You likely know that Medicare covers healthcare treatments, services and equipment to help those with a wide range of conditions. But what about those who are looking to prevent disease or illnesses in the first place?
Although sickness may sometimes be inevitable, living healthy and preventing it is a win-win for everyone.
This leads to a common question many people have which is, “Does Medicare cover preventive services?” In this article, we answer the question in clear, plain English.
Does Medicare Cover Preventive Services?
The short answer is yes; Medicare will cover the cost of preventive services. But not 100% of the time. And it also depends on the type of preventive care.
As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your preventive services. Below we look at what these are so you know what to expect.
Original Medicare Coverage of Preventive Services
Original Medicare (Medicare Part A and Part B) mostly provides coverage for a treatment or service if is is considered medically necessary.
Most of the time, coverage for most preventive services is provided by Medicare Part B. Original Medicare provides coverage for preventive exams such as Initial Preventive Physical Examination and Annual Wellness Visits.
Original Medicare provides coverage for Initial Preventive Physical Examination. Many also know it as the “Welcome to Medicare” physical.
Coverage for Initial Preventive Physical Examination is provided by Medicare Part B. This physical exam is a one-time test that a beneficiary must complete within 12 months of enrolling in Medicare Part B.
Some of the tests that the Initial Preventive Physical Examination includes consist of the following:
- medical history reviews
- preventive services education
- social health history reviews
Then, if your healthcare provider accepts the assignment, this type of physical exam is free.
Common Prevention Covered by Medicare
Another program that includes a physical exam that Original Medicare covers is Annual Wellness Visits. Medicare Part B provides coverage for Annual Wellness Visits.
If your healthcare provider accepts the assignment, the Yearly Wellness Visit is free.
However, if your healthcare provider includes additional services on the bill, you may pay some copayment or deductible. Here are the following medical professionals that can provide you with the service:
- Nurse practitioner
- Certified clinical nurse specialist
- Physician assistant
- Health educator
- Registered dietician
More Preventive Services Part B Covers
Coverage is provided every 12 months for Annual Wellness Visits. Common offerings in the Annual Wellness Visit consist of:
- Developing a personal prevention plan
- Completing a health risk assessment
- Updating your protection plan
The website Medicare.gov also states that Medicare Part B provides coverage for many services. Some of which include the following services:
- Alcohol misuse screenings & counseling
- Bone mass measurements (bone density)
- Cardiovascular disease screenings
- Cervical & vaginal cancer screening
- Colorectal cancer screenings
- Depression screenings
- Diabetes screenings
- Flu shots
- Glaucoma tests
- Nutrition therapy services
- Obesity screenings & counseling
- One-time “Welcome to Medicare” preventive visit
- Sexually transmitted infections screening & counseling
- Yearly “Wellness” visit
Part B may cover 100 percent of the costs of these preventive services if it is approved by the U.S. Preventive Services Task Force.
Medicare Advantage Coverage of Preventive Services
Next, Medicare Advantage plans (Medicare Part C) also provide coverage for preventive services. These plans must cover everything Original Medicare covers.
But they also offer additional benefits as well, including some preventive services. What additional services a plan covers and how much one of these plans cost will depend on the Advantage plan you have.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare Cover Eye Drops For Cataract Surgery?