For Consumers

What preventive care services, such as shots and tests, are covered?

The following services are available to Medicare clients who meet the coverage criteria below. Be sure to read more about Medicare's preventive and screening services (www.medicare.gov) for details about what's covered.

No out-of-pocket costs

Preventive services

What's covered

Who's covered

Abdominal aortic aneurysm

Ultrasound

Medicare clients with certain risk factors for abdominal aortic aneurysm

You must get a referral for it as part of your one-time "Welcome to Medicare" preventive visit

Alcohol misuse screening and counseling

 

One alcohol misuse screening per year

Four face-to-face counseling sessions per year if primary care provider determines misuse of alcohol

Medicare clients (including pregnant women) who use alcohol, but don't meet the medical criteria for alcohol dependency

 

Bone-mass measurement

Bone-density measurement covered once every 24 months - more often if medially necessary

Medicare clients who have certain medical conditions or who meet certain criteria

Breast cancer screening (mammograms)

Screening mammograms to check for breast cancer once every 12 months

Screening for all women with Medicare who are age 40 and older

One baseline mammogram for women between ages 35-39

Cardiovascular disease (behavioral therapy)

One visit per year

All Medicare clients

Cardiovascular disease
screenings

One screening test every five years for:

  • Lipids
  • Cholesterol
  • Lipoprotein
  • Triglycerides

All Medicare clients without signs or symptoms of cardiovascular disease

Cervical and vaginal cancer screening

  • Pap tests and pelvic exams to screen for cervical and vaginal cancers
  • Clinical breast exam to check for breast cancer
  • Human Papilloma virus test (as part of Pap tests) once every five years

All women on Medicare once every 24 months

Once every 12 months for high-risk women or women of child-bearing age with an abnormal pap test within the past 36 months

Colorectal cancer screening

Fecal occult blood test

Flexible sigmoidoscopy

Screening colonoscopy

All Medicare clients age 50+

Depression screening

Annual depression screening (if medical provider accepts Medicare)

All Medicare clients

Diabetes screening

Fasting blood glucose test

Medicare clients at risk for diabetes

May qualify for up to 2 screenings per year

Flu shot

One flu shot per flu season

All Medicare clients

Hepatitis B shot

 

Scheduled shots - three shots required to complete protection - check doctor on when to have shots

 

Medicare clients at medium or high risk for Hepatitis B

Hepatitis C screening test

  • One screening test
  • Repeat screenings for people who are high risk
  • Primary care doctor/provider must order screening test

All Medicare clients age 50+

 

Human Immunodeficiency Virus (HIV) screening

  • HIV test once a year
  • HIV test up to three times during a pregnancy

Medicare clients and pregnant women at increased risk for HIV

Lung cancer screening

 

Once a year Low Dose Compute Tomography (LDCT)

Medicare clients must meet these conditions:

  • Age 55-77
  • Current smoker or quit within last 15 years
  • History of smoking an average of a pack a day for 30 years

Medical nutrition therapy

Three hours of one-on-one counseling services for the first year

Two hours each year after that

  • Medicare clients with diabetes or renal disease, or who've had a kidney transplant with the last 3 years
  • Doctor must prescribe services and renew referral yearly if continue treatment into next calendar year

Obesity screening

15-minute face-to-face individual weight loss behavioral therapy sessions

30-minute face-to-face group weight loss behavioral sessions

Medicare clients with a body mass index of 30 or higher

Pneumococcal shot

Once in a lifetime

May provide revaccinations based on risk

Medicare clients

Sexually transmitted infections (STI)

Screening and face-to-face counseling sessions

Medicare clients who are pregnant and for some clients who are at increased risk for an STI

Smoking and tobacco-use prevention cessation counseling

Eight face-to-face counseling visits per 12-month period

Medicare clients who are not diagnosed with illness/complication due to tobacco use

 

Possible out-of-pocket costs

You may have to pay a deductible or coinsurance for the following services:

Preventive services

What's covered

Who's covered

Colorectal cancer screening

  • Barium enema once every 48 months
  • Screening once every 24 months if you're high risk

All Medicare clients age 50+

Diabetes self-management training

Diabetes self-management training

 

Medicare clients with diabetes who have a written order from a medical provider

Glaucoma test

Glaucoma tests once every 12 months

Medicare clients at high risk for glaucoma:

  • Clients with diabetes, family history of glaucoma
  • African-Americans age 50+
  • Hispanic-Americans age 65+

Physical therapy/occupational therapy/speech language pathology services

  • Medically necessary outpatient physical and occupational therapy
  • Speech-language pathology services

All Medicare clients

 

Prostate cancer screening

Prostate Specific Antigen (PSA) test and digital rectal exam once every 12 months

All men with Medicare age 50+

Tobacco-use cessation counseling

 

Eight face-to-face visits in a 12-month period

 

Medicare clients who are diagnosed with illness/complication due to tobacco use, or take medicine that's affected by tobacco use

 

Doctor visits with no out-of-pocket costs

Service

What's covered

When it occurs

Who's covered

"Welcome to Medicare" visit

When you make your appointment, tell your doctor's office you want to schedule your "Welcome to Medicare" exam

Comprehensive doctor's visit (with referrals for other care if you need it)

One-time visit within the first 12 months after you join Medicare Part B

All Medicare clients whose Part B coverage started on or after 1/1/05

Yearly wellness visit

This visit is not a routine annual physical exam - Medicare does not cover routine physicals

Develop or update a prevention plan with your doctor, based on your current health and risk factors

Once a year

All Medicare clients once 12 months have passed after first receiving Part B; or

Within 12 months after client's "Welcome to Medicare" visit.