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Does Medicare cover preventive services?


Yes. In fact, Medicare Part B covers many preventive services free of charge.

The Affordable Care Act (ACA) expanded access to free preventive care starting in 2011, allowing Medicare to offer several preventive and wellness services without deductibles, copayments or coinsurance charges.

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Eligibility for free preventive screenings is typically based on age, risk factors and Medicare-determined time frames. Your doctor or other health care provider must accept assignment, which means the provider accepts the Medicare-approved amount as payment in full. Medicare offers a list of detailed requirements for each of the services.

You may find it helpful to use your online Medicare account to keep track of preventive services you used previously and to see a schedule of Medicare-covered tests and screenings you may be eligible for in the next two years.

What preventive services does Medicare pay for?

Medicare covers about two dozen preventive services without any cost to you. Some tests are restricted by age or health history.

Although the vast majority of Medicare beneficiaries are 65 or older, about 1 in 7 are younger. Most Social Security Disability Insurance (SSDI) recipients qualify for Medicare 24 months after they become eligible for disability benefits.

Abdominal aortic aneurysm screening. One-time screening ultrasound for people at risk.

Alcohol misuse screenings. One screening and up to four counseling sessions a year.

Bone mass measurements. Every 24 months if you’re in certain high-risk categories for broken bones or osteoporosis, more often if medically necessary.

Breast cancer screening. One baseline mammogram for women ages 35 to 39, and a screening mammogram every year for women starting at 40. Diagnostic mammograms can be more frequent but have to be medically necessary. Those types of mammograms come with a 20 percent copay.

Cardiovascular behavioral therapy. Yearly visit with your primary care doctor to check your blood pressure and discuss ways to lower your risk for cardiovascular disease.

Cardiovascular disease screenings. Every five years for tests to measure good and bad cholesterol and triglycerides, a type of fat, in your blood.

Cervical and vaginal cancer screening. Pap tests and pelvic exams every 24 months — every 12 months if you’re at high risk — to check for cervical and vaginal cancers.

Colorectal cancer screenings. Four tests are completely covered:

  • Every 12 months, starting at age 45, a fecal occult blood test to detect blood in the stool.
  • Every 48 months, a flexible sigmoidoscopy, starting at 45 if you haven’t had a colonoscopy in the previous 10 years. The procedure uses a scope to look at the lower part of the large intestine, also called the sigmoid colon.
  • Every three years, a stool DNA test for those ages 45 to 85 without high risk of colon cancer or colon cancer symptoms.
  • Every 10 years, a screening colonoscopy if you’re not at high risk for colon cancer, or every two years if you’ve had a history of colon problems or a family history of colon cancer. 

If your doctor finds and removes a polyp or other tissue during a screening colonoscopy, the procedure becomes a diagnostic colonoscopy. In this case, you still won’t have to worry about the Part B deductible, but you will have to pay 15 percent of the cost.

Medicare plans to reduce the cost to 10 percent from 2027 to 2029 and to waive the coinsurance starting in 2030. Similar rules apply if the doctor removes a lesion or growth during a flexible sigmoidoscopy screening.

COVID-19 vaccinesas available. Providers who participate in Medicare can’t charge Medicare beneficiaries.

Depression screeningsYearly through your primary care doctor.

Diabetes prevention program. Medicare covers a yearlong diabetes prevention program if your body mass index and blood sugar test results are within certain levels.

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Diabetes screenings. Up to two diabetes screenings a year if your doctor determines you’re at risk for developing diabetes or have certain risk factors.

Flu shots. Yearly flu shots around flu season.

Hepatitis B shots. Medicare Part B covers the hepatitis B vaccine as a preventive service if you’re at medium or high risk for the virus. Medicare Part D covers the shot for adults 60 and older if they have low or no known risk factors.

Hepatitis B virus (HBV) infection screening. Yearly if you’re at high risk. Medicare will cover additional screenings if you’re pregnant.

Hepatitis C screeningIf your primary care doctor or other qualified health care provider orders it and you meet risk conditions.

HIV screening. Yearly if you’re 15 to 65 or if you’re younger or older and are at increased risk for HIV. HIV screenings can be scheduled up to three times during a pregnancy term.

Lung cancer screening. Yearly for people ages 50 to 77 who are current smokers or have quit within the past 15 years and averaged a pack of cigarettes a day for 20 years but have no lung cancer symptoms.

Nutrition therapy services. If you have diabetes or kidney disease or have had a kidney transplant in the past 36 months.

Obesity behavioral therapy. Dietary assessment and counseling to help you lose weight if your body mass index (BMI) is 30 or higher.

Pneumonia vaccines. One pneumococcal shot at any time to help prevent a type of bacterial pneumonia and a second shot at least a year later for those 65 and older.

Prostate cancer screenings. Prostate-specific antigen (PSA) blood tests every 12 months for men who have passed their 50th birthday. A digital rectal exam is also covered but with a 20 percent copayment.

Sexually transmitted infections screening. Every 12 months if a doctor orders it and up to two counseling sessions every year through your primary care physician.

Smoking cessation counseling. Up to eight sessions during a 12-month period to help you quit using tobacco products, including chewing tobacco, cigarettes, cigars and snuff.

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Can I see a doctor at other times for free?

Yes, but Medicare limits the amount of free services. You won’t have to pay for annual preventive and wellness visits.

Welcome to Medicare checkup. You’re eligible for this one-time preventive visit during your first 12 months of participation in Part B. Your doctor will review your medical history and discuss ways to prevent health problems.

Yearly wellness visit. After you’ve had Part B for one year, you’re eligible for one free annual appointment with your primary care provider to create or update a personalized prevention plan. Your doctor will develop a screening checklist for recommended preventive services.

What preventive services aren’t free?

If your doctor finds something during a screening that requires additional treatment, such as discovering and removing a polyp during a colonoscopy, you may have to pay extra. You also will pay extra if you schedule a separate doctor visit before or after receiving your screening.

Medicare also covers the following preventive services, but you must pay the 20 percent Part B coinsurance and you may need to meet the Part B deductible.

  • Diabetes self-management training. Up to 10 hours of education to help people diagnosed with diabetes lower their blood sugar, prevent complications and improve their quality of life.
  • Screening barium enemas. This colorectal cancer test is covered every 48 months if you’re 45 or older instead of a flexible sigmoidoscopy or colonoscopy. If you’re at high risk for colorectal cancer and 45 or older, Medicare covers the test every 24 months. The Part B deductible does not apply to this test.

Keep in mind

If you have coverage through a Medicare Advantage plan rather than original Medicare, the plan must cover free preventive services without any cost to you if you use an in-network provider. You may be charged if you use an out-of-network provider.

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