What preventive services does Medicare cover?

Preventive medicine helps people identify risk factors before a disease or illness comes to fruition. If you are a Medicare beneficiary, you have access to a range of different preventive services. These are the preventive services that are automatically covered under Original Medicare policies.

Screenings:

• Abdominal aortic aneurysm screening: Medicare will cover a one abdominal aortic aneurysm ultrasound if you are determined to be at risk. At-risk individuals will have a family history of abdominal aortic aneurysms. For men aged 65-75, having smoked a minimum of 100 cigarettes in your life will put you in the at-risk category. This service costs nothing for people that are covered under Original Medicare. 
• Alcohol misuse screening and counseling: If you are an adult who misuses alcohol but has not met the medical criteria for alcohol dependency, you qualify for this service. The screening and counseling program includes up to four brief face-to-face counseling sessions per year in a primary care setting. 
• Breast cancer screening (mammograms): This service is available every 12 months for women aged 40 and over. If you are age 35-39, you are eligible for one mammogram under your Medicare benefits. Medicare beneficiaries pay nothing for this service. 
• Cardiovascular disease (behavioral therapy): This service is available to every person with Medicare benefits once per year. Each therapy visit includes:
  • Screening for high blood pressure
  • Diet counseling
  • Information about when to use aspirin to offset cardiovascular issues
• Cardiovascular disease screening: If ordered by a doctor, this service is available at no cost to any person with Medicare benefits. The screen includes tests for: 
  • Cholesterol
  • Lipid
  • Triglyceride levels
• Cervical and vaginal cancer screening: This service is available at no cost to all women with Medicare. The screen includes:
  • Pap tests
  • Pelvic examinations
  • Clinical breast examination
• Colorectal cancer screening: This service is available at no cost for Medicare beneficiaries age 50 and older. The screen includes:
  • Fecal occult blood test screening
  • Flexible sigmoidoscopy screening
  • Colonoscopy screening
  • Barium enema screening
• Depression screening: All people with medicare coverage are eligible for a depression screening once per year. This screening is done in a primary care setting and will allow recipients to get follow-up treatment referrals. 
• Diabetes screening and self-management training: This service is available at no cost to all Medicare beneficiaries. The service includes:
  • Blood screening
  • Educational training for managing diabetes
• Human Immunodeficiency Virus (HIV) screening: HIV screening is available annually at no cost for anyone aged 15-65 who asks for the screening. If you are above or below this age range, and in an at-risk community, you are eligible for the screening. The screening is available three times during any individual pregnancy. 
• Lung cancer screening: Medicare offers an annual lung cancer screening using Low Dose Computed Tomography to meet the following criteria:
  • Patient is age 55-77
  • Patient is asymptomatic
  • Patient is a current smoker or smoker who quit with 15 years
  • Patient has a history of smoking a pack a day for 30 years
  • Patient has a written order from a doctor or qualified practitioner
• Obesity screening and counseling: Medicare will cover intensive behavioral therapy for any person with a body mass index of 30 or higher. This service includes behavioral therapy sessions targeted at helping patients lose weight. 
• Prostate cancer screening: All male beneficiaries aged 50 or over are eligible for a digital rectal examination and PSA test once every 12 months. 
• Sexually transmitted infection screenings and counseling: If referred by a primary care doctor or qualified practitioner, Medicare covers STI tests for people who are at an increased risk once every 12 months. Two face-to-face behavioral counseling sessions are offered each year as well. 
• Smoking and tobacco use cessation counseling: Any tobacco user can get counseling from a qualified doctor who will help them quit using tobacco. Medicare will cover up to 8 face-to-face visits during a 12 month period.

Other Preventive Services

• Bone mass measurements: This service is designed to help patients determine whether they are at risk for breaking bones due to osteoporosis. Medicare beneficiaries pay nothing for this service if they receive it once every 24 months. The measurements are covered for: 
  • Women who are deemed estrogen-deficient and at risk for osteoporosis
  • Anyone with vertebral abnormalities
  • Anyone receiving pr expecting to receive steroid treatments
  • Anyone with hyperparathyroidism
  • Anyone taking an osteoporosis drug
• Medical nutrition therapy: If you have diabetes, renal disease, or have had a kidney transplant within the last three years, you are eligible for 3 hours of one-on-one medical nutrition therapy for the first year you request it, and 2 hours for each year after that. With a doctor’s referral, it is possible to get additional treatment hours covered. 
• Shots (flu, pneumococcal, and Hepatitis B): Original Medicare covers the following shots:
  • Flu – once per flu season
  • Pneumococcal – Two shots, one 11 months after the first
  • Hepatitis B – Three shots for people who are at medium or high risk for the illness

The preventive services offered by Medicare can be life-saving. If you are looking for more information about how you can access Medicare benefits and these services, contact Fidelis Consultants.