In order to help you stay healthy over your lifetime, Medicare offers many preventive care services. They range from immunizations to screening for diseases to counseling if you need assistance making health changes to your life.
None of the preventive screenings and tests included below have an out-of-pocket cost to you as long as your healthcare provider accepts payment from Medicare. You may have to pay if your healthcare provider performs tests or services that aren’t included in the preventive service. It never hurts to ask the doctor’s office about any costs you may not be aware of.
Jump to Main Topic:
- “Welcome to Medicare” Preventive Visit
- Medicare Yearly Wellness Visits
- Behavioral Preventive Services
- Cancer Screenings
- Other Screenings
“Welcome to Medicare” Preventive Visit
When you first enroll in Medicare, you’ll want to schedule what’s called the “Welcome to Medicare” preventive visit within 12 months. It helps you get a snapshot of your health so you can stay on track or get services moving forward. They’ll ask you lots of questions about your health and lifestyle. Your height, weight, and blood pressure will be taken and your BMI (body mass index) calculated. You’ll do screenings like for vision and depression. The flu shot will be offered as well.
A very important topic will be covered- filling out your advance directive. Your advance directive is a document that allows you to choose what life-saving medical procedures you may want to opt out of in the future if you are very ill. This document allows you to specify your wishes so if that situation arises, your healthcare professionals will know your wishes.
The best part of your Welcome to Medicare Preventive Visit is that you’ll get a plan for your health. If any issues need to be addressed, you can get referred to a specialist or schedule further tests and visits. Consider it the starting line for your future in the Medicare health system.
Medicare Yearly Wellness Visits
If the Welcome to Medicare Visit is the starting line of the race, the Yearly Wellness Visit is the pit stop. You’re entitled to a wellness visit every 12 months where your health is evaluated again. Your doctor will help you develop a personalized prevention plan to keep you healthy or manage illness going forward. Your doctor may also perform a cognitive impairment assessment. This is a check for signs of Alzheimers and dementia.
Is the Wellness Visit the Same as an Annual Physical?
An annual physical isn’t the same as the covered yearly wellness visit. A wellness visit focuses on preventive services, while a physical exam may include bloodwork and a physical exam. Be sure to use the exact words “wellness visit” when scheduling your appointment if you want your visit to be no-cost. Lots of people have had a surprise bill after confusing the two.
Behavioral Preventive Services
Medicare Can Help You Manage Your Weight
Your doctor may screen you for obesity by using a measurement called the BMI (body mass index), which takes into account your height and weight. If your BMI is 30 or higher, your doctor may recommend obesity behavioral therapy.
Therapy will help you assess your eating habits and develop a good exercise regimen. The therapy is no-cost if your doctor provides it in their office or clinic.
Medicare Can Help You Change Your Diet
Getting diabetes, kidney disease, or a kidney transplant can be a life-changing event. Thankfully, Medicare offers Medical Nutrition Therapy (MNT) to help you transition to healthier eating habits.
Your doctor can refer you to a registered dietitian or similar professional who will do a nutrition and lifestyle assessment. Then they’ll work with you to understand good eating and exercise choices that will help you stay healthier with your condition. Your dietitian may also schedule follow up visits to help you stay on track.
Telehealth nutrition therapy is available for those in rural areas.
Medicare Can Help You Quit Smoking
If you’re ready to kick the habit, Medicare Part B is there to help. Medicare pays for smoking cessation counseling visits to help you stop smoking, as long as you don’t yet have a smoking-related condition. You’re covered for a quitting attempt twice a year, and each time you’ll receive 4 visits with a smoking cessation counselor. Medicare may pay a portion of your visit costs if you have already been diagnosed with a smoking-related condition.
Medicare Part D (prescription drug coverage) may pay for prescription drugs to help you quit smoking. It won’t pay for getting hypnotised, nicotine patches, or nicotine gum.
Medicare Can Help You Change Your Alcohol Habits
If your alcohol use isn’t categorized as a serious dependency, your doctor may offer you alcohol misuse screening and counseling. Medicare covers 4 short sessions per year from your doctor.
Depression Screenings are Available Through Medicare
Your doctor can screen you for depression once a year in their office at no cost to you. Depression screenings are important because depression can affect every aspect of your life. Depression can cause legitimate issues with your body, not just your mind. By ruling out depression, you can get to the bottom of any other medical concerns.
Medicare Pays for Immunizations
Immunizations are a good way to keep you healthy all year long. Medicare will pay for one flu shot each season.
You can also get protected from two different strains of pneumococcal bacteria, which cause pneumonia, sepsis, and bacterial meningitis. Your doctor will have more information on whether you need one or both pneumococcal shots.
Hepatitis B shots are no-cost if your doctor determines that you have a higher-than-average risk of contracting Hepatitis B. Some risk factors are hemophilia, End-Stage-Renal-Disease, you’re a health care worker, someone in your household has Hepatitis B, or you have diabetes.
Part of the prostate screening exam is free once a year for men over 50. The PSA (prostate specific antigen) blood test won’t have out-of-pocket costs. The often joked about, but very important digital rectal exam is subject to the normal deductible, copay, or coinsurance.
Colorectal Cancer Screenings
There are several ways to screen for colorectal cancer. Medicare will cover many of them if you meet certain qualifications. Many people ask if Medicare covers colonoscopies, and the answer is- sometimes. Screenings covered include at-home stool tests, colonoscopies, and other tests. Some screenings are no-cost unless they result in another procedure being performed at the same visit. Be sure to talk to you doctor about any other costs you might incur.
Catch Breast Cancer Early with Mammograms
Medicare allows for one mammogram between the ages of 35 and 39. Once women turn 40, you’re allowed a screening mammogram every 12 months.
If your doctor determines that you need more than one mammogram per year due to medical necessity, you’ll pay your regular deductible, copay, or coinsurance when you get it.
Pap Tests Catch Cervical & Vaginal Cancer
Women should get a Pap test and pelvic exam every 24 months. Medicare pays for this test as well. If you’ve had an abnormal test within 36 months and you’re of child bearing age, or you are at high risk, you can get the test every 12 months. Your doctor will likely perform a breast exam during your appointment. HPV (Human Papillomavirus) tests should be done every 5 years from age 30 to 65 and are no-cost as long as you don’t have symptoms.
Lung Cancer Screening for Smokers
Even if you’re asymptomatic, you may be at risk for lung cancer if you smoke. If you’re a current smoker or have quit within the past 15 years and you’re age 55-77, your doctor may order a lung cancer screening for you. You also must have a history of smoking a pack a day for at least 30 years to qualify.
The screening is called a Low Dose Computed Tomography (LDCT). It uses x-ray technology to create pictures of cross sections of your chest to help a radiologist detect cancer. There are a few risks, so your doctor will meet with you beforehand to help you decide if it’s right for you. The test is allowed once a year at no cost if you meet the criteria.
Other Health Screenings
Having high blood pressure, abnormal triglyceride or cholesterol levels, high blood sugar, or obesity puts you at a higher risk for diabetes. You can get a diabetes screening up to twice a year if one or more of those apply to you, or if you have pre-diabetes.
Other smaller risk factors are being 65 or older, being overweight, a gestational diabetes history, you gave birth to a baby weighing over 9 pounds, or you have a family history of diabetes. If you have at least 2 of these risk factors, you’re eligible for the diabetes screening as well.
Screening for Abdominal Aortic Aneurysm
Men aged 65-75 who have smoked more than 100 cigarettes are considered more likely to suffer from an abdominal aortic aneurysm. Medicare pays for one screening in your lifetime if you fall into this category, or if you have a family history of the aneurysm.
Cardiovascular Behavior Therapy & Disease Screening
Once a year your doctor may talk with you about heart health. They may review your blood pressure, talk about heart-healthy nutrition, or discuss aspirin use.
Cardiovascular disease screenings are covered every 5 years. It’s a simple blood test that may detect risk for a stroke or heart attack.
Bone Mineral Density (BMD) Test
Women are at increased risk of losing bone density, so Medicare allows a bone mass measurement once every two years if you meet certain conditions. It’s similar to an x-ray, but the BMD measures your bone density and compares it to an average young adult. It can be a predictor of osteoporosis, or broken bones, but it can also determine if steps you’re taking against osteoporosis are working.
Screenings and Counseling for Sexually Transmitted Infections
If your doctor determines that your risk for STIs is above-average you can receive screening for Hepatitis B, syphilis, gonorrhea, and chlamydia once per 12 month period. Pregnant women may be able to receive free STI screenings more often.
You may receive counseling to help you reduce your risk of STI once a year if you’re sexually active. Two half hour sessions are allowed with your doctor in their office or clinic. Those in skilled nursing facilities usually aren’t eligible for counseling without paying the deductible or copay.
Those aged 15-65 are eligible for no-cost HIV (Human Immunodeficiency Virus) screenings once a year. If you’re outside that age range, but do have a higher risk of contracting the virus, you can get tested for free as well. Pregnant women may get tested 3 times during their pregnancy at no cost to them.
Hepatitis C Screenings Are Often Covered by Medicare
You’re at higher risk for Hepatitis C if you have used injection drugs, had a blood transfusion before 1992, and you were born between 1945 and 1965. If you have some of these risk factors your doctor may order a Hepatitis C screening. As long as your doctor orders the test, Medicare will cover it with no cost to you.
Hepatitis B Virus Infection Screenings
There’s a long list of risk factors for Hepatitis B. Traveling to certain parts of the world, being a healthcare worker, living in institutions for the disabled, using illicit drugs via needle, and many more activities can transmit Hepatitis B. If you talk to your doctor, they can determine if a Hepatitis screening is important and order it. The screening doesn’t have a cost if ordered by your doctor.
It’s easy for infants to become infected by their mothers, and once infected, they’re likely to carry the virus the rest of their lives. For this reason, Medicare allows a no-cost screening at the first prenatal visit and at delivery.
Hepatitis B is thankfully preventable with an immunization. Medicare will cover this shot at no cost, so it’s an easy way to better your health.
Medicare has a financial interest in keeping you healthy. That’s why there are so many no-cost screenings and preventive services available to you. Take advantage of the Welcome to Medicare Preventive Visit and subsequent Medicare Wellness Visits to get help from your doctor in mapping out which screenings, immunizations, and counseling you should schedule.