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Does Medicare cover preventive services?

En español | Yes. 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.

Eligibility for free preventive screenings is generally based on age, risk factors and Medicare-determined time frames. But your doctor or other health care provider must accept assignment, which means that he or she accepts the Medicare-approved amount as payment in full. Medicare has 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 previous preventive services and find a list of Medicare-covered tests and screenings based on your eligibility.

What preventive services does Medicare pay for?

In 2022, 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. (Gordon Lightfoot was 63 in 2002 when he ended up in a coma for six weeks after an abdominal aortic aneurysm.)

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

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

Breast cancer screening. One baseline mammogram for women 35 to 39, and a screening mammogram every 12 months for women starting at age 40. (Diagnostic mammograms, which can be more frequent but have to be medically necessary, require a 20 percent copay.)

Cardiovascular disease 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 — 12 months if you’re at high risk — to check for cervical and vaginal cancers.

Colorectal cancer screenings. Four tests are totally covered:

  • Every 12 months starting at 50, a fecal occult blood test or fecal immunochemical test to detect blood in the stool.
  • Every 48 months, a flexible sigmoidoscopy, starting at 50 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 50 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. 

COVID-19 vaccines, as available. Providers who participate in Medicare can’t charge Medicare beneficiaries.

Depression screeningsYearly through your primary care doctor.

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

Flu shots. Yearly, around flu season.

Hepatitis B shots. Whenever a doctor orders them if you’re at risk.

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, up to three times during pregnancy.

Lung cancer screening. Yearly for people ages 55-77 who are current smokers (or 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 older than 50, starting the day after your 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.

Can I see a doctor at other times for free?

Yes, but the free services are limited. You won’t have to pay for annual preventive and wellness visits.

Welcome to Medicare checkupYou’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 future health problems.

Yearly wellness visitAfter 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, you may have to pay extra, for example, if your doctor finds and removes a polyp during a colonoscopy. You also will pay extra if you schedule a separate doctor visit before or after receiving your screening.

Also in 2022, Medicare covers the following preventive services, but you must pay the 20 percent Part B coinsurance:

  • 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 50 or older instead of a flexible sigmoidoscopy or colonoscopy. If you’re at high risk for colorectal cancer and 50 or older, Medicare covers the test every 24 months.

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.

Updated September 16, 2022



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