Medicare Interactive - Medicare coverage of preventive care services

Medicare coverage of preventive care services

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Last Update: August 13, 2012

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).

As of 2011, 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. However, 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.
Starting in 2012, 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	Starting January 1, 2011 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	Beginning in October 2011, 100% of the Medicare-approved amount (no Part B deductible)
Depression screenings	Beginning in October 2011, 100% of the Medicare-approved amount (no Part B deductible)
Sexually transmitted infection (STI) screening and counseling	Beginning in November 2011, 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	Beginning in November 2011, 100% of the Medicare-approved amount (no Part B deductible)
Obesity screening and counseling	Beginning in November 2011, 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, fleixible 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)

¹As of January 1, 2011, in some states (CA, FL, IN, KS, KY, MO, NC, OH, PA, SC, TX),Medicare will only cover your mail-order diabetic supplies if you get them from an approved supplier.