Medicare will pay for many preventive services
April 1, 2018
Did you know that if you have Medicare Part B you are eligible to receive a large number of preventive services that will cost you nothing? Medicare’s goal in offering these preventive screenings is to find health problems early when treatment works best.
Under Medicare Part B, preventive services are part of your benefits and you will pay no co-payment if you get the services from a provider (doctor, other provider, or supplier) who takes assignment. Taking assignment means that this provider has an agreement with Medicare to accept the amount as full payment for covered services and will not bill you for any more than the Medicare deductible and coinsurance.
Coverage for preventive services is based on age, gender and medical history.
The Affordable Care Act waived deductibles, copayments or coinsurance for the following Medicare-covered preventive services:
Welcome to Medicare Visit. This visit is offered during the first 12 months of having Part B. During this visit the provider will review your medical and social history, check your blood pressure, height, weight and body mass index to create a baseline for your care. They will perform a simple vision test, review risk factors for depression, review functional ability and safety, educate and counsel you to help you stay well, and refer you for additional screenings if needed.
The Annual Wellness Visit is offered only after 12 months of having Part B and is covered annually. It includes a review of your medical and family history, developing or updating a list of current providers and medications being taken, cognitive evaluation, personalized health advice, an evaluation of your height and weight, blood pressure and other routine measurements. You will be provided with a list of risk factors and treatment options for you and a screening schedule for appropriate preventive services.
The Alcohol Misuse Screening is offered annually for adults and can include four brief face to face counseling sessions per year.
A Bone Mass Measurement is covered every 24 months or more often if medically necessary, if you meet specific criteria such as those who are high risk for osteoporosis and meet other criteria.
Breast Cancer Screening Mammogram is covered; one baseline mammogram for women between the ages of 35 to 49 then once a year starting at age 40
The Cardiovascular Disease (CVD) Risk Reduction Visit is covered once per year, including behavioral therapy.
A Cardiovascular Disease Screening including blood test for early risk detection of heart disease or stroke, total cholesterol, high-density lipoproteins, triglycerides, is covered once every five years.
Cervical and Vaginal Cancer Screening including pap tests and pelvic exams with clinical breast exam is covered once every 24 months for all women and once every 12 months if you’re at high risk.
The Colorectal Cancer Screening are offered to beneficiaries who are 50 years of age or older with Part B. This can be one of several tests including barium enema, colonoscopy, fecal occult blood test, flexible sigmoidoscopy, and multi-target stool DNA test. Different time frames apply. If during the screening colonoscopy or the screening flexible sigmoidoscopy, a biopsy or the removal of a lesion or growth, the procedure is then considered a diagnostic tool and you may have to pay coinsurance or a copayment.
One Depression Screening by a primary care provider is covered per year and must be done in a primary care setting like a doctor’s office that is able to provide follow-up treatment and/or referrals if necessary.
Diabetes Screening for people at risk
Flu Shot (Influenza) Vaccine is covered once every flu season
Pneumococcal Shots includes two vaccines given one year apart
Hepatitis B Vaccine for people at medium to high risk
Hepatitis C Screening Test is a single once-in-a-lifetime screening test, covered for adults who are not considered high-risk and were born from 1945 through 1965.
Human Immunodeficiency Virus (HIV) Screening annually for those who are between the ages of 15 and 65 years without regard to perceived risk and those who are younger than 15 and older than 65. High risk persons can have a repeat screening annually. No cost for the test if the provider accepts assignment, but you may pay 20 percent of the Medicare approved amount for the visit. Pregnant beneficiaries may have up to three voluntary screenings during a pregnancy.
Lung Cancer Screening if you are age 55 to 77, are a current smoker or have quit smoking within the last 15 years, have a tobacco smoking history of at least 30 “pack years” (which equals a pack a day for 30 years). Requires a written order from your doctor or non-doctor practitioner.
Obesity Screening and Counseling includes body mass index measurement and intensive behavioral therapy.
Prostate Cancer Screening for Medicare beneficiaries who are over 50 – tests include a Prostate-Specific Antigen (PSA) blood test and a digital rectal exam. Note: you pay nothing for the PSA although a copayment may apply in a hospital outpatient setting. You will pay 20 percent after the Part B deductible for digital rectal exam.
Sexually Transmitted Infections (STI) Screening and Counseling covers STI screenings for chlamydia, gonorrhea, syphilis and Hepatitis B for pregnant women and for high risk people. Can be gotten once a year or at certain times during a pregnancy. This also covers up to two individual face–to–face, high-intensity behavioral counseling sessions each year.
Smoking and Tobacco-use Cessation Counseling Medicare will cover two attempts each year for you to quit tobacco. This counseling can be provided in a hospital or an out-patient basis. Each of these attempts can have up to four counseling sessions for a total of up to eight sessions every 12 months. These can be provided either as an inpatient or an outpatient, however a copayment may apply in a hospital setting. Note that Medicare prescription drug coverage (Part D) also covers smoking and tobacco-use cessation products prescribed by a doctor.
Nila Morgan is a Certified Medicare Counselor and Medicare Fraud Education Coordinator who works at the Anchorage Senior Activity Center.