Medicare's Coverage of Preventative Services
By Elie Harriett
August 17, 2016
Medicare Parts A & B are primarily hospital and medical insurance, which means when you need necessary services, Medicare is there to cover the lion’s share of the bill. However, in the last several years, Medicare has also been covering a number of preventative services, many of which at no cost to you, so both the deductible and the 20% typically left by Medicare Part B would not apply to preventative services. Here is a list of some of the preventative services Medicare typically covers.
- Bone mass measurements: tests to see if you are at risk for osteoporosis. Once every 24 months
- Mammograms: Breast cancer screenings. Once every 12 months for women over 40.
- Cholesterol screenings: tests for cholesterol, lipid, and triglyceride levels. Once every 5 years.
- Colorectal cancer screenings: Colonoscopies and various other tests. Durations and age requirements vary for how often Medicare covers this. Ask your doctor for more specifics based on the tests you may need.
- Depression screening: screening for depression. Once per year.
- Diabetes screening and training: Tests for people at risk for diabetes and training for the management of it for new diabetics are covered. The screening is covered twice a year. The management training is covered only once.
- Glaucoma tests: Testing for people at risk for glaucoma. Covered once every 12 months.
- Prostate cancer screening: PSA and digital rectal examinations. Covered for all men over 50 with Medicare once every 12 months.
- Flu shots: Covered once a year for all people on Medicare
- Pneumonia shots: covered when ordered by a doctor.
- Yearly Wellness Exam: After 12 months on Medicare, an annual preventative service is covered by Medicare Part B. This exam is covered to develop and update your personal prevention plan. This is covered once every 12 months.
These are examples of services Medicare considers “preventative.” Usually, these services, when done with the frequency listed above, have no cost associated with them. However, these screenings can be ordered more frequently as necessary to maintain your good health or of you are a “high risk” individual for any disease these tests detect to prevent. When ordered more frequently, sometimes you might have co-pays associated with the services.
Medical providers often perform other medically necessary services at the time they administer these tests. It is possible you might be subject to any applicable charges as a result of the other services performed during your visit. So it is a good idea to be aware of your co-pay responsibilities before your doctor begins treatment.
Both Medicare Advantage and Medicare Supplements cover the above listed preventative services with no copays and no deductibles. But it is important to be aware of your charges for any services beyond preventative, should your medical visit become more comprehensive.
This is only a small list of Medicare’s preventative services covered. For a detailed list, consult your Medicare and You 2016 guidebook, or request a copy of Your Guide to Medicare’s Preventative Services from the medicare.gov website. And if you would like as some guidance as to how preventative services works with your insurance, you can always ask us directly.
Keywords: medicare benefits
