What Preventive Care Services Does Medicare Cover?
Maintaining our health is important, especially as we age and the risk of developing medical conditions increases.
Medicare covers many preventive services, but some are only covered if you meet specific criteria. Most of these services are fully covered, meaning you'll have no cost. Some, however, require a copayment or coinsurance. It's also important to know that your doctor must accept Medicare assignment to receive coverage. You should also be aware of how often a specific service is covered. Services may be covered one time in your life, once every twelve months, or even once every five years.
What are preventive care services?
Preventive care services are there to help you:
Maintain your health
Detect new medical complications earlier
Choose the best treatments
Prevent disease
Preventive healthcare can include vaccinations, screenings and tests, doctor visits, and counseling.
Medicare-covered preventive services
Medicare covers many preventive services to help you maintain or improve your physical and mental health. Below are some of the most common preventive services covered under Medicare.
For every preventive service you receive, make sure your doctor accepts Medicare assignment to ensure you're covered. In some cases, your doctor may recommend you receive certain healthcare services more often than what Medicare will cover. If this happens, you may be responsible for all or some of the costs. So, be sure to ask questions before you receive services and treatments. If you have questions, we’re here to help! Give us a call at (855) 900-2427 to get your Medicare questions answered—our support is always free.
Shots and vaccines
Vaccines help your body learn how to defend itself and can prevent a full-blown reaction when you come into contact with a disease. Because any infection is more serious for older adults, it’s important to know which vaccines are out there so you can get the best preventive care.
Covid-19 vaccinations, boosters, and tests
Even though the Public Health Emergency for Covid-19 ended, Medicare continues to fully cover Covid vaccines. You may, however, have cost sharing for Covid tests—and Medicare doesn’t cover over-the-counter tests. Learn more about Covid-19 Medicare coverage at Medicare.gov.
Flu shots
Getting the flu shot prevents you from getting the flu and from passing it on to others. If your doctor accepts Medicare, your flu shot is fully covered under Medicare Part B.
Hepatitis B shots
Medicare fully covers Hepatitis B shots if you’re at medium or high risk for Hepatitis B. In other words, if at least one of the following conditions applies to you:
You have hemophilia
You have End-Stage Kidney Disease (ESKD)
You have diabetes
You live with someone who has Hepatitis B
You’re a healthcare worker who has frequent contact with blood or bodily fluids
Pneumococcal shots
Pneumococcal shots help prevent a number of infections: pneumonia, bacteremia, sinusitis (sinus infection), meningitis, and otitis media (middle ear infection). Both the single-dose and 2-dose Pneumococcal shots are fully covered by Medicare Part B once in your lifetime.
Part D vaccines
If you have a Part D (prescription drug) plan, your Part D will cover any commercially available vaccines that are reasonable and necessary to prevent illness. Even if a vaccine isn’t on your formulary, you may be entitled to coverage. Some examples of vaccines covered by Part D plans are the shingles vaccine, the RSV vaccine, and the tetanus-diphtheria-whooping cough vaccine.
Screenings and tests
Screenings help healthcare providers catch treatable infections and diseases early. As we age, we’re more likely to develop medical conditions, and catching them early can help us seek early treatment, which leads to better outcomes.
Alcohol misuse screenings
Medicare Part B fully covers one alcohol misuse screening each year. This screening is for individuals who use alcohol but aren’t considered alcohol-dependent.
Cardiovascular disease screenings
Medicare Part B fully covers a cardiovascular blood test screening once every five years.
Cervical and vaginal cancer screenings
In most cases, Medicare Part B covers the following services every 24 months, as part of the cervical and vaginal cancer screening:
Pap test
Pelvic exam
Clinical breast exam
If you’re at high risk, are of childbearing age, or have had an abnormal Pap test in the past 36 months, Medicare covers these services once every 12 months.
Depression screenings
Medicare Part B fully covers one depression screening each year. The screening must occur in a primary care setting where you can receive follow-up treatment or a referral.
If you or someone you know is struggling or in crisis, call or text 988, the free and confidential Suicide & Crisis Lifeline. You can call and speak with a trained crisis counselor 24 hours a day, 7 days a week. You can also connect with a counselor through web chat at 988lifeline.org.
Call 911 if you're in immediate medical crisis.
Diabetes screenings
Over 37 million US adults have diabetes, and the disease can cause other medical complications. Part B covers up to two blood glucose lab test screenings each year if you have any of the following:
High blood pressure (hypertension)
History of abnormal cholesterol and triglyceride levels
Obesity
History of high blood sugar
Part B will also cover these screenings if you:
Are 65 or older
Are overweight
Have a daily history of diabetes
Have a history of gestational diabetes or delivery of a baby weighing more than 9lbs
Hepatitis B Virus (HBV) screenings
Medicare covers an HBV screening one time per year if a doctor orders it and you are either at high risk for HBV or pregnant.
Hepatitis C screenings
Medicare covers Hepatitis C screenings if your healthcare provider orders one and you’re at high risk.
If you are at high risk because of one of the following reasons, Medicare will pay for one screening test:
You received a blood transfusion before 1992
You were born between 1945 and 1965
You’ve used illicit injection drugs
If you are at high risk because you’re still using illicit injection drugs, Medicare will cover one screening each year.
HIV screenings
Medicare Part B covers an HIV screening one time each year if one of the following is true:
You’re between age 15-65
You’re outside of ages 15-65 and at increased risk for HIV
You can get up to three HIV screenings during a pregnancy.
Lung cancer screenings
You must meet all of the following conditions to have Medicare cover a lung cancer screening:
50-77 years old
No lung cancer symptoms
Current smoker or quit smoking within the past 15 years
Smoked an average of one pack of cigarettes a day for 20 years or more
Have an order from your doctor
Mammograms
Mammograms help catch breast cancer early and are covered by Medicare Part B. There are two types of mammograms: screening and diagnostic. Medicare fully covers screening mammograms. For diagnostic mammograms, once you meet your Part B deductible, you’ll pay 20% of the costs.
A baseline screening mammogram is covered once in your lifetime for women between ages 35-39. If you’re 40 or older, screening mammograms are covered once every twelve months. Diagnostic mammograms are covered more than once a year if they’re medically necessary. Learn more about how Medicare covers mammograms, including what Medicare pays and how much you'll be responsible for.
Prostate cancer screenings
There are two parts of a prostate cancer screening: the digital rectal exam and the prostate specific antigen (PSA) blood test. Both of these are covered by Medicare, and you can receive them once every twelve months after you turn 50.
The PSA blood test is fully covered by Medicare. For the digital rectal exam, once you meet your Part B deductible, you’ll owe 20% of the Medicare-Approved Amount. If you receive the rectal exam in an outpatient hospital setting, you may also owe a copay.
Sexually transmitted disease (STD) screenings
Medicare Part B covers STD screenings once every twelve months for those who are pregnant or at increased risk for STDs. STD screenings are also covered during certain times of a pregnancy.
Doctor visits
When you first enroll in Medicare, you’re eligible for a one-time “Welcome to Medicare” visit. After this, Medicare covers a “Wellness” visit one time each year.
For any services provided during your “Wellness” visit that aren’t explicitly covered by the visit, you may be responsible for all or part of the costs of services. If your doctor determines you need additional services or care during your “Wellness” visit, you will need to make another appointment to receive those services at a later date.
Yearly “Wellness” visit
Yearly “Wellness” visits share some similarities with a physical exam, but offer fewer services. Your Yearly “Wellness” visit is fully covered by Part B. During your visit, your healthcare provider will:
Take routine measurements
Review your medical history
Review your current prescriptions
Provide you with personalized health advice
Support your advance care planning
One-time “Welcome to Medicare” visit
The “Welcome to Medicare” visit includes all of the services you’ll receive with your yearly “Wellness” visit, and also:
A calculator of your body mass index (BMI)
A basic vision test
A depression and safety screening
Counseling
Whether you’re struggling with drug misuse, specific diseases,or your weight, Medicare covers counseling to provide face-to-face support. Not all mental health support is listed as “preventive care.” Get a full understanding of how Medicare covers therapy and mental health needs here.
Alcohol misuse counseling
In addition to the alcohol misuse screenings mentioned above, if your primary care provider determines you’re misusing alcohol, Medicare fully covers up to four counseling sessions each year.
Behavioral therapy for cardiovascular disease
Cardiovascular (heart) disease is the leading cause of death in the US, but lifestyle changes can cause better outcomes. During your session, your doctor will check your blood pressure and provide advice on eating well.
Medical nutrition counseling
Medicare Part B covers nutrition counseling if your doctor refers you for the services and you meet any of the following criteria:
You have diabetes
You have kidney disease
You’ve had a kidney transplant in the past 36 months
Obesity counseling
If you have a BMI of 30 or more, Medicare Part B fully covers obesity screenings and counseling. Your behavioral therapy sessions will provide you with a dietary assessment and counseling to support weight loss through diet and exercise.
STD counseling
In addition to STD screenings mentioned above, Medicare also covered two behavioral counseling sessions each year for sexually active adults at increased risk for STDs.
Tobacco use cessation counseling
Medicare Part B covers up to eight counseling sessions in a twelve-month period to help current tobacco users stop their use of tobacco products.
Most preventive care services are free, as long as they apply to you. We highly recommend you use these services because they can help you catch medical complications early and help you better maintain your health as you age. If you have questions about how a specific service is covered under Medicare or any other Medicare-related questions, we’re here to help!
Schedule a free consultation or call us at (855) 900-2427 to get your questions answered.