What free preventive services does Medicare offer?

It’s not often you can get something for nothing. But the authors of the Affordable Care Act believed that it’s cheaper to prevent illness than to treat it, so they added to Medicare free mammograms, colonoscopies and other preventive services.

Read about other changes for Medicare beneficiaries under Obamacare.

Many of these tests and medical services used to require a co-payment, but not anymore. Some preventive services are covered with a copayment or coinsurance.

Also, be aware that coverage for some services depends on the patient’s age.

Wellness visits

• “Welcome to Medicare” physical exam – A one-time review of your health, education and counseling about preventive services, and referrals for other care if needed. You can only get this within 12 months of signing up for Medicare Part B.
• “Annual 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.

Free tests or screenings:

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Did you take advantage of the Medicare Advantage Open Enrollment Period?

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6.4%

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• Abdominal aortic aneurysm screening, a one-time screening for people at risk (family history of abdominal aortic aneurysms, or you’re a man between 65 and 75 who has ever smoked). Get a referral during your initial Medicare wellness exam.
• Alcohol misuse screening and counseling, which can be part of your Welcome to Medicare or Annual Wellness Visit.
• Bone mass measurement, or bone density test, which you can get every two years.
• Cardiovascular disease screening, covered every five years, plus one behavior therapy visit per year (to discuss strategies with your doctor for lowering your cardiovascular disease risk).
• Depression screening, once per year.
• Diabetes screening, up to twice per year, for people at high risk of diabetes
• Flu shots
• Hepatitis B shots, if you are at medium or high risk.
• Hepatitis C screening test, for those at high risk whose doctor orders the test
• HIV screening, every 12 months (for people older than 65, screening is only covered if the person is considered high risk)
• Colorectal cancer screening, which may involve a fecal occult blood test, colonoscopy, flexible sigmoidoscopy and/or barium enema. The 20 percent coinsurance under Medicare Part B may apply if polyps are found and removed during the screening, and also if you have a barium enema as part of the colorectal cancer screening.
• Lung cancer screening for current and former smokers
• Mammogram each year (screening only; diagnostic mammograms are detailed below, and do include some cost-sharing for the patient).
• Nutrition therapy services for people who have diabetes, kidney disease, or who have had a recent kidney transplant.
• Obesity screening and counseling, for people with a BMI of 30 or more.
• Pap test and pelvic exam (including clinical breast exam) every two years, or more often if at high risk.
• Pneumococcal shot
• PSA screening for prostate cancer (no charge for an annual PSA test, but the Medicare Part B deductible and coinsurance apply to a digital rectal exam.)
• Sexually transmitted infection screening and counseling. This includes screening tests for Chlamydia, Syphilis, Gonorrhea, and Hepatitis B.
• Smoking cessation counseling

Covered preventive services that include cost-sharing for the enrollee:

• Diabetes self-management training, for people at risk of diabetes complications. You’ll pay your Part B deductible if you haven’t already met it for the year (in 2020, it’s $198), plus 20 percent of Medicare’s cost for the training.
• Diagnostic mammogram (i.e., the mammogram has been ordered to diagnose a potential lump or other area of concern, as opposed to a routine screening test when no symptoms are present). You’ll pay your Part B deductible if you haven’t already met it for the year, plus 20 percent of the cost of the screening.
• Digital rectal exam for prostate cancer (PSA test is covered in full, but the Part B deductible and coinsurance apply for the digital rectal exam).
• Glaucoma test if you are at risk. You’ll pay your part B deductible if you haven’t already met it for the year, plus 20 percent of the cost of the screening. A copay may also apply if the screening is conducted in a hospital outpatient setting.

If you’re enrolled in a Medigap plan, it may pay some or all of the Part B charges incurred for these services. (Note that if you become newly eligible for Medicare after the end of 2019, you cannot purchase a Medigap plan that covers the Part B deductible, although you’ll still be able to get a plan that covers the Part B coinsurance.)

For more information, see this list of Medicare’s preventive services and this about initial and annual checkups.

Tags: Medicare & You, Medicare Part A, Medicare Part B, Original Medicare, preventive services, screenings