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Medicare Preventive Services

Coverage that treats medical problems is good, but avoiding disease and conditions altogether is even better. Medicare provides excellent preventive care to stave off some of the diseases that can affect people 65 and older.

Thanks to the Affordable Care Act, many of these preventive tests, screenings and counseling sessions now come free (no copays or deductibles). Find out what services are available to you and why they’re important below.

Abdominal aortic aneurysm screening

An aneurysm that grows and becomes large enough can burst, causing dangerous, often fatal bleeding inside the body. About 15,000 Americans die each year from ruptured aortic aneurysms. If found early, many aneurysms can be treated before they rupture. Because aneurysms can develop and become large before causing any symptoms, it is important to look for them in people who are at the highest risk.

  • Who is covered: People at risk for abdominal aortic aneurysm, which typically includes men 65-75 who have ever smoked
  • How often it is covered: The screening is covered one time, as long as you receive a referral for this screening during your “Welcome to Medicare” exam.
  • Your cost: Free

Alcohol misuse screening

Alcohol abuse is a growing problem. Currently, 1 in 6 people in the United States has a drinking problem. This screening can help prevent you from becoming dependent on alcohol.

  • Who is covered: People who use alcohol, but do not qualify as dependent on alcohol
  • How often it is covered: 1 screening per year. People who screen positive can get up to 4 brief face-to-face counseling sessions.
  • Your cost: Free

Annual wellness visit

This visit with your doctor is to develop a personalized plan for preventive screenings. Medicare pays for the visit every 12 months. The visit includes:

  • A review of your medical and family history
  • Developing or updating a list of current providers and prescriptions
  • Height, weight, blood pressure, and other routine measurements
  • Detection of any cognitive impairment
  • Personalized health advice
  • A list of risk factors and treatment options for you
  • A screening schedule (like a checklist) for appropriate preventive services. Get details about coverage for screenings, shots, and other preventive services.
  • New in 2016, the option to include an advance care planning discussion

This visit is covered once every 12 months (11 full months must have passed since the last visit).

Bone mass measurement

Bone mass measurements help your doctor tell if you are at risk for a broken bone (fracture). The test is painless, quick and accurate. The results will help you and your doctor choose the best way to keep your bones strong.

  • Who is covered: People at risk for osteoporosis, which typically includes women 50+ with low body weight and a history of broken bones
  • How often it is covered: Once every 24 months (more often if medically necessary)
  • Your cost: Free

Breast cancer screening/mammogram

Breast cancer is the most common non-skin cancer in women and the second leading cause of cancer death in women in the United States. Every woman is at risk, and this risk increases with age.

The good news is that breast cancer can usually be treated successfully when found early. Medicare covers screening that can find breast cancer before you or a doctor may be able to feel it. Because risk increases with age, it is important to continue with screening, even if you were screened before you entered Medicare.

  • Who is covered: Women 40+
  • How often it is covered: Once every 12 months
  • Your cost: Free

Cardiovascular heart disease screening

Cardiovascular diseases affect your heart or your blood vessels. High blood pressure (also known as hypertension), stroke and heart failure are types of cardiovascular diseases. So is coronary heart disease, which includes heart attack and chest pain (angina pectoris).

High levels of cholesterol can increase your risk for heart disease and stroke. Blood tests check your cholesterol and other blood fat (lipid) levels and will tell if you have high cholesterol.

Also, your doctor can ask you a series of simple questions to see if you are at risk for developing heart disease. If so, your doctor can help you learn ways to make lifestyle changes, like changing your diet or using aspirin, to help lower your cholesterol and stay healthy.

  • Who is covered: Anyone with Medicare
  • How often it is covered: Screening: Your doctor will screen you to see if you are at risk for heart disease, covered once a year. If at risk, the blood test is generally covered once every 5 years.
  • Your cost: Screenings are free, but the doctor visit may require a copay

Cervical and vaginal cancer screening

Cervical and vaginal cancers are cancers of the womb and birth canal. To check for these, your doctor will do a pelvic exam and look inside your cervix. He or she also will also take some cells from your cervix for a Pap test.

Regular pelvic exams and Pap tests help prevent these cancers. Your doctor can find abnormal changes in the cervix and vagina and treat you before cancer develops. Women who do not regularly have Pap tests have an increased risk of cervical cancer.

  • Who is covered: All women with Medicare are covered
  • How often it is covered: Generally covered once every 24 months; once every 12 months if you are at high risk
  • Your cost: Free

Colon colorectal cancer screening

Cancer of the colon or rectum is called colorectal cancer. This cancer is more common in people over 50, and the risk increases with age. In the United States, it is the fourth most common cancer in men and women.

These tests help find growths in the colon (pre-cancerous polyps) so your doctor can remove them before they turn into cancer. Treatment works best when colorectal cancer is found early.

Fecal occult blood test

  • Who is covered: People age 50 or older are covered
  • How often it is covered: Once every 12 months
  • Your cost: Free

Flexible sigmoidoscopy

  • Who is covered: People age 50 or older are covered
  • How often it is covered: Once every 48 months
  • Your cost: Free

Colonoscopy

  • Who is covered: People age 50 or older are covered
  • How often it is covered: Once every 24 months if you are at high risk; once every 120 months if you are at low risk
  • Your cost: The test is free, but there may be a copay for polyp removal

Barium enema (when used instead of prior 2 procedures)

  • Who is covered: People age 50 or older are covered
  • How often it is covered: Once every 24 months if you are at high risk; once every 48 months if you are at low risk
  • Your cost: A copay is required

Multi-target stool DNA test (Cologuard™)

  • Who is covered: People between ages 50-85, show no signs or symptoms, or at average risk for developing colorectal cancer, meaning:
    • No personal history of adenomatous polyps, colorectal cancer, inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.
    • No family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.
  • How often it is covered: Once every 3 years for people who meet all of these conditions
  • Your cost: Free

Depression screening

Among people over the age of 65, 1 in 6 suffers from depression. Many people who suffer from depression are not diagnosed or treated, which can lead to other health problems, even death. Left untreated, older adults are the highest at risk for suicide. This screening can help you get treatment to improve your quality of life.

  • Who is covered: Everyone with Medicare is covered
  • How often it is covered: Once per year in a primary care setting
  • Your cost: Free

Diabetes screening

Diabetes is the seventh leading cause of death in the United States. Millions of people have diabetes and do not know it. If you have diabetes and your doctor finds it early, he or she may be able to prevent or delay the serious health problems diabetes can cause.

  • Who is covered: People with any of the following risk factors: high blood pressure, history of abnormal cholesterol and triglyceride levels, history of high blood sugar
  • How often it is covered: Up to twice a year
  • Your cost: Free

EKG heart screening

Heart disease is the leading cause of death in the United States. Your doctor may recommend an EKG test if you are at risk for heart disease or if you have symptoms of heart trouble, such as chest pain or trouble breathing.

  • Who is covered: Anyone with Medicare
  • How often it is covered: Once, with a referral during your “Welcome to Medicare” exam and any time your doctor recommends one to diagnose a condition
  • Your cost: Free

Flu shot

You can get very sick or even die from the flu. It also can cause pneumonia. The flu can be dangerous for people age 50 and older. You need a flu shot each year because flu viruses are always changing. Each year, they make a new shot that fights that year’s viruses. You may still get the flu if you get a shot, but you will not get as sick.

Also, the flu shot only helps protect you from the flu for about 1 year. You should get a flu shot in the late fall or early winter.

  • Who is covered: Anyone with Medicare
  • How often it is covered: Once each year during the fall or winter
  • Your cost: Free

Glaucoma test

Glaucoma is a group of eye diseases that gradually take away your sight. Glaucoma usually happens when the normal fluid pressure inside the eyes slowly rises.

To check for glaucoma, your doctor will look at the inside of your eyes. He or she may measure the pressure in your eye or the angle of your eye. If you find and treat glaucoma early, you can often protect your eyes against serious vision loss.

  • Who is covered: People at risk for glaucoma are covered for this test. Typically, this includes those who have a family history of glaucoma, have diabetes, are African American and age 50 or older or are Hispanic and age 65 or older
  • How often it is covered: The test is covered once every 12 months
  • Your cost: A copay and your Part B deductible apply

Hepatitis B shots

Hepatitis is a swelling of the liver that makes it stop working well. Your liver helps your body digest food, store energy and remove poisons.

These shots can keep you from getting hepatitis. Medicare covers the shot if you are at medium to high risk for hepatitis B. You should discuss your risks with your doctor.

  • Who is covered: People at medium to high risk for hepatitis B are covered, which typically includes those who have hemophilia, end stage renal disease (ESRD) or a condition that lowers resistance to infection
  • How often it is covered: Whenever your doctor orders them, the series of 3 shots are covered
  • Your cost: Free

Hepatitis C screening

Hepatitis C is a virus that spreads from person to person through blood and infects the liver. Chronic (or long-lasting) Hep C is a viral infection of the liver that progresses slowly. If left untreated, over time it can cause liver damage or liver failure.

Medicare covers one Hepatitis C screening test. Medicare also covers yearly repeat screening for certain people at high risk.

  • Who is covered: People at high risk because they have a current or past history of illicit injection drug use, had a blood transfusion before 1992, or were born between 1945-1965.
  • How often it is covered: Medicare covers one Hepatitis C screening test. Medicare also covers yearly repeat screening for certain people at high risk.
  • Your cost: Free

HIV screening

HIV, or Human Immunodeficiency Virus, is a virus that attacks a person’s immune system. Our immune systems are made up of several types of cells and organs that help us fight off everyday infections and diseases. HIV attacks one kind of these immune cells, called T-cells. T-cells help us fight infections and diseases.

Over time, HIV depletes the body’s supply of T-cells, leaving fewer cells to fight infection and disease. This leads to AIDS, or acquired immunodeficiency syndrome. AIDS is the final stage of the HIV infection. At this point, a person may develop life-threatening infections and diseases.

Once the virus is in your body, it can only be treated, not removed. If you are at risk, it is important for you to get tested each year. That way, if you are infected, you can get help right away. If you get help early, you may not get AIDS until much later.

Yearly tests also help prevent the spread of HIV. More than 1 million Americans live with HIV/AIDS. But 1 in 5 people do not know they are infected. They may give it to other people without knowing.

  • Who is covered: Anyone with Medicare
  • How often it is covered: Once every 12 months or every 3 months for pregnant women
  • Your cost: Free

Laboratory services

Simple laboratory procedures can help doctors diagnose and treat (or rule out) various diseases. Outside of the realm of specific preventive tests, these services are additional measures covered by Medicare.

  • Who is covered: Anyone with Medicare
  • How often it is covered: Blood tests and urinalysis, as ordered by your doctor anytime
  • Your cost: Free

Lung cancer screening

Lung cancer is the leading cause of cancer deaths in the United States, among both men and women. Lung cancer claims more lives each year than do colon, prostate, ovarian and breast cancers combined.

People who smoke have a greater risk of lung cancer, increasing with length of time and number of cigarettes smoked.

  • Who is covered: People age 55-77, current smoker of have quit smoking within the last 15 years, have a tobacco smoking history of at least 30 “pack years” (an average of one pack a day for 30 years), or written order from physician.
  • How often it is covered: Medicare Part B (Medical Insurance) covers a lung cancer screening with Low Dose Computed Tomography (LDCT) once per year.
  • Your cost: Free

Medical nutrition therapy

Medical nutrition therapy gives you advice on eating the right foods to better manage your medical condition.

A registered dietitian or nutrition professional can give you:

  • An initial opinion on what you eat and your lifestyle
  • Advice on what foods to eat and how to follow a personal meal plan
  • How to manage certain lifestyle factors that affect your diet, such as exercise and stress
  • Follow-up visits to help you manage your diet
  • Who is covered: Anyone in need with a doctor’s prescription, which typically includes those who have diabetes, have kidney disease but are not on dialysis or have had a kidney transplant
  • How often it is covered: Once a year; 3 hours of therapy in the first year and 2 hours of follow-up services each year after that
  • Your cost: Free

Obesity screening and counseling

Obesity has become a major health concern in the United States. Almost 1 in 3 people with Medicare is estimated to be obese. Obesity is also more likely to affect people of minority groups such as African-Americans and Latinos. This screening can help you get treatment to improve your quality of life.

  • Who is covered: Anyone with Medicare
  • How often it is covered: Once per year. If you screen positive for obesity, Medicare will cover counseling for up to 1 year to help you learn ways to reduce your weight and improve your overall health.
  • Your cost: Free

Pneumonia shots

Pneumococcal disease can make you very sick or even kill you. It happens when bacteria (called pneumococcus) attack different parts of the body. It can invade the lungs and cause pneumonia and It can invade the bloodstream and cause bacteremia. Or it can invade the covering of the brain and cause meningitis. It can also cause middle ear and sinus infections. The shot may protect you.

You can get this shot on the same day that you get the flu shot, but you can also get it at any time of year. One shot may be all you ever need, but you should discuss this with your doctor.

  • Who is covered: Anyone with Medicare
  • How often it is covered: Once after age 65, or more often for some people
  • Your cost: Free

Prostate cancer screening

Prostate cancer affects the prostate, which is the gland below a man’s bladder that produces fluid for semen. Prostate cancer is the second most common type of cancer in American men. A rectal exam and a blood test called a Prostate Specific Antigen (PSA) test can find this cancer. Medicare covers both of these.

  • Who is covered: Men age 50 or older
  • How often it is covered: Both the digital rectal exam and the PSA test are covered once every 12 months
  • Your cost: The PSA test is free. The digital rectal exam requires a copay, and your Part B deductible applies.

Sexually Transmitted Illness (STI) screening and counseling

Screening for sexually transmitted illnesses is important for sexually active adults of all ages. Medicare covers these tests to keep you healthy and diagnose and treat illnesses if necessary.

  • Who is covered: Everyone with Medicare
  • How often it is covered: Once every 12 months or more often for pregnant women. Up to 2 counseling sessions are covered if the test is positive.
  • Your cost: Free if doctor orders tests and they are performed in a Medicare-approved lab

Smoking cessation counseling

This counseling can help you quit smoking. If you stop smoking, you can significantly lower your risk for certain diseases, even if you have smoked for years.

  • Who is covered: Anyone with Medicare who smokes, regardless of illness or symptoms
  • How often it is covered: Up to 8 face-to-face visits during a 12-month period, as ordered by your doctor
  • Your cost: Free

Welcome to Medicare exam

During the first year that you have Medicare Part B, you can get a one-time exam that will help you prevent illness.

The exam will give you a full review of your health. It will teach you about the preventive services you need to stay well, like certain screenings and shots. Your doctor can also refer you to other professionals for other healthcare.

During the exam, your doctor will record your medical history and check your blood pressure, weight and height. Your doctor may give you a vision test and make sure that your shots are up to date.

He or she may order further tests if you need them. Your doctor will tell you how to prevent disease, improve your health or stay well. You also will get a written plan when you leave. This checklist will let you know which screenings you should get.

  • Who is covered: Anyone with Medicare
  • How often it is covered: Once, in the first year of Medicare
  • Your cost: Free, but you may have to pay for some costs if your doctor does other tests or procedures during this visit that are not included as part of the exam

Next steps:

Learn About Coverage for Conditions  or  Learn About Part C