What preventive services are covered by Medicare?
Which preventive care services, like screenings and vaccines, are covered under Medicare?
Medicare Part B provides coverage for a wide range of preventive care services to help detect and prevent potential health problems. These services are often covered at no cost to you, as long as you visit a healthcare provider who accepts Medicare. Here’s an overview of the key screenings, vaccines, and other preventive care services that Medicare covers:
1. Annual Wellness Visit:
Medicare Part B covers an Annual Wellness Visit to develop or update a personalized prevention plan based on your current health and risk factors. This visit includes:
A review of your medical and family history.
A checklist of preventive services.
A plan for any screenings or follow-up care you may need.
2. Screenings:
Medicare covers a variety of screenings to detect health conditions early, including:
Colorectal Cancer Screenings:
Fecal occult blood test: Once every 12 months if you’re 50 or older.
Colonoscopy: Once every 10 years (or more often if you’re at high risk).
Flexible sigmoidoscopy: Once every 4 years (or more often if you’re at high risk).
Mammograms: Medicare covers screening mammograms for breast cancer once every 12 months for women aged 40 and older.
Cervical Cancer Screenings: Pap tests and pelvic exams are covered once every 24 months, or annually for women at high risk.
Cardiovascular Disease Screenings: Blood tests to check cholesterol, lipid, and triglyceride levels are covered every 5 years.
Diabetes Screenings: Medicare covers up to two diabetes screenings per year if you’re at risk for diabetes, including if you have high blood pressure or a family history of diabetes.
Bone Mass Measurements: Every 24 months (or more often if medically necessary) for people at risk of osteoporosis.
Prostate Cancer Screenings: Medicare covers a prostate-specific antigen (PSA) test and a digital rectal exam once every 12 months for men aged 50 and older.
Lung Cancer Screenings: For people aged 55-77 who are at high risk due to smoking history, Medicare covers annual low-dose computed tomography (LDCT) lung cancer screenings.
Glaucoma Screenings: Once every 12 months for people at high risk of developing glaucoma, including those with diabetes or a family history of glaucoma.
3. Vaccines:
Medicare Part B covers important vaccinations to protect your health:
Flu Shots: Covered once every flu season at no cost to you.
Pneumococcal Vaccines: Covered in two parts (initial shot and booster) to protect against pneumonia.
Hepatitis B Vaccine: Covered for individuals at medium or high risk of contracting Hepatitis B, including people with diabetes, kidney disease, or certain other conditions.
COVID-19 Vaccines: Medicare Part B covers COVID-19 vaccinations and boosters.
Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine: Covered if needed for injury, though not as a routine preventive measure.
4. Obesity Counseling:
Medicare covers obesity screenings and counseling for individuals with a body mass index (BMI) of 30 or higher. These services include counseling sessions to help you develop a healthy diet and exercise plan.
5. Diabetes Self-Management Training (DSMT):
If you have diabetes, Medicare covers diabetes self-management training to help you manage your condition, including advice on medication, diet, and physical activity.
6. Tobacco Cessation Counseling:
Medicare covers tobacco cessation counseling for individuals who use tobacco. These services include up to 8 counseling sessions per year to help you quit smoking or using other forms of tobacco.
7. HIV Screening:
Medicare covers an HIV screening once a year for individuals who are at high risk for HIV infection. Medicare also covers up to three screenings during pregnancy.
8. Depression Screenings:
Medicare covers an annual depression screening in a primary care setting that can provide follow-up treatment and referrals.
9. Alcohol Misuse Screenings:
Medicare covers an annual screening for alcohol misuse and up to four counseling sessions per year for individuals who screen positive for alcohol misuse but are not alcohol-dependent.
10. Abdominal Aortic Aneurysm Screening:
Medicare covers a one-time abdominal aortic aneurysm ultrasound for individuals at risk, including men aged 65-75 who have smoked at least 100 cigarettes in their lifetime.
Key Takeaways:
Medicare Part B covers a wide range of preventive services, including screenings, vaccines, and wellness visits.
Many preventive services are covered at no cost to you, as long as you visit a provider who accepts Medicare.
For help understanding your preventive care coverage or scheduling necessary screenings, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
