Medicare coverage of preventive care services

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Medicare covers many preventive services.  As long as you meet basic eligibility standards, you have the right to receive these services no matter if you have Original Medicare or a Medicare Advantage plan (Medicare private health plan).

  • If you have Original Medicare you will have no coinsurance or deductible for certain preventive care services recommended by the U.S. Preventive Services Task Force if you see a doctor or other health care provider who accepts assignment. Doctors who accept assignment cannot charge you more than the Medicare approved amount.
  • Although the preventive services itself may be free, you may be charged additional fees for certain services related to preventive care.
    • You may have costs for some of these preventive services if your doctor makes a diagnosis during the service or does additional tests or procedures. Doctors do diagnostic tests and procedures when patients have distinct symptoms of a condition or a history of that condition.  For example, if your doctor finds and removes a polyp during a colonoscopy, the colonoscopy is diagnostic and costs will apply.  Also, if during your annual wellness visit, your doctor needs to investigate or to treat a new or existing problem, costs may apply.
    • You may have to pay a facility fee depending on where you receive the service. For example, certain hospitals will often charge separate facilities fees when you are receiving a preventive service.
    • You may be charged for a doctor’s visit if you meet with a physician before or after the service.  
  • If you are in a Medicare Advantage plan, your plan will not be able to charge you for preventive care services that are free for people with Original Medicare as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.
  • Original Medicare still requires its normal deductible and/or a 20 percent coinsurance for some preventive services. Some of these services are glaucoma screenings, diabetes self-management trainings, barium enemas (to detect colon cancer), and digital rectal exams (to detect prostate cancer).
  • To view or print our packet of information with explanations of each preventive service, please click here.

Be sure to follow the Medicare guidelines for receiving these services in order to ensure that Medicare will cover them since some are covered only once every few years and others are only covered if you meet specific criteria.

Note: The coverage guidelines specified in the following pages are only for preventive screenings. Medicare may cover these tests more frequently if they are needed to diagnose or treat an illness or condition.

Service Original Medicare covers...
Diabetes screening 100% of the Medicare-approved amount (no Part B deductible)
Diabetes services and supplies1 80% of the Medicare-approved amount (after Part B deductible)
Medical Nutritional Therapy 100% of the Medicare-approved amount (no Part B deductible)
Alcohol Misuse screening and counseling 100% of the Medicare-approved amount (no Part B deductible)
Depression screenings  100% of the Medicare-approved amount (no Part B deductible)
Sexually transmitted infection (STI) screening and counseling 100 % of the Medicare approved amount (not Part B deductible) for those at risk
 HIV Screenings 100% of the Medicare-approved amount (no Part B deductible)
Smoking Cessation 100% of the Medicare-approved amount (no Part B deductible) for those who do not have a smoking-related illness (80% for those who do)
Glaucoma screening 80% of the Medicare-approved amount (after Part B deductible)
Blood tests for heart disease 100% of the Medicare-approved amount (no Part B deductible)
Bone mass measurement 100% of the Medicare-approved amount (no Part B deductible)
Cardiovascular risk reduction visits 100% of the Medicare-approved amount (no Part B deductible)
Obesity screening and counseling 100% of the Medicare-approved amount (no Part B deductible)
Screening mammograms 100% of the Medicare-approved amount (no Part B deductible)
Pap smears, pelvic exams and clinical breast exams 100% for Pap lab test, Pap test collection, pelvic exam and clinical breast exam (no Part B deductible)
Colon cancer screening 100% for fecal occult blood test, flexible sigmoidoscopy, and colonoscopy (no Part B dedutible). 80% of the Medicare-approved amount for barium enema (no Part B deductible)
Prostate cancer screening 100% for PSA test (no Part B deductible); 80% of the Medicare-approved amount for digital rectal exam (after Part B deductible)
Flu shot 100% of the Medicare-approved amount (no Part B deductible)
Pneumonia vaccine 100% of the Medicare-approved amount (no Part B deductible)
Hepatitis B vaccine

100% of the Medicare-approved amount for people at  medium or high risk of hepatitis (no Part B deductible); covered by Part D for people with low risk

Annual Wellness Visit 100% of the Medicare-approved amount (no Part B deductible)
Abdominal Aortic Aneurysm (AAA) screening 100% of the Medicare-approved amount (no Part B deductible) for people at increased risk for an AAA who receive a referral during their Welcome to Medicare preventive visit
Welcome to Medicare preventive visit 100% of the Medicare-approved amount (no Part B deductible)

1In some states,Medicare will only cover your mail-order diabetic supplies if you get them from an approved supplier. Click here for more information.


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Medicare coverage of diabetes screenings and supplies

Medicare coverage of medical nutrition therapy

Medicare coverage of glaucoma screenings

Medicare coverage of screening tests for heart disease

Medicare coverage of bone mass measurements

Medicare coverage of mammogram screenings

Medicare coverage of Pap smears, pelvic exams and physical breast exams

Medicare coverage of colorectal cancer screenings

Medicare coverage of prostate cancer screenings

Medicare coverage of flu shots

Medicare coverage of pneumonia shots

Medicare coverage of hepatitis B shots

Help Understanding Medicare Benefits and Options

 
LINKS
MyMedicare.gov: Access your Medicare information

National Directory of Medicare Regional Carriers and Intermediaries

Medicare.gov: National A/B MAC Information

 
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