopy—Once every 48 months after the last
    flexible sigmoidoscopy or barium enema, or 120 months after a previous
    screening colonoscopy.
    • Screening colonoscopy—Once every 120 months (high risk every 24
    months) or 48 months after a previous flexible sigmoidoscopy.
    • Screening barium enema—Once every 48 months (high risk every 24
    months) when used instead of sigmoidoscopy or colonoscopy.
    Your costs if you have Original Medicare
    You pay nothing for the fecal occult blood test. You pay nothing for the flexible
    sigmoidoscopy or screening colonoscopy if your doctor accepts assignment.
    Note: If a polyp or other tissue is found and removed during the
    colonoscopy, you may have to pay 20% of the Medicare-approved amount
    for the doctor’s services and a copayment in a hospital outpatient setting.
    For barium enemas, you pay 20% of the Medicare-approved amount for the
    doctor’s services. The Part B deductible doesn’t apply. If it’s done in a hospital
    outpatient setting, you pay a copayment.
    Am I at high risk for colorectal cancer?
    Risk for colorectal cancer increases with age. It’s important to continue with
    screenings, even if you were screened before you had Medicare. Your risk for
    colorectal cancer increases if any of these are true:
    • • You’ve had colorectal cancer before.
    • • You have a close relative who had colorectal polyps or colorectal cancer.
    • • You have a history of polyps.
    • • You have inflammatory bowel disease (like ulcerative colitis or Crohn’s disease).

  • Depression Screening

    Who's covered?
    All people with Medicare.
    How often is it covered
    Medicare covers one depression screening per year. The screening must be
    done in a primary care setting (like a doctor’s office) that can provide followup
    treatment and referrals.
    Your costs if you have Original Medicare
    You pay nothing for this test if your doctor or other qualified health care
    provider accepts assignment.

  • Diabetes Screening & Self-Management Training

    Diabetes is a medical condition in which your body doesn’t make enough
    insulin, or has a reduced response to insulin. Diabetes causes your blood sugar
    to be too high because insulin is needed to use sugar properly. A high blood
    sugar level isn’t good for your health. Medicare covers a blood screening test to
    check for diabetes for people at risk. For people with diabetes, Medicare covers
    educational training to help manage their diabetes.
    Diabetes screening (Fasting blood glucose test)
    Who's covered?
    People who are at risk for diabetes.
    How often is it covered
    Based on the results of your screening tests, you may be eligible for up to 2
    diabetes screenings per year.
    Your costs if you have Original Medicare
    You pay nothing for this screening.
    Are you at high risk for diabetes?
    You’re considered at high risk if you have high blood pressure, dyslipidemia
    (history of abnormal cholesterol and triglyceride levels), obesity, or a history of
    high blood sugar (glucose). Medicare also covers these tests if you answer “yes”
    to 2 or more of the following questions:
    • • Are you 65 or older?
    • • Are you overweight?
    • • Do you have a family history of diabetes (parents, brothers, or sisters)?
    • • Do you have a history of gestational diabetes (diabetes during pregnancy), or
    • have you had a baby weighing more than 9 pounds?
    Diabetes self-management training
    Who's covered?
    This training is for people with diabetes to teach them to manage their
    condition and prevent complications. You must have a written order from a
    doctor or other health care provider.
    Your costs if you have Original Medicare
    You pay 20% of the Medicare-approved amount after the yearly Part B
    deductible.

  • Glaucoma Tests

    Glaucoma is an eye disease caused by high pressure in the eye. It can develop
    gradually without warning and often without symptoms. The best way for
    people at high risk for glaucoma to protect themselves is to have regular eye
    exams.
    Who's covered?
    People with Medicare whose doctor says they’re at high risk for glaucoma.
    How often is it covered
    Once every 12 months.
    Your costs if you have Original Medicare
    You pay 20% of the Medicare-approved amount after the yearly Part B
    deductible.
    Am I at high risk for glaucoma?
    Your risk for glaucoma increases if any of these are true:
    • You have diabetes.
    • You have a family history of glaucoma.
    • You’re African-American and 50 or older.
    • You’re Hispanic and 65 or older.

  • HIV Screening

    Medicare covers voluntary HIV (Human Immunodeficiency Virus) screenings
    for people at increased risk for the infection, including anyone who asks for
    the test and pregnant women.
    How often is it covered
    Medicare covers this test once every 12 months, or up to 3 times during a
    pregnancy.
    Your costs if you have Original Medicare
    You pay nothing for this test.

  • Medical Nutrition Therapy

    Medicare may cover medical nutrition therapy if you have diabetes or kidney
    disease, and your doctor refers you for this service. These services can be
    given by a registered dietitian or Medicare-approved nutrition professional,
    and include a nutritional assessment and counseling to help you manage your
    diabetes or kidney disease.
    Who's covered?
    Certain people who have any of these:
    • • Diabetes
    • • Renal disease (people who have kidney disease, but aren’t on dialysis)
    • • Have had a kidney transplant within the last 3 years
    Your doctor needs to refer you for this service.
    How often is it covered
    Medicare covers 3 hours of one-on-one counseling services the first year,
    and 2 hours each year after that. If your condition, treatment, or diagnosis
    changes, you may be able to get more hours of treatment with a doctor’s
    referral. A doctor must prescribe these services and renew your referral yearly
    if continuing treatment is needed into another calendar year.
    Your costs if you have Original Medicare
    You pay nothing for these services if the doctor accepts assignment.
    For more information about diabetes and medical nutrition therapy
    Visit www.medicare.gov/publications to view the booklet “Medicare Coverage
    of Diabetes Supplies & Services.” You can also call 1-800-MEDICARE
    (1-800-633-4227). TTY users should call 1-877-486-2048.

  • Obesity Screening & Counseling

    Medicare covers intensive behavioral therapy for people with obesity, defined
    as a body mass index of 30 or more.
    Who's covered?
    All people with Medicare may be screened for obesity. Counseling is covered
    for anyone found to have a body mass index of 30 or more.
    How often is it covered
    This counseling may be covered if you get it in a primary care setting (like a
    doctor’s office). Talk to your primary care doctor or primary care practitioner
    to find out more.
    People with a body mass index of 30 or more are eligible for:
    • One face-to-face visit each week for the first month
    • One face-to-face visit every other week for months 2–6
    • One face-to-face visit every month for months 7–12, if you lose 6.6 pounds
    during months 1–6
    Your costs if you have Original Medicare
    You pay nothing for this service if your primary care doctor or other qualified
    primary care practitioner accepts assignment.

  • Prostate Cancer Screening

    Prostate cancer may be found by testing the amount of PSA (Prostate Specific
    Antigen) in your blood. Another way prostate cancer may be found is when
    your doctor performs a digital rectal exam. Medicare covers both of these tests.
    Who's covered?
    All men with Medicare over 50 (coverage for this test begins the day after your
    50th birthday).
    How often is it covered
    • Digital rectal examination—Once every 12 months.
    • PSA test—Once every 12 months.
    Your costs if you have Original Medicare
    Generally, you pay 20% of the Medicare-approved amount for the digital rectal
    exam after the yearly Part B deductible. There’s no coinsurance and no Part B
    deductible for the PSA test.
    Am I at high risk for prostate cancer?
    Talk to your doctor or practitioner about whether you’re at risk for prostate
    cancer.

  • Sexually Transmitted Infections Screening & Counseling

    Medicare covers sexually transmitted infection (STI) screenings for chlamydia,
    gonorrhea, syphilis, and/or Hepatitis B.
    Who's covered?
    People with Medicare who are pregnant and/or certain people who are at
    increased risk for an STI when the tests are ordered by a primary care doctor
    or other primary care practitioner.
    How often is it covered
    Medicare covers these tests once every 12 months or at certain times during
    pregnancy. Medicare also covers up to 2 individual 20 to 30 minute, face-to-face,
    high-intensity behavioral counseling sessions each year for sexually active
    adults at increased risk for STIs. Medicare will only cover these counseling
    sessions if they’re provided by a primary care doctor or other primary care
    practitioner and take place in a primary care setting (like a doctor’s office).
    Counseling conducted in an inpatient setting, like a skilled nursing facility,
    won’t be covered as a preventive service.
    Your costs if you have Original Medicare
    You pay nothing for these services if your primary care doctor or other
    qualified primary care practitioner accepts assignment.

  • Shots (Flu, Pneumococcal, Hepititis B)

    Medicare covers flu, pneumococcal, and Hepatitis B shots. Flu, pneumococcal
    infections, and Hepatitis B can be life threatening to an older person. All people
    65 and older should get flu and pneumococcal shots. People with Medicare
    who are under 65 but have chronic illness, including heart disease, lung disease,
    diabetes, or End-Stage Renal Disease (ESRD) (permanent kidney failure
    requiring dialysis or a kidney transplant) should get a flu shot. People at medium
    to high risk for Hepatitis B should get Hepatitis B shots.
    Flu shot
    Who's covered?
    All people with Medicare.
    How often is it covered
    Once a flu season.
    Your costs if you have Original Medicare
    You pay nothing if your doctor or health care provider accepts assignment for
    giving the shot.
    Pneumococcal shot
    Who's covered?
    All people with Medicare.
    How often is it covered
    Most people only need this shot once in their lifetime.
    Your costs if you have Original Medicare
    You pay nothing if your doctor or health care provider accepts assignment for
    giving the shot.
    Hepatitis B shots
    Who's covered?
    Certain people with Medicare whose doctor says they’re at medium or high risk
    for Hepatitis B.
    How often is it covered
    Three shots are needed for complete protection. Check with your doctor about
    when to get these shots if you qualify to get them.
    Your costs if you have Original Medicare
    You pay nothing if your doctor or health care provider accepts assignment.
    Am I at medium or high risk for Hepatitis B?
    These are some of the factors that put you at medium or high risk for Hepatitis B:
    • Hemophilia
    • ESRD (End-Stage Renal Disease)
    • Diabetes
    • Certain other conditions that increase your risk for infection, like if you live
    with someone who has Hepatitis B, or if you’re a health care worker and have
    frequent contact with blood or body fluids.
    Other factors may increase your risk for Hepatitis B. Check with your doctor to
    see if you’re at medium or high risk for Hepatitis B.

  • Tobacco Use Cessation Counseling

    The U.S. Surgeon General has reported that quitting smoking and stopping
    tobacco use leads to significant risk reduction for certain diseases and
    other health benefits, even in older adults who have smoked for years. Any
    person who uses tobacco can get counseling from a qualified doctor or other
    Medicare-recognized practitioner who can help them stop using tobacco.
    Who's covered?
    Medicare covers these counseling sessions as a preventive service if you haven’t
    been diagnosed with an illness caused by tobacco use.
    How often is it covered
    Medicare will cover up to 8 face-to-face visits during a 12-month period. These
    visits must be provided by a qualified doctor or other Medicare-recognized
    practitioner.
    Your costs if you have Original Medicare
    You pay nothing for the counseling sessions.
    Ask your doctor about Medicare-covered tobacco cessation programs near
you, or visit www.nih.gov for more information about stopping tobacco use.

  • Welcome to Medicare Preventative Visit

    This visit is only covered one time. You must have the visit within the first 12 months you’re enrolled in Part B..
    What happens during the visit?
    During the visit, your doctor will:
    • Record your medical and social history (like alcohol or tobacco use, your diet,
    and your activity level).
    • Check your height, weight, and blood pressure.
    • Calculate your body mass index.
    • Give you a simple vision test.
    • Review your potential risk for depression and your level of safety.
    • Offer to talk with you about creating advance directives. Advance directives are
    legal documents that allow you to put in writing what kind of health care you
    would want if you were too ill to speak for yourself.
    Depending on your general health and medical history, you’ll get advice,
    education, and counseling to help you prevent disease, improve your health, and
    stay well. You’ll also get a written plan (like a checklist) letting you know which
    screenings, shots, and other preventive services you need.
    People at risk for abdominal aortic aneurysms may get a referral for a one-time
screening ultrasound at their “Welcome to Medicare” preventive visit.
If you have a family history of abdominal aortic aneurysms, or you’re a man 65 to
75 and you have smoked at least 100 cigarettes in your lifetime, you’re considered
at risk. You pay nothing for this screening ultrasound.
    What should I bring to the visit?
    When you go to your “Welcome to Medicare” preventive visit, bring these items:
    • Your medical records, including immunization records (if you’re seeing a new
    doctor). Call your old doctor to get copies of your medical records.
    • Your family health history—try to learn as much as you can about your family’s
    health history before your appointment. Any information you can give your
    doctor can help determine if you’re at risk for certain diseases.
    • A list of prescription and over-the-counter drugs that you currently take, how
    often you take them, and why.
    Who's covered and how often is it covered?
    This visit is only covered one time, and you must have the visit within the first
    12 months you’re enrolled in Part B.
    Your costs if you have Original Medicare
    You pay nothing if your doctor accepts assignment.

  • Yearly Wellness Visit

    If you’ve had Part B for longer than 12 months, you can get a yearly “Wellness”
    visit to develop or update a personalized prevention plan based on your current
    health and risk factors. This includes:
    • Health risk assessment (Your doctor or health professional will ask you to
    answer some questions before or during your visit, which is called a health
    risk assessment. Your responses to the questions will help you and your health
    professional get the most from your yearly “Wellness” visit.)
    • Review of medical and family history.
    • Develop or update a list of current providers and prescriptions.
    • Height, weight, blood pressure, and other routine measurements.
    • Detection of any cognitive impairment.
    • Personalized health advice.
    • A list of risk factors and treatment options for you.
    • A screening schedule (like a checklist) for appropriate preventive services.
    How often is it covered?
    Once every 12 months.
    Your costs if you have Original Medicare
    You pay nothing for this visit if your doctor accepts assignment.
    You don’t need to have had a “Welcome to Medicare” preventive visit before
getting a yearly “Wellness” visit. If you do get the “Welcome to Medicare”
preventive visit during your first year with Part B, you’ll have to wait 12 months
before you can get your first yearly “Wellness” visit.

Note: This information was current and correct as of this writing. Changes may occur. Visit medicare.gov or call 1-800-Medicare to get the most current information.

Information contained above was taken from “Your Guide To Medicare’s Preventive Services” booklet produced by Centers For Medicare & Medicaid Services, the official government booklet regarding Medicare’s Preventive Services.