How Does Medicare Cover Preventative Health Services?

February 28, 2024

Medicare provides you with the medical coverage you need at a set cost. But Medicare is not just about having medical care when you get sick; it’s also about providing you with care that helps you stay healthy.

As the medical insurance component of Medicare, Part B covers your typical healthcare services, including preventive care. This covers screenings, doctor exams, lab tests, and even therapy and counseling services that can help you better take care of your health.

Let’s look at some of the most common (and important) preventive care services covered by Medicare:

Wellness Visits

Getting an annual checkup is a crucial component of your preventive care. Your Medicare coverage helps you build a personalized prevention plan with your wellness visits in two ways.
First is your Initial Preventive Physical Exam (IPPE), also known as a Welcome to Medicare Preventive Visit. You’ll schedule this one-time visit within the first 12 months of enrolling in Medicare Part B to review your medical history, check your status of recommended preventative screenings, and then set any needed preventive care appointments.
After your Initial Preventive Physical Exam and your first full year of Medicare Part B coverage, you are eligible for your Annual Wellness Visit. These visits are 100% covered every 12 months and are your yearly opportunity to get a checkup with your doctor and review your overall health, risk factors, and personalized prevention plan.

Preventative Tests and Screenings

From your IPPE and Annual Wellness Exams, your doctor will determine which preventative tests and screenings you need and when. Your doctor’s recommendations will be based on criteria such as your health, gender, risk factors, and family history.

Below is a list of some of the most common preventive screenings recommended for those aged 65 and older—all covered by Medicare. You can see the complete list of preventive tests and screening services covered at Medicare.gov.

Cardiovascular screenings: Blood tests for cholesterol, lipid, and triglyceride levels are recommended and covered annually.

Breast cancer screening: Mammograms are recommended annually for women through age 75 to screen for breast cancer. After age 75, your doctor may recommend a different cadence based on risk factors.

Colorectal cancer screenings: The U.S. Preventive Services Task Force recommends adults aged 45 to 75 be screened for colorectal cancer every five years. Covered screening tests include colonoscopies, sigmoidoscopies, and fecal occult blood tests based on your risk factors and doctor’s recommendations.

Prostate cancer screenings: Men with an average risk for prostate cancer should start screenings at age 50 with digital rectal exams and prostate-specific antigen (PSA) blood tests. The frequency for screenings depends on the results: yearly for men whose PSA level is 2.5 ng/mL or higher, while men who have a PSA of less than 2.5 ng/mL may only need to be retested every two years, according to the American Cancer Society.

Lung cancer screenings: If you’re a smoker or have a history of smoking, you should be screened for lung cancer with a low-dose computed tomography (LDCT) scan. This screening is recommended yearly for those aged 50 to 80 who currently smoke or had a “20 pack-year history of smoking,” meaning you smoked one pack per day for a year or more.

Osteoporosis screening: Bone mass measurement and density imaging (called a DEXA scan) to detect and monitor osteoporosis is recommended for postmenopausal women, as well as men with certain risk factors, aged 50 and older. Medicare covers this test once every 24 months.

Diabetes screenings: If you’re at risk for developing diabetes, Medicare covers up to two screenings per year, based on your doctor’s recommendations. Documented risk factors include a family history of diabetes, obesity, high blood pressure, high blood sugar levels, and/or high cholesterol.

Infectious disease screenings: Based on your health history and risk factors, Medicare covers screenings for infectious diseases. These screenings include hepatitis C (recommended at least once for all adults aged 18 to 79), human immunodeficiency virus (HIV), and sexually transmitted infections (STI).

Shots and Vaccinations

Vaccines are one of the most effective ways to protect yourself from many preventable diseases. Vaccines and vaccine boosters can be especially important for older adults, as the immune system’s defenses weaken as you age, make you them more susceptible to disease and illness. That’s why Medicare covers all the vaccines recommended by the CDC for adults ages 65 and older. However, the different vaccines are covered under different “parts” of Medicare.

Medicare Part B covers the vaccines for COVID-19, influenza, and pneumonia, as well as hepatitis B based on health risk factors. All other vaccines “prescribed by a physician to prevent a patient’s illness” are covered by Medicare Part D under your prescription drug plan. This includes the CDC-recommended shingles vaccine, Tdap (tetanus, diphtheria, and whooping cough) or Td (tetanus and diphtheria) vaccines, as well as the vaccine for respiratory syncytial virus (RSV), suggested for adults aged 60 or older.

Counseling, Therapy and Mental Health Services

Preventative care that helps you stay healthy isn’t just about getting a shot or a screening. It’s taking care of your overall health by covering critical therapies, counseling, and mental health services.

Based on risk factors and doctor referral, Medicare covers counseling for alcohol abuse, smoking cessation, and STI prevention. Medicare also covers behavioral therapy sessions for obesity (counseling to help you lose weight by focusing on diet and exercise) and an annual cardiovascular behavioral therapy doctor’s visit focused on lowering your risk for cardiovascular disease.

Based on risk factors and the result of diabetes screening, Medicare provides a Medicare Diabetes Prevention Program, “a proven health behavior change program to help prevent type 2 diabetes.” The program covers six months of weekly group sessions and six months of follow-up sessions. Those diagnosed with diabetes can be eligible for Medicare’s diabetes self-management training (10 hours focused on maintaining your health as a diabetic) and medical nutrition therapy services with a registered dietitian.

To support your emotional and mental health, Medicare covers one depression screening per year with a primary care doctor that can provide follow-up treatments and/or referrals. Covered follow-up care can include psychiatric evaluation, individual or group therapy sessions (up to 20 outpatient therapy sessions covered per year), family counseling, and testing to ensure you’re getting the services you need and that your treatment is helping.

Medicare’s preventive services not only help you stay healthy by detecting health problems early, but they can also support and empower you to live your healthiest by preventing disease and health issues as you age. Ready to take charge of your healthcare? Connect with the Wandacare Team for expert guidance to navigate your Medicare journey.

Contact us to get started today!

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