How Medicare Covers Preventive Health Services
Medicare currently covers a wide array of free preventive and screening services to help you stay healthy, but not all services are completely covered.
You also need to be aware that the repeal of the Affordable Care Act (aka Obamacare) - which helps financially support Medicare - may very well cause these free preventive services to be eliminated in the future. But in the meantime, here's how it works.
Free Preventive ServicesCurrently, most of Medicare's preventive services are available to all Part B beneficiaries for free, with no copays or deductibles, as long as you meet basic eligibility standards. Mammograms; colonoscopies; shots against flu, pneumonia and hepatitis B; screenings for diabetes, depression, and heart conditions; and counseling to combat obesity, alcohol abuse and smoking are just some of Medicare's lengthy list of covered services. But to get these services for free, you need to go to a doctor who accepts Medicare "on assignment," which means he or she has agreed to accept the Medicare approved rate as full payment.
Also, the tests are free only if they're used at specified intervals. For example, prostate cancer PSA tests, once every 12 months for men over 50; or colonoscopy, once every 10 years or every two years if you're at high risk.
Medicare also offers a free "Welcome to Medicare" exam with your doctor in your first year, along with annual wellness visits thereafter. But don't confuse these with full physical examinations. These are prevention-focused visits that provide only an overview of your health and medical risk factors and serve as a baseline for future care.
For a complete list of services along with their eligibility requirements, visit Medicare.gov and click on the "What Medicare Covers" tab at the top of the page, followed by "Preventive & screening services."
Hidden CostsYou also need to know that while the previously listed Medicare services are completely free, you can be charged for certain diagnostic services or additional tests or procedures related to the preventive service. For example, if your doctor finds and removes a polyp during your preventive care colonoscopy screening, the removal of the polyp is considered diagnostic and you will likely be charged for it. Or, if during your annual wellness visit, your doctor needs to investigate or to treat a new or existing problem, you will probably be charged here too.
You may also have to pay a facility fee depending on where you receive the service. Certain hospitals, for example, will often charge separate facilities fees when you are receiving a preventive service. In addition, you can be charged for a doctor's visit if you meet with a physician before or after the service.
To eliminate billing surprises, talk to your doctor before any preventive service procedure to find out if you may be subject to a charge and what it would be.
Cost Sharing ServicesMedicare also offers several other preventive services that require some out-of-pocket cost sharing. With these tests, you'll have to pay 20% of the cost of the service after you've met your $183 Part B yearly deductible. The services that fall under this category include glaucoma screenings, diabetes self-management trainings, barium enemas to detect colon cancer and digital rectal exams to detect prostate cancer.
Medicare Advantage MembersIf you have a Medicare Advantage plan, your plans are also required to cover the same free preventive services as original Medicare as long as you see in-network providers. If you see providers that are not in your plan's network, charges will typically apply.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.