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Medicare preventive services, senior check-upNow is the time to get the most out of your Medicare. The best way to stay healthy is to live a healthy lifestyle.

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You can live a healthy lifestyle and prevent disease by exercising, eating well, keeping a healthy weight, and not smoking. Medicare can help.

Medicare pays for many preventive services to keep you healthy. Preventive services can find health problems early, when treatment works best, and can keep you from getting certain diseases or illnesses. Preventive services include exams, lab tests, and screenings. They also include shots, monitoring, and information to help you take care of your own health.


Medicare Covers the Following Preventive Services:

One time “Welcome To Medicare” Physical Exam
Cardiovascular Screening
Screening Mammograms
Cervical and Vaginal Cancer Screening
Colorectal Cancer Screening
Prostate Cancer Screening
Flu, Pneumococcal, and Hepatitis B shots
Diabetes Screening, Supplies, and Self-Management Training
Medical Nutrition Therapy
Glaucoma Tests
Smoking Cessation (Counselling to quit smoking)

One time "Welcome To Medicare" Physical Exam

Medicare covers a one-time preventive physical exam within the first 12 months that you have Part B. This exam is called the "Welcome to Medicare" physical exam. The exam includes a medical and social history review of your health, and education and counseling about preventive services, including certain screenings, shots, and referrals for other care if needed. The exam is a great way to get up-to-date on important screenings and shots and to talk with your doctor about your family history and how to stay healthy.

When you go to your "Welcome to Medicare" physical exam, bring the following items:

  • Your medical records, including immunization records (if you are seeing a new doctor). Call your old doctor to get copies of your medical records.
  • Your family health history- try to learn as much as you can about your family’s health history before your appointment. Any information you can give your doctor can help determine if you are at risk for certain diseases.
  • A list of prescription and over-the-counter drugs that you currently take, how often you take them, and why.

Who is covered? All people who have had Medicare Part B for 12 months or less.
How often is it covered? Only one time and you must have the exam within the first 12 months you have Part B, even if the effective date of your Part B enrollment began in 2008.
Your costs if you have Original Medicare- You pay 20% of the Medicare- approved amount, and no Part B deductible.

Cardiovascular Screening

Medicare covers cardiovascular screenings that check your cholesterol and other blood fat (lipid) levels. High levels of cholesterol can increase your risk for heart disease and stroke. These screenings will tell if you have high cholesterol. You might be able to make lifestyle changes (like changing your diet and increasing your activity level or exercising more often) to lower your cholesterol and stay healthy.

Who is covered? All people with Medicare.
What is covered? Tests for cholesterol, lipid, and triglyceride levels.
How often is it covered? Once every 5 years.
Your costs if you have Original Medicare– You pay nothing if your doctor or health care provider accepts assignment.

Screening Mammograms

Breast cancer is the most common non-skin cancer in women and the second leading cause of cancer death in women in the United States. Every woman is at risk, and this risk increases with age. Breast cancer can usually be successfully treated when found early. Medicare covers screening mammograms and digital technologies for screening mammograms to check for breast cancer before you or a doctor may be able to find it.

Who is covered? All women with Medicare age 40 and older can get a screening mammogram every 12 months. Medicare also covers one baseline mammogram for women with Medicare between ages 35 and 39.
How often is it covered? Once every 12 months.
Your costs if you have Original Medicare– You pay 20% of the Medicare-approved


Cervical and Vaginal Cancer Screening

Medicare covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer.

Who is covered? All women with Medicare.
How often is it covered? Medicare covers these screening tests once every 24 months, or once every 12 months for women at high risk, and for women of child-bearing age who have had an exam that indicated cancer or other abnormalities in the past 3 years.
Your costs if you have Original Medicare– You pay nothing for the Pap lab test. For Pap test collection and pelvic and breast exams, you pay 20% of the Medicare- approved amount with no Part B deductible.

Colorectal Cancer Screening

Colorectal cancer is usually found in people age 50 or older, and the risk of getting it increases with age. Medicare covers colorectal screening tests to help find pre-cancerous polyps (growths in the colon) so they can be removed before they turn into cancer. Treatment works best when colorectal cancer is found early.

Who is covered? All people with Medicare age 50 and older, except there is no minimum age for having a screening colonoscopy.
How often is it covered?

  • Fecal Occult Blood Test- Once every 12 months. You pay nothing for this test, but you usually have to pay 20% of the Medicare-approved amount for the doctor’s visit.
  • Flexible Sigmoidoscopy- Generally, once every 48 months, or for those not at high risk, 120 months after a previous screening colonoscopy.
  • Screening Colonoscopy- Once every 120 months (high risk every 24 months) or 48 months after a previous flexible sigmoidoscopy.
  • Barium Enema- Once every 48 months (high risk every 24 months) when used instead of sigmoidoscopy or colonoscopy.

Your costs if you have Original Medicare-You pay nothing for the fecal occult blood test. For all other tests, you pay 20% of the Medicare-approved amount with no Part B deductible. If the flexible sigmoidoscopy or colonoscopy is done in a hospital outpatient department or an ambulatory surgical center, you pay 25% of the Medicare-approved amount.

Prostate Cancer Screening

Prostate cancer can often be found early by testing the amount of PSA (Prostate Specific Antigen) in your blood. Another way prostate cancer is found early is when your doctor performs a rectal exam. Medicare covers both of these tests so that prostate cancer can be detected and treated early.

Who is covered?
All men with Medicare over age 50 (coverage for this test begins the day after your 50th birthday).
How often are they covered?

  • Digital Rectal Examination- Once every 12 months.
  • PSA Test-Once every 12 months.

Your costs if you have Original Medicare– Generally, you pay 20% of the Medicare-approved amount for the digital rectal exam after the yearly Part B deductible. There is no coinsurance and no Part B deductible for the PSA Test.

Flu, Pneumococcal, and Hepatitis B shots

Medicare covers flu, pneumococcal, and Hepatitis B shots. Flu, pneumococcal infections, and Hepatitis B can be life threatening to an older person. All people age 65 and older should get flu and pneumococcal shots. People with Medicare who are under age 65 but have chronic illness, including heart disease, lung disease, diabetes, or End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) should get a flu shot. People at medium to high risk for Hepatitis B should get Hepatitis B shots.

Flu Shot

Who is covered? All people with Medicare.
How often is it covered? Once a flu season in the fall or winter.
Your costs if you have Original Medicare– You pay nothing if your doctor or health care provider accepts assignment.

Pneumococcal Shot

Who is covered? All people with Medicare.
How often is it covered? Most people only need this shot once in their lifetime.
Your costs if you have Original Medicare– You pay nothing if your doctor or health care provider accepts assignment.

Hepatitis B Shots

Who is covered? People with Medicare whose doctor says they are at medium to high risk for Hepatitis B.
How often is it covered? Three shots are needed for complete protection. Check with your doctor about when to get these shots if you qualify to get them.
Your costs if you have Original Medicare– You pay 20% of the Medicare- approved amount after the yearly Part B deductible.

Bone Mass Measurements

Medicare covers bone mass measurements to see if are at risk for broken bones. People are at risk for broken bones because of osteoporosis. Osteoporosis is a disease in which your bones become weak. In general, the lower your bone density, the higher your risk is for a fracture. Bone mass measurement test results will help you and your doctor choose the best way to keep your bones strong.

Who is covered?
All people with Medicare whose doctors say they are at risk for osteoporosis.
How often is it covered? Once every 24 months (more often if medically necessary).
Your costs if you have Original Medicare– You pay 20% of the Medicare- approved amount after the yearly Part B deductible.

Diabetes Screening, Supplies, and Self-Management Training

Diabetes is a medical condition in which your body doesn’t make enough insulin, or has a reduced response to insulin. Diabetes causes your blood sugar to be too high because insulin is needed to use sugar properly. A high blood sugar level isn’t good for your health. For people with Medicare at risk for getting diabetes, Medicare covers a blood screening test to check for diabetes. For people with diabetes, Medicare covers certain supplies and educational training to help manage their diabetes.

Diabetes Screening (Fasting Blood Glucose Test)

Who is covered? People with Medicare whose doctor says they are at risk for diabetes.
How often is it covered? Based on the results of your screening tests, you may be eligible for up to two diabetes screenings per year.
Your costs if you have Original Medicare- You pay nothing if your doctor or health care provider accepts assignment.

Diabetes glucose monitors, test strips, and lancets

Who is covered? All people with Medicare who have diabetes.
Your costs if you have Original Medicare- You pay 20% of the Medicare-
approved amount after the yearly Part B deductible.

Diabetes Self-Management Training

Who is covered?
This training is for people with diabetes. Your doctor must provide a written training order.
Your costs if you have Original Medicare- You pay 20% of the Medicare- approved amount after the yearly Part B deductible.

Medical Nutrition Therapy

Medicare may cover medical nutrition therapy if you have diabetes or kidney disease, and your doctor refers you for this service. These services can be given by a registered dietitian or Medicare-approved nutrition professional and include a nutritional assessment and counseling to help you manage your diabetes or kidney disease.

Who is covered? People who have diabetes or renal disease (people who have kidney disease but aren’t on dialysis or haven’t had a kidney transplant, or for people who have kidney disease [but aren’t on dialysis]) with a doctor’s referral up to 3 years after a kidney transplant.
How often is it covered? Medicare covers 3 hours of one-on-one counseling services the first year, and 2 hours each year after that. If your condition, treatment, or diagnosis changes, you may be able to get more hours of treatment with a doctor’s referral. A doctor must prescribe these services and renew your referral yearly if continuing treatment is needed into another calendar year.
Your costs if you have Original Medicare– You pay 20% of the Medicare- approved amount for services after the yearly Part B deductible.


Glaucoma Tests

Glaucoma is an eye disease caused by high pressure in the eye. It can develop gradually without warning and often without symptoms. The best way for people at high risk for glaucoma to protect themselves is to have regular eye exams.

Who is covered? People with Medicare whose doctor says they are at high risk for glaucoma.
How often is it covered? Once every 12 months.
Your costs if you have Original Medicare– You pay 20% of the Medicare-approved amount after the yearly Part B deductible.

Smoking Cessation (Counselling to quit smoking)

The U.S. Surgeon General has reported that quitting smoking leads to significant risk reduction for certain diseases and other health benefits, even in older adults who have smoked for years.

People with Medicare who are diagnosed with a smoking-related disease, including heart disease, cerebrovascular disease (stroke), multiple cancers, lung disease, weak bones, blood clots, and cataracts can get coverage for smoking and tobacco use cessation counseling. These diseases account for the bulk of Medicare spending today. People with Medicare who take any of the many medications whose effectiveness is complicated by tobacco use including insulin and some medicines for high blood pressure, blood clots, and depression are also eligible for the counseling.

Who is covered? People with Medicare who are diagnosed with a smoking- related illness or are taking medicine that may be affected by tobacco.
How often is it covered? Medicare will cover up to 8 face-to-face visits during a 12-month period. These visits must be ordered by your doctor and provided by a qualified doctor or other Medicare-recognized practitioner.
Your costs if you have Original Medicare- You pay 20% of the Medicare- approved amount after you meet the yearly Part B deductible.

In providing good care, your doctor or health care provider may do exams or tests that Medicare doesn’t cover. Your doctor or health care provider may also recommend that you have tests more or less often than Medicare covers them. In some cases, you may have to pay for these services. Talk to your doctor or health care provider to find out how often you need these exams to stay healthy.

If a service you get isn’t covered and you think it should be, you may appeal this decision. To file an appeal, follow the instructions on your Medicare Summary Notice (MSN). The MSN is an easy-to-read statement that clearly lists your health insurance claims information. For more information on filing an appeal, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov. TTY users should call 1-877-486-2048.

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SeniorCareHomes Admin

SeniorCareHomes Admin

Senior Advocate & Co-Founder at SeniorCareHomes.Com
Kate’s grandmother battled Alzheimer’s Disease and Kate personally understands what millions of families are going through. She not only is very passionate in making a difference in the lives of others, but also supporting organizations that are researching a cure for Alzheimer’s Disease.
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