Medicare: Preventive Care Services

by Sue Bailey

Question: I have heard that Medicare covers some preventative care services and they might be free. Is this true?

Answer: As part of the Affordable Care Act, Medicare has increased the number of preventative services and in many cases has eliminated the previous deductibles and co-insurance associated with the services. The following is a list of preventive services available to Medicare beneficiaries at no cost as long as your physician accepts Medicare assignment.

  • “Welcome to Medicare” Physical exam – Available during your first year with Medicare. It will review your medical and social history related to your health and includes education and counseling about preventative services, including certain screenings, shot and referrals for other care if needed.
  • Yearly “wellness” exam – This will include review of medical and family history, current doctors and medications, routine measurements such as weight, blood pressure, scheduling the appropriate preventative screenings and a personalized prevention plan.
  • Cardiovascular screening – Test for cholesterol, lipid and triglyceride levels once every five years.
  • Mammograms – Women age 40 and older are eligible for screening every year.
  • Pap tests, pelvic exams and clinical breast exams – Covered every two years, and every year for
    those at high risk.
  • Colorectal cancer screening – Once every year or 10 years, depending on screening type and your risk
    factors.
  • Prostate cancer screening – PSA test once every year.
  • Shots – Flu: once every flu season; Pneumococcal: once in lifetime; Hepatitis B: only those at medium or high risk for Hepatitis B.
  • Bone mass measurement – Once every two years for those at risk for osteoporosis.
  • Diabetes screening – Up to 2 screening per year for those at risk.
  • Medical nutrition therapy – two to three hours of one-on-one counseling for individuals with qualifying conditions such as diabetes and renal disease.
  • Tobacco use cessation counseling – up to eight face-to-face visits in a year with a Medicare-recognized practitioner.
  • HIV screening – Once every year (every four months if pregnant) for any Medicare beneficiary that
    request the test.

While these screenings have no cost, there may be some costs to you for the visit required to do the
screenings. For more information go to medicare.gov or call 1-800-Medicare and request CMS Publication No. 10110.

Your questions on Medicare and Medicaid answered by the local State Health Insurance Assistance Program an objective, not-for-profit counseling, assistance and advocacy service sponsored by DPHHS of Montana and Centers for Medicare and Medicaid Services. Do you have a question about Medicare or Medicaid? Please send your question to SHIP Program c/o Adult Resource Alliance, 1505 Avenue D, Billings, MT 59102 or helenh@allianceyc.org.

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