- Original Medicare covers many preventive services to keep you in good health.
- Medicare Advantage (Part C) plans offer the same preventive care as original Medicare, plus some extra benefits.
- Most of the screenings, tests, and vaccines are covered under Medicare Part B at no cost to you.
An important part of good self-care is preventing illness and detecting any health problems early.
Medicare Part B, which covers medical costs like doctor visits and outpatient procedures, includes coverage for a number of preventive health screenings, tests, and vaccines. Medicare Advantage (Part C) plans, which are private insurance products, also offer preventive care. In fact, many of these plans offer access to extra services.
Read on to learn what preventive services are covered under Medicare, how often they’re covered, and how much you’ll pay for them, if anything.
Most of the time, Medicare limits preventive screenings to a certain number of tests per year. If you’re at a higher risk for certain health conditions, Medicare may offer you additional screenings. If you’re pregnant, for example, Medicare may pay for additional hepatitis screenings at several points during your pregnancy.
Medicare sometimes offers preventive care at no cost to you, but other tests, screenings, and vaccines may require a copay or coinsurance. Here’s an at-a-glance summary of Medicare’s preventive services.
|Preventive care||How often?||Medicare requirements||Cost to you|
|abdominal aortic aneurysm screening||once||you need a referral||$0|
|alcohol misuse screening||once every 12 months||you must be an adult who isn’t alcohol dependent||$0|
|alcohol misuse counseling||4 sessions every 12 months||your doctor must determine that you’re misusing alcohol||$0|
|bone density screening||once every 24 months||one of these must be true: you’re estrogen deficient and at risk for osteoporosis; an x-ray shows osteoporosis or fractures; you’re taking prednisolone or other steroids; your doctor is monitoring your osteoporosis drug therapy||$0|
|cardiovascular disease||once every 5 years||screening includes tests for cholesterol, lipid, and triglycerides||$0|
|cardiovascular behavior therapy||once every 12 months||therapy must take place in a primary care setting||$0|
|cervical/vaginal cancer screening||once every 24 months||tests will include HPV and breast cancer screenings. If you had a positive pap test or you’re at high risk, you can be screened once a year||$0|
|colorectal cancer (CRC) screen: multi-target stool DNA||once every 3 years||you must be age 50–85, have no CRC symptoms, and have an average risk level||$0|
|CRC screen: barium enema||once every 48 months||you must be 50 or older; if you’re at high risk, you can be screened once every 24 months||20% of cost, plus copay|
|CRC screen: colonoscopy||once every 24 months||you must be at high risk; if you aren’t at high risk, you can be screened once every 120 months||20% of the cost of polyp removal|
|CRC screen: fecal occult blood test||once every 12 months||you must be 50 or older and have a referral||$0|
|CRC screen: sigmoidoscopy||once every 48 months||you must be 50 or older; if you aren’t at high risk, you can be screened once every 120 months||if you have a biopsy, you may pay coinsurance or a copay|
|depression||once every 12 months||screening must happen in a primary care setting||$0|
|diabetes screening||twice every 12 months||your doctor will affirm you’re at high risk if two of these are true: you’re over age 65, you’re overweight, you have a family history of diabetes, you have a history of gestational diabetes, or you had a baby that weighed 9 lbs. or more||$0|
|Diabetes self-management training||10 hours initially||You may qualify for an additional 2 hours per year||20% of cost|
|glaucoma screening||once every 12 months||one must be true: you have diabetes; you have a family history of glaucoma; you’re Black and over age 50; you’re Hispanic and over age 65||20% of cost, plus any hospital copay|
|hepatitis B virus infection screening||once every 12 months||you must be at high risk; if you’re pregnant, you can be screened three times during pregnancy||$0|
|hepatitis C virus infection screening||once every 12 months||your doctor must order it, plus: you must be high risk, you must have had a blood transfusion before 1992, or you must have been born 1945–1965||$0|
|HIV||once every 12 months||you must be 15–65 years old or at high risk||$0|
|lung cancer screening||once every 12 months||you must be 55–77 years old and have no symptoms, or you must be a smoker (or have a history of smoking one pack of cigarettes per day for 30 years or longer); your doctor must order this test||$0|
|mammogram||once every 12 months||you must be 40 years or older; you may also have one baseline test between ages 35–39; you may have additional tests if it’s medically necessary||if your test is diagnostic, you pay 20% of the cost|
|nutrition therapy||3 hours the first year, 2|
hours each year after that
|your doctor must write a referral, and you must have diabetes, renal disease, or have had a kidney transplant within the last 3 years||$0|
|obesity screening||one initial screening, plus behavioral therapy sessions||you must have a body mass index of 30 or more; screening must happen in a primary care setting||$0|
|prostate cancer screening||once every 12 months||screening includes a digital exam and a blood test||$0 for exam, 20% for blood test|
|sexually transmitted infection screening||once every 12 months||screening includes chlamydia, gonorrhea, syphilis, and hepatitis B; two 20- to 30-minute counseling sessions are included||$0|
|flu shot||once each flu season||—||$0|
|hepatitis B shots||—||you must be at medium to high risk||$0|
|pneumococcal shots||2 shots||they must be at least 1 year apart||$0|
|smoking cessation counseling||8 visits every 12 months||—||$0|
|wellness visit||once every 12 months||—||there may be coinsurance if your doctor runs extra tests|
|welcome to Medicare examination||once within 12 months of enrolling in Medicare Part B||—||$0|
Most of these screenings and preventive services are covered by Medicare Part B at no cost to you. You’ll have to pay Medicare Part B premiums, deductibles, and any applicable copays or coinsurance costs.
If your healthcare provider decides to add on other diagnostic tests, you may be responsible for part of the cost.
If you’re not sure whether a test is covered, talk to your healthcare provider about the costs beforehand, so you don’t have any surprising expenses.
If your screening is followed by a visit with your doctor, you may be charged separately for that visit. If your screening takes place in a specialized facility, there may be fees associated with that facility.
If you have a Medicare Advantage plan, you’ll receive the same preventive services covered by original Medicare.
Many Medicare Advantage plans offer extra preventive services, including:
Since each plan is different, check your summary of coverage to see what preventive services are included in your plan.
Preventive screenings must be administered by Medicare-approved healthcare providers. Other limitations are described in the table above.
- Original Medicare and Medicare Advantage plans offer a number of preventive services to help you maintain good health and detect any health problems early, when treatment may be most effective.
- Though a few tests require a copay or coinsurance, most screenings and vaccines are covered under Medicare Part B and won’t cost you anything.
- Talk to your healthcare provider to schedule these preventive service. A good time for that discussion might be during your annual wellness visit.
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