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Many people don't realize that all Medicare health plans will cover several preventive tests and services that may not be offered by private health plans covering younger people. These preventive services include exams, lab tests and screenings, innoculations, monitoring, and counseling aimed at early detection and maintaining optimum health.
The amount you pay for these services will vary depending on how you get your Medicare benefits, either through Original Medicare, or through a Medicare Advantage Plan. The information below explains how the most common preventive services are covered for those with Part B under Original Medicare (sometimes called fee-for-service). If you get your healthcare coverage through a Medicare Advantage Plan (like an HMO or PPO), call your plan for more information.
In the interest of providing good care, a doctor or health care provider may do exams or tests that Medicare doesn't cover, or may recommend tests more often than Medicare covers them. Before consenting to any medical tests be sure to confirm that they will be covered, and find out what the cost will be if they are not.
One-time "Welcome to Medicare" Physical Exam
Medicare covers a one-time preventive physical exam within the first 12 months that you have Part B. This exam is called the "Welcome to Medicare" physical exam. The exam includes a medical and social history review of your health, and educationand counseling about preventive services, including certain screenings, shots, and referrals for other care if needed.
Cardiovascular Screening
Medicare covers cardiovascular screenings that check your cholesterol and other blood fat (lipid) levels.
Who is covered? All people with Medicare
What is covered? Tests for cholesterol, lipid, and triglyceride levels
How often is it covered? Once every 5 years
Your costs with Original Medicare: You pay nothing if your doctor or health care provider accepts assignment.
Breast Cancer Screening (Mammograms)
Medicare covers screening mammograms and digital technologies for screening mammograms
Who is covered? All women with Medicare age 40 and older can get a screening mammogram every 12 months. Medicare also covers one baseline mammogram for women with Medicare between ages 35 and 39.
How often is it covered? Once every 12 months.
Your costs with Original Medicare: You pay 20% of the Medicare-approved amount with no Part B deductible.
Cervical and Vaginal Cancer Screening
Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer.
Who is 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 with Original Medicare: You pay nothing for the Pap lab test. For Pap test collection and pelvic and breast exams, you pay 20% of the Medicare-approved amount with no Part B deductible.
Colorectal Cancer Screening
Medicare covers colorectal screening tests to help find pre-cancerous polyps (growths in the colon) so they can be removed before they turn into cancer.
Who is covered? All people with Medicare age 50 and older, except there is no minimum age for having a screening colonoscopy.
How often is it covered?
• Fecal Occult Blood Test--Once every 12 months. You pay nothing for this test, but you usually have to pay 20% of the Medicare-approved amount for the doctor's visit
• Flexible Sigmoidoscopy--Generally, once every 48 months, or for those not at high risk, 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
• Barium Enema--Once every 48 months (high risk every 24 months) when used instead of sigmoidoscopy or colonoscopy.
Your costs with Original Medicare: You pay nothing for the fecal occult blood test. For all other tests, you pay 20% of the Medicare-approved amount with no Part B deductible. If the flexible sigmoidoscopy or colonoscopy is done in a hospital outpatient department or an ambulatory surgical center, you pay 25% of the Medicare-approved amount.
Prostate Cancer Screening
Prostate cancer can often be found early by testing the amount of PSA (Prostate Specific Antigen) in the blood and by a rectal exam. Medicare covers both of these tests.
Who is covered? All men with Medicare over age 50 (coverage for this test begins the day after your 50th birthday)
How often are they covered?
• Digital Rectal Examination--Once every 12 months
• PSA Test--Once every 12 months
Your costs with Original Medicare: Generally, the patient pays 20% of the Medicare-approved amount for the digital rectal exam after the yearly Part B deductible. There is no coinsurance and no Part B deductible for the PSA Test.
Shots (Flu, Pneumococcal, Hepatitis B)
All people age 65 and older are covered for flu and pneumococcal shots. People with Medicare who are under age 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 is covered? All people with Medicare
How often is it covered? Once a flu season in the fall or winter
Your costs with Original Medicare: You pay nothing if your doctor or health care provider accepts assignment.
Pneumococcal Shot
Who is covered? All people with Medicare
How often is it covered? Most people only need this shot once in their lifetime
Your costs with Original Medicare: You pay nothing if your doctor or health care provider accepts assignment.
Hepatitis B Shots
Who is covered? People with Medicare whose doctor says they are at medium to 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 for them
Your costs with Original Medicare: You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
Bone Mass Measurements
Who is covered? All people with Medicare whose doctors say they are at risk for osteoporosis
How often is it covered? Once every 24 months (more often if medically necessary)
Your costs with Original Medicare: You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
Diabetes Screening, Supplies, and Self-Management Training
For people with Medicare at risk for getting diabetes, Medicare covers a blood screening test to check for diabetes. For people with diabetes, Medicare covers certain supplies and educational training to help manage their diabetes.
Diabetes Screening (Fasting Blood Glucose Test)
Who is covered? People with Medicare whose doctor says they are at risk for diabetes
You are 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 two or more of the following questions:
• If you are age 65 or older?
• If you are overweight?
• If you have a family history of diabetes (parents, brothers, sisters)?
• If you have a history of gestational diabetes (diabetes during pregnancy), or delivery of a baby weighing more than 9 pounds?
How often is it covered? Based on the results of your screening tests, you maybe eligible for up to two diabetes screenings per year
Your costs with Original Medicare: You pay nothing if your doctor or health care provider accepts assignment.
Diabetes glucose monitors, test strips, and lancets
Who is covered? All people with Medicare who have diabetes
Your costs with Original Medicare: You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
Diabetes Self-Management Training
Who is covered? People with diabetes. Your doctor must provide a written training order
Your costs with Original Medicare: You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
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. Nutrition therapy includes a nutritional assessment and counseling to help you manage diabetes or kidney disease.
Who is covered? People who have diabetes or renal disease...people who have kidney disease but aren't on dialysis or haven't had a kidney transplant, or for people who have kidney disease but aren't on dialysis... with a doctor's referral up to 3 years after a kidney transplant.
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 with Original Medicare: You pay 20% of the Medicare-approved amount for services after the yearly Part B deductible.
Glaucoma Tests
Who is covered? People with Medicare whose doctor says they are at high risk for glaucoma. The risk for glaucoma increases if any of the following are true:
• You have diabetes
• You have a family history of glaucoma
• You are African-American and age 50 or older
• You are Hispanic and age 65 and older
How often is it covered? Once every 12 months
Your costs with Original Medicare: You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
Smoking Cessation
People with Medicare who are diagnosed with a smoking-related disease, including heart disease, cerebrovascular disease (stroke), multiple cancers, lung disease, weak bones, blood clots, and cataracts can get coverage for smoking and tobacco use cessation counseling.
Who is covered? People with Medicare who are diagnosed with a smoking-related illness or are taking medicine that may be affected by tobacco
How often is it covered? Medicare will cover up to 8 face-to-face visits during a 12-month period. These visits must be ordered by your doctor and provided by a qualified doctor or other Medicare-recognized practitioner
Your costs with Original Medicare: You pay 20% of the Medicare-approved amount after you meet the yearly Part B deductible.
Many doctors do not seem to be aware of the nutritional counseling offered to people with diabetes. We have found that this particular benefit is of enormous help to both those who have had diabetes for years as well as the newly-diagnosed. As a caregiver you can usually attend with your diabetic senior at no additonal cost. If you are the one in charge of preparing meals and watching your elder's diet, attending these counseling sessions will actually make your life easier as you will better understand what's going on with diabetes and how to manage it without losing your temper or your mind.