Medicare is a health insurance program managed by the government that provides coverage for older adults and individuals with certain disabilities. It offers vital insurance for medical services such as hospital stays, doctor appointments, and prescription medications.
One of the significant advantages of Medicare is the availability of preventive care services. This ensures that beneficiaries can receive essential screenings and tests without any out-of-pocket expenses. The purpose of this article is to inform you about the preventive services covered by Medicare so you can enjoy these free Medicare benefits.
Medicare Part B and Preventive Services
Medicare Part B provides coverage for essential preventive services that are crucial for maintaining good health. These services include cancer and heart attack disease screenings, routine check-ups, and a variety of vaccines. Let’s take a closer look at the preventive services covered by Medicare Part B.
Alcohol Misuse Screening and Counseling
This is a preventive service covered by Part B. It is available to any individual who tests positive for alcohol misuse but not alcohol dependency. This service can be obtained from a primary care physician or practitioner in the primary care setting, and the counseling must be delivered while the beneficiary is alert and competent.
Beneficiaries are eligible to have this screening once per year and counseling up to four times per year if they test positive for misuse. The best part is that there are no out-of-pocket expenses such as deductibles, copays, or coinsurance for this preventive service.
Annual Wellness Visit
Medicare Part B provides coverage for an Annual Wellness Visit (AWV) once per year for beneficiaries who are outside of their first 12 months of Part B coverage and have not had an AWV or initial preventive physical exam within the past 12 months. This means that beneficiaries are eligible for one AWV per year, and it is completely covered by Part B.
Bone Mass Measurements
Medicare provides coverage for bone mass measurements, but to be eligible, individuals must meet certain criteria.
- Estrogen-deficient women who are at risk for osteoporosis
- Any person showing vertebral abnormalities
- Any person who has been getting glucocorticoid therapy for more than three months
- People with primary hyperparathyroidism
- People being monitored to assess an FDA-approved osteoporosis medication response
Bone mass measurements are covered at least once every two years, but beneficiaries may be eligible for more frequent coverage if it is medically necessary.
Cardiovascular Disease Screening Tests
Medicare provides coverage for cardiovascular disease screening, even if the individual does not exhibit any apparent symptoms. This preventive service can be obtained once every five years and is covered 100%.
Cervical Cancer Screening
Medicare Part B covers preventive cervical cancer screenings for asymptomatic women between the ages of 30 and 65. This screening can be performed once every five years for eligible beneficiaries.
Colorectal Cancer Screening
There are two types of colorectal cancer screenings available through Medicare. One screening uses MT-sDNA and blood-based biomarkers and is performed on beneficiaries who are between the ages of 50 and 85, are asymptomatic, and are at average risk for colorectal cancer. This type of screening is covered once every three years.
Another screening uses Fecal Occult Blood Tests (FOBTs) and is covered for beneficiaries who are at least 50 years old and at average risk or for those who have a high risk of colorectal cancer. Both groups are eligible for testing once every 12 months, as long as it is medically necessary and ordered by a physician.
Tobacco Use Prevention Counseling
Medicare provides coverage for inpatient and outpatient counseling for individuals who use tobacco and wish to quit. As long as the services are provided by a qualified practitioner, Medicare will cover two cessation attempts per year, with up to four intermediate sessions per attempt.
Depression Screening
An annual depression screening is available to all individuals who are covered under Medicare Part B.
Diabetes Screening
For individuals who have been diagnosed with pre-diabetes, this screening is available once every six months. If the individual has previously been tested but does not have pre-diabetes, they can have this screening once every 12 months. Beneficiaries who have been previously diagnosed with diabetes are not eligible for this preventive service.
Diabetes Prevention Program
To qualify for the diabetes prevention program, you must meet certain requirements, including a specific BMI (Body Mass Index) and qualified blood testing results. If you meet the criteria, Medicare provides 24 counseling sessions within the first two years of the program.
Training for Diabetes Self-Management
Individuals who have been diagnosed with diabetes and have received a physician referral are eligible for diabetes self-management training. In the first year, you are eligible for up to ten hours of training. After the initial training has been completed, you can have two hours of training each year for continued management. To qualify for this subsequent training, you must complete the full ten hours within the first year.
Flu Shot
Every Medicare Part B beneficiary is eligible for one flu shot per season. However, if additional flu shots are medically necessary, they are also covered by Medicare.
Glaucoma Screening
Part B pays for an annual glaucoma screening for people who fall into at least one of these categories:
- Diagnosed diabetes mellitus
- People with a family history of glaucoma
- African-Americans age 50 and older
- Hispanic-Americans age 65 and older
Hepatitis B Screening and Vaccine
The hepatitis B screening is available to people who are at high-risk, as well as all pregnant women, regardless of their risk factors. Those who are not at high-risk are eligible for this screening once in their lifetime. High-risk people are eligible for yearly screenings. Pregnant women can have a screening at their first prenatal visit. If they present with new or ongoing risk factors, they can have a second screening during labor.
Medicare also provides coverage for a hepatitis B vaccine for individuals who are at intermediate or high risk of contracting the disease. This vaccine is administered in two doses, with one month between each dose. It’s important to note that individuals who test positive for hepatitis B antibodies are not eligible for this vaccine.
Hepatitis C Screening
Part B covers hepatitis C screening for individuals who meet specific criteria. This includes anyone with a high risk of contracting HCV, those born between 1945-1965, and those who received a blood transfusion before 1992.
People born within those years and are not at high risk are eligible for a one-time hepatitis C screening. Those who are at high risk and have had blood transfusions prior to 1992 are eligible for an initial screening. People who are currently using injectable illicit drugs are eligible for one screening per year.
HIV Screening
Any person who requests an HIV screening is eligible to receive one, regardless of their perceived risk. Beneficiaries can have this test once every year. For pregnant women, HIV screening is available three times during their pregnancy. They can have the first test when they begin the pregnancy, the second test during the third trimester, and the third test at the time of
labor.
Cardiovascular Disease IBT
Intensive Behavioral Therapy (IBT) is available to individuals who are competent and alert and receive this therapy from a qualified primary care physician or practitioner in a primary care
setting. Medicare covers this service once every year.
Obesity IBT
Those with a BMI over 30 are eligible for IBT. Medicare covers up to 22 IBT visits within a 12-month period. This includes weekly visits during the first month, bi-weekly visits during months 2-6, and monthly visits during months 7-12.
Initial Preventive Physical Exam
Medicare Part B covers an initial preventive physical exam for beneficiaries during the first 12 months of their coverage. This is a one-time service that must be obtained within the first year of coverage.
Lung Cancer Screening
Individuals who meet all of the following criteria are eligible for one lung cancer screening per year.
- Between the ages of 55-77
- Asymptomatic
- Have a history of extensive smoking (one pack per day for 30+ years)
- Are current smokers or quit within the last 15 years
Mammography Screening
Medicare Part B covers mammograms for all women who are 35 years and older. Women between the ages of 35-39 are eligible for one baseline screening. Women who are 40 years and above can have one mammogram screening per year.
Medical Nutrition Therapy
Medical nutrition therapy is available to those who have been referred by their treating physician and have been diagnosed with diabetes or renal disease within the last three years. Therapy must be provided by a registered dietician.
You may have three hours of one-on-one counseling during the first year of therapy. After the year is up, you can have two hours of counseling every subsequent year.
Pap Tests
Every woman with Medicare is eligible for a Pap test. Those who are at high risk, are of childbearing age, or have had an abnormal test within the last three years can have an annual test. For low-risk women, the test is available every two years.
Pneumococcal Shot and Administration
Medicare Part B covers the cost of the pneumococcal vaccine for all individuals who have not received it before and have certain chronic conditions or risk factors. The Centers for Disease Control and Prevention (CDC) recommends different vaccination timelines based on the person’s health history.
Prolonged Preventive Services
The category of prolonged preventive service includes several codes. It refers to any preventive service that lasts longer than the typical duration of the procedure. Coverage and frequency for these codes vary depending on the specific procedure.
Prostate Cancer Screening
Men who are 50 years old or older are eligible for a prostate cancer screening once every year.
STI Screening and HBI to Prevent STIs
Medicare covers STI screening for sexually active adolescents and adults who are at an increased risk of contracting an STI. The frequency of the screening will depend on the type of STI being tested for.
Screening Pelvic Exams
Women who are at a high risk of developing cervical cancer, are of childbearing age, and have had abnormal Pap tests within the last three years are eligible for an annual pelvic exam. Women at low risk can have this exam performed once every two years.
Ultrasound AAA Screening
Medicare Part B covers an AAA ultrasound for individuals who have specific risk factors and have been referred by a physician or another healthcare provider. Beneficiaries are eligible for one screening per lifetime.
Medicare offers a range of preventive services to eligible individuals to promote their overall health and well-being. If you have additional coverage, like a Medicare Advantage (Part C) plan, you may have even more options available to you at varying costs. It is important to take advantage of these services to detect health problems early and prevent them from worsening. By understanding what preventive services are available and who is eligible for them, Medicare beneficiaries can work with their healthcare providers to maintain their health and quality of life.
