Medicare covers most medically-necessary treatments and services. One commonly asked question we see is “Does Medicare Cover Preventive Care?” Preventive care is defined as medical care that is designed for disease/sickness prevention rather than disease/sickness treatment.
As you go on Medicare and get older, it is important to understand what your options are for preventive care. In the past, Medicare had more limited coverage for preventive care. In fact, it is still a prevalent myth that Medicare does not cover preventive care. So… is that true? Does Medicare cover preventive care?
Yes, Medicare definitely does now cover many preventive care services, tests and procedures. From the “Welcome to Medicare” physical to recurring screenings and tests, Medicare follows a preventive care model that was expanded with the passage of the Affordable Care Act (ACA).
Medicare has published a guide designed to help you know what preventive care is covered by Medicare: Your Guide to Medicare’s Preventive Services. That particular guide is very comprehensive, and you can request a hard copy from Medicare. But below, we’ve included a list of preventive care services that are covered by Medicare. As always, it is advisable to check with your doctor’s office as they can go over does Medicare cover preventive care that you are specifically seeking. It can vary by person, as some are considered to be at more “high risk” due to current health, family history, etc.
- Abdominal Aortic Aneurysm Screening – Medicare covers this for people considered at risk. You are considered at risk if you have a family history of abdominal aortic aneurysms or are a man age 67-75 and have smoked 100 cigarettes in your lifetime
- Alcohol misuse screening and counseling – Available to adults with Medicare who use alcohol but don’t meet the definition for alcohol dependency
- Bone mass measurements – Covered once every 24 months (more often if medically necessary) for people considered at risk for osteoporosis
- Breast cancer screening (mammograms) – Covered once every 12 months for women over 40
- Cardiovascular disease (behavioral therapy) – Covered once per year for all people with Medicare
- Cardiovascular disease screening – Covered once every five years for people with Medicare when ordered by a doctor
- Cervical and vaginal cancer screening – Available to all women with Medicare once every 24 months or every 12 months if you are considered to be at high risk
- Colorectal cancer screening – Different testing timelines vary, but in general, basic testing covered annually and colonoscopies are covered every 10 years or more frequently for certain risk classes
- Depression screening – Medicare covers one screening per year
- Diabetes screening and self-management training – Available up to 2 times per year, depending on test results
- Flu shot – Covered once every 12 months
- Glaucoma tests – Covered once every 12 months for people at risk for glaucoma
- Hepatitis C screening test – Medicare covers a one-time Hepatitis C test or repeated screenings for those at high risk
- HIV screening – Covered once every 12 months for people at high risk
- Lung cancer screening – Covered once every 12 months for people who meet certain risk criteria (current or former smoker)
- Medical nutrition therapy – Medicare covers three hours the first year (and two hours every year thereafter) if you have diabetes, kidney disease or have had a kidney transplant
- Obesity screening and counseling – Covered for everyone
- Prostate cancer screening – Covered annually for men over 50
- Sexually transmitted infections screening and counseling – Testing covered once every 12 months for people at high risk
- Shots (flu, pneumococcal and Hepatitis B) – Medicare covers shots – flu shot (once every 12 months), pneumococcal (once per lifetime), and Hepatitis B (three shots if at high risk)
- Tobacco use cessation counseling – Medicare covers 8 visits during a 12 month period
- “Welcome to Medicare” preventive visit – Medicare covers a one-time “Welcome to Medicare” visit during the first 12 months that you have Medicare. This is designed to get you on a good start with Medicare, update any screenings or shots and get a baseline for any future treatment/care needed
- Yearly “Wellness” visit – Covered once every 12 months. This sets an appropriate screenings schedule and allows you to get personalized, current health advice based on current health
So, does Medicare cover preventive care? The answer is now a resounding “yes”. All that’s left is for you to take control of your health by enacting wellness strategies and pursuing appropriate preventive care for your specific health and lifestyle.
If you have questions about Medicare’s coverage of preventive care or anything else regarding Medicare or Medicare plans, please contact us at 877.506.3378 or online here.