Medicare Covered Preventive Screenings

We get a lot of questions about what Medicare does and does not cover in the realm of preventive services.  So, we've decided to provide a list of the current services that Medicare covers.  Unless otherwise noted in the list, these services are covered 100% by Original Medicare (Part A & Part B).

• Abdominal Aortic Aneurysm Screenings: A one-time screening ultrasound for people at risk.
• Alcohol Misuse Counseling: Medicare covers one alcohol misuse screening per year. Counseling may be covered if your screening result is positive.
• Bone Mass Measurements: Helps to see if you are at risk for broken bones. This service is covered once every 24 months (more often if medically necessary) for people who have certain medical conditions or meet certain criteria.
• Cardiovascular Screenings: Helps detect conditions that may lead to a heart attack or stroke. This service is covered every 5 years to test your cholesterol, lipid, and triglyceride levels.
• Colon Cancer Screenings (Colorectal): 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.
  • You pay 20% of the Medicare-approved amount for barium enemas.  The Part B deductible does not apply.  If done in a hospital facility, you will also have to pay the hospital copay.
• Depression Screenings: Medicare covers depression screenings by your primary care doctor once every 12 months.
• Diabetes Screenings: Diabetes screenings are covered if you have any of the following risk factors: high blood pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar (glucose). Based on the results of these tests, you may be eligible for up to two diabetes screenings every year. 
  • You pay 20% of the Medicare-approved amount after the yearly Part B deductible for any glucose monitors, test strips, and lancets.
  • Insulin and syringes are covered under Part D.
• Diabetes Self-Management Training: Your doctor or other health care provider must provide a written order. 
  • You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
• EKG Screenings: Medicare covers a one-time screening EKG if you get a referral for it as a result of your one-time "Welcome to Medicare" Preventive Visit.
• Flu Shots: Covered once a flu season in the fall or winter.
• Glaucoma Tests: Covered once every 12 months for people at high risk for glaucoma. 
  • You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
• Hepatitis B Shots: This is covered for people at high or medium risk for Hepatitis B. Your risk for Hepatitis B increases if you have hemophilia,End-Stage Renal Disease (ESRD), or a condition that increases your risk for infection. Other factors may increase your risk for Hepatitis B, so check with your doctor. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
• HIV Screenings: Medicare covers HIV screening for people with Medicare who are pregnant and people at increased risk for the infection, including anyone who asks for the test. 
  • You pay nothing for the tests, but you generally have to pay 20% of the Medicare-approved amount for the doctor visit.
• Mammograms: Medicare covers screening mammograms once every 12 months for all women with Medicare age 40 and older. Medicare covers one baseline mammogram for women between ages 35–39.
• Medical Nutrition Therapy Services: Medicare may cover medical nutrition therapy and certain related services if you have diabetes or kidney disease, or you have had a kidney transplant in the last 36 months, and your doctor refers you for the service.
• Obesity Screening and Counseling: If you have a body mass index of 30 or more, Medicare covers intensive counseling to help you lose weight. This counseling may be covered if you get it in a primary care setting, where it can be coordinated with your comprehensive prevention plan. Talk to your primary care physician or practitioner to find out more.
• Pap Tests and Pelvic Exams: 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.
• Preventive Visits: Medicare will cover two types of preventive visits—one when you’re new to Medicare and one each year after that. 
  • You pay nothing for the yearly “wellness” visit if the doctor or other health care provider accepts assignment. If you get additional tests or services during the same visit that aren’t covered under these preventive benefits, you may have to pay coinsurance, and the Part B deductible may apply.
• Pneumococcal Shots: Most people only need this preventive shot once in their lifetime.
• Prostate Cancer Screenings: Medicare covers a digital rectal exam and Prostate Specific Antigen (PSA) test once every 12 months for all men with Medicare over age 50. 
  • Generally, you pay 20% of the Medicare-approved amount for the digital rectal exam after the yearly Part B deductible.
• Smoking Cessation (counseling to stop smoking): Medicare covers smoking cessation counseling as a preventive service and you'll pay nothing for the counseling sessions.

This information was provided by Medicare.  For more detailed information on these services, visit the Medicare Preventive Services page by clicking here.