Medicare Preventive Services, What you need to know !!!

Under the Affordable Care Act, if you have Original Medicare, you may qualify for a yearly wellness visit and many preventive services for free.

Medicare provides preventive benefits to keep you healthy including a yearly wellness visit, tobacco use cessation counseling, and a range of no-cost screenings for cancer, diabetes, and other chronic diseases.

What This Means for You

As of January 1, 2011, many preventive services are covered under Medicare if you get them from a doctor or other health care provider who accepts assignment.

Annual Wellness Visits: If you are new to Medicare, your “Welcome to Medicare” preventive visit is now covered without cost sharing during your first 12 months of Part B coverage. This exam is a one-time review of your health as well as education and counseling about preventive services and other care. If you’ve had Part B for longer than 12 months, you can get a yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. Video: Learn More About Annual Wellness Visits.

Several preventive services that qualify are listed below:

  • Tobacco Use Cessation Counseling: This benefit is now considered a covered preventive service, whether or not you have been diagnosed with an illness caused or complicated by tobacco use.  While the counseling is a covered service, the co-insurance and deductible will apply if you have already been diagnosed with a tobacco related illness.
  • Screenings: No more Medicare Part B deductible or copayment for these screenings if certain coverage criteria apply:
    • Bone mass measurement
    • Cervical cancer screening, including Pap smear tests and pelvic exams
    • Cholesterol and other cardiovascular screenings
    • Colorectal cancer screening (except for barium enemas)
    • Diabetes screening
    • Flu shot, pneumonia shot, and the hepatitis B shot
    • HIV screening for people at increased risk or who ask for the test
    • Mammograms
    • Medical nutrition therapy to help people manage diabetes or kidney disease
    • Prostate cancer screening (except digital rectal examinations)
    • See the full list of preventive services at Medicare.gov

Some Important Details

  • For some preventive services, you will pay nothing. You may have to pay co-insurance (a part of the cost) for the office visit when you get these services.
  • Your first yearly wellness visit can’t take place within 12 months of your “Welcome to Medicare” preventive visit.
  • If you’re in a Medicare Advantage Plan, check with your plan to see if these benefits will also be free for you.
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