Medicare has expanded the types of preventative screenings and services in 2014. Here are the highlights of some of the medical screenings and services that Medicare Part B (Medical Insurance) covers:
Abdominal aortic aneurysm screening
Medicare covers a one-time screening abdominal aortic aneurysm ultrasound for people at risk. You must get a referral for it from your doctor. You pay nothing for the screening if the health care provider accepts assignment.
Alcohol misuse screening and counseling
Medicare covers 1 alcohol misuse screening per year for adults with Medicare (including pregnant women) who use alcohol, but do not meet the medical criteria for alcohol dependency. If your primary care practitioner determines you are misusing alcohol, you can get up to 4 brief face-to-face counseling sessions per year (if you’re competent and alert during counseling). A qualified primary care practitioner must provide the counseling in a primary care setting (like a doctor’s office). You pay nothing if the qualified practitioner accepts assignment.
Bone Mass Measurement (Bone density) screening
This test helps to see if you’re at risk for broken bones. It’s covered once every 24 months (more often if medically necessary) for people who have certain medical conditions or meet certain criteria. You pay nothing for this test if the qualified health care provider accepts assignment.
Cardiovascular Disease (behavioral therapy)
Medicare will cover one visit per year with your primary care doctor in a primary care setting (like a doctor’s office) to help lower your risk for cardiovascular disease. During this visit, your doctor may discuss aspirin use (if appropriate), check your blood pressure, and give you tips to make sure you’re eating well. You pay nothing if the qualified heath care professional accepts assignment.
These screenings include blood tests that help detect conditions that may lead to a heart attack or stroke. Medicare covers these screening tests every 5 years to test your cholesterol, lipid, lipoprotein, and triglyceride levels. You pay nothing for the tests, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit (% may vary if you are also covered by a Medigap policy or Medicare Advantage program).
Cervical and vaginal cancer screening
Medicare covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the exam, Medicare also covers a clinical breast exam to check for breast cancer. Medicare covers these screen tests once every 24 months for all women; Medicare covers these screening tests once every 12 months if you’re at high risk for cervical or vaginal cancer or if you’re of child-bearing age and had an abnormal Pap test in the past 36 months. You pay nothing if the doctor or other qualified health care provider accepts assignment.
Medicare covers the following screenings to help find precancerous growths or find cancer early, when treatment is most effective. One or more of the following tests may be covered.
- Fecal occult blood test – covered every 12 months if you’re 50 or older. You pay nothing for the test if the doctor or other qualified health care provider accepts assignment.
- Flexible sigmoidoscopy – generally covered once every 48 months if you’re 50 or older, or 120 months after a previous screening colonoscopy for those not at high risk. You pay nothing for the test if the doctor or other qualified health care provider accepts assignment.
- Colonoscopy – generally covered once every 120 months (high risk every 24 months) or 48 months after a previous flexible sigmoidoscopy. There is no minimum age. You pay nothing for the test if the doctor or other qualified health care provider accepts assignment. Note: If a polyp or other tissue is found and removed during the colonoscopy, the procedure is considered diagnostic and you'll have to pay coinsurance or a copayment.
- Barium enema – generally covered once every 48 months if you’re 50 or older (high risk every 24 months) when used instead of a sigmoidoscopy or colonoscopy. You pay 20% of the Medicare-approved amount for the doctor services. In a hospital outpatient setting, you also pay the hospital a copayment.
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 follow-up treatment and referrals. You pay nothing for this test if the doctor or other qualified health care provider accepts assignment.
Medicare covers screenings to check for diabetes. You may be eligible for up to 2 diabetes screenings each year. You pay nothing for the test .
Diabetes Self-Management Training
Medicare covers a program to help people cope with and manage diabetes. The program may include tips for eating health, being active, monitoring blood sugar, taking medication, and reducing risks. You must have diabetes and a written order from your doctor or other health care provider. You pay 20% of the Medicare approved amount, and the Part B deductible applies.
These tests are covered once every 12 months for people at high risk for the eye disease glaucoma. You’re at high risk if you have diabetes, a family history of glaucoma, are African-American and 50 or older, or are Hispanic and 65 or older. An eye doctor who is legally allowed by the state must do the tests. You pay 20% if the Medicare-approved amount (your Medigap or Medicare Advantage program may cover a portion or all of the 20%), and the Part B deductible applies for the doctor’s visit. In a hospital outpatient setting, you also pay the hospital a copayment (your Medigap or Medicare Advantage program may cover a portion or all of the 20%).
Hepatitis C screening test
Medicare covers one Hepatitis C screening test. Medicare also covers yearly repeat screening for certain people at high risk. Eligible individuals are people with Medicare who meet one of these conditions:
- Those at high risk because they have a current or past history of illicit injection drug use.
- Those who had a blood transfusion before 1992.
- Those born between 1945-1965.
Medicare will only cover Hepatitis C screening tests if they’re ordered by a primary care doctor or practitioner.You pay nothing for the screening test if the doctor or other qualified health care provider accepts assignment.
Medicare covers HIV (Human Immunodeficiency Virus) screenings for people at increased risk for the virus, anyone who asks for the test, and pregnant women. Medicare covers this test once every 12 months or up to 3 times during a pregnancy. You pay nothing for the HIV screening if the doctor or other qualified health care provider accepts assignment.
Lung cancer screeing
Medicare Part B (Medical Insurance) covers a lung cancer screening with Low Dose Computed Tomography (LDCT) once per year. Medicare covers people with Part B who meet all of these conditions:
Medicare covers screening mammograms to check for breast cancer once every 12 months for all women with Medicare 40 and older. Medicare covers one baseline mammogram for women 35-39. You pay nothing for the test if the doctor or other qualified health care provider accepts assignment.
Nutrition therapy services
Medicare covers medical nutrition therapy services and certain related services. A registered dietician or nutrition professional who meets certain requirements can provide these services, which may include nutritional assessment, one-on-one counseling, and therapy services through an interactive telecommunications system. People with Medicare who are eligible must meet at least one of these conditions: Have diabetes, have kidney disease, have had a kidney transplant in the last 36 months or whose doctor or health care provider professional refers them for the service. You pay nothing for these services if the doctor accepts assignment. You
Obesity screening and counseling
If you have a body mass index (BMI) of 30 or more, Medicare covers intensive counseling to help you lose weight. This counseling may be covered if you get it in a primary care setting (like doctor’s office), where it can be coordinated with your personalized prevention plan. Talk to your primary care practitioner to find out more. You pay nothing for this service if the primary care practitioner accepts assignment.
One-time "Welcome to Medicare" preventative visit
You can get this introductory visit only within the first 12 months you have Part B. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including certain screenings, shots, and referrals for other care, if needed. It also includes:
- They're 55-77.
- They're asymptomatic (they don’t have signs or symptoms of lung cancer).
- They're either a current smoker or have quit smoking within the last 15 years.
- They have a tobacco smoking history of at least 30 “pack years” (an average of one pack a day for 30 years).
- They get a written order from their physician or qualified non-physician practitioner.
- Height, weight, and blood pressure measurements
- A calculation of your body mass index
- A simple vision test
- A review of your potential risk for depression and your level of safety
- An offer to talk with you about creating advance directives.
- A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.
This visit is covered one time. You don’t need to have this visit to be covered for yearly "Wellness" visits.
Prostate cancer screening
Medicare covers a Prostate Specific Antigen (PSA) test and a digital rectal exam once every 12 months for men over 50 (beginning the day after your 50th birthday). You pay nothing for the PSA test if the doctor or other health care provider accepts assignment. You pay 20% of the Medicare-approved amount, and the Part B deductible applies for the digital rectal exam (your Medigap or Medicare Advantage program may cover a portion or all of the 20% and/or deductible). In a hospital outpatient setting, you also pay the hospital copayment amount (your Medigap or Medicare Advantage program may cover a portion or all of the 20%).
Sexually transmitted infections (STI) screening & counseling
Medicare Part B (Medical Insurance) covers sexually transmitted infection (STI) screenings for chlamydia, gonorrhea, syphilis and/or Hepatitis B 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 adolescents and adults at increased risk for STIs, if referred by a primary care physician or practitioner.
People with Part B are eligible if they are pregnant and 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. Sexually active adults who are at an increased risk for STIs are also eligible for behavioral counseling sessions.
You pay nothing for STI screenings or counseling if the primary care doctor or primary care practitioner accepts assignment. Medicare will only cover behavioral counseling sessions if they’re provided by a primary care practitioner and take place in a primary care doctor's office or primary care clinic. Behavioral counseling sessions conducted in an inpatient setting, like a skilled nursing facility, won't be covered as a preventive service.
Note: Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
- Flu Shots
- Hepatitis B shots
- Pneumococcal shots
Smoking & tobacco use cessation Counseling
Medicare Part B (Medical Insurance) covers up to 8 face-to-face visits in a 12-month period for people with Part B and who use tobacco. These visits must be provided by a qualified doctor or other Medicare-recognized practitioner. You pay nothing for the counseling sessions if your doctor or other health care provider accepts assignment.
Refer to the Centers for Medicare & Medicaid Services' Medicare & You 2017 Handbook for more information.
Yearly "Wellness" visits
If you've had Part B for longer than 12 months, you can get this visit to develop or update a personalized prevention help plan to prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It also includes:
This visit is covered once every 12 months (11 full months must have passed since the last visit). All people with Part B are covered. You pay nothing for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your doctor or other qualified health care provider accepts assignment.
The Part B deductible doesn’t apply. However, if your doctor or other health care provider performs additional tests or services during the same visit that aren’t covered under these preventive benefits, you may have to pay coinsurance, and the Part B.
- A review of your medical and family history
- Developing or updating 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. Get details about coverage for screenings, shots, and other preventive services.