Fri, Mar 3, 2017

Medicare-Covered Preventive & Screening Services

See what Medicare offers

1. Alcohol misuse screenings & counseling

Medicare Part B (Medical Insurance) covers this screening once per year.

2. Bone mass measurements (bone density)

Medicare Part B (Medical Insurance) covers this test once every 24 months (more often if medically necessary) for people who meet the criteria below. This test helps to see if you’re at risk for broken bones. Medicare only covers this test when it’s ordered by a doctor or other qualified provider.

3. Cardiovascular disease screenings

Medicare Part B (Medical Insurance) covers screening blood tests for cholesterol, lipid, and triglyceride levels every 5 years, when ordered by a doctor. These screening tests help detect conditions that may lead to a heart attack or stroke

4. Cardiovascular disease (behavioral therapy)

Medicare covers one visit per year with your primary care doctor in a primary care doctor’s office or primary care clinic to help you lower your risk for cardiovascular disease. During this visit, your doctor may discuss aspirin use (if appropriate), check your blood pressure, and give you tips to make sure you’re eating well.

5. Cervical & vaginal cancer screening

Medicare Part B (Medical Insurance) covers Pap tests and pelvic exams to check for cervical and vaginal cancer. As part of the exam, Part B also covers a clinical breast exam to check for breast cancer. Part B covers these screening tests:

Once every 24 months for all women

Once every 12 months if you’re at high risk for cervical or vaginal cancer, or if you’re of childbearing age and have had an abnormal Pap test in the past 36 months

6. Colorectal cancer screenings

Medicare Part B (Medical Insurance) covers several types of colorectal cancer screening tests to help find precancerous growths or find cancer early, when treatment is most effective. One or more of these tests may be covered:

Screening barium enema: When this test is used instead of a flexible sigmoidoscopy or colonoscopy, Medicare covers it once every 48 months if you’re 50 or over and once every 24 months if you’re at high risk for colorectal cancer.

Screening colonoscopy: Medicare covers this test once every 24 months if you’re at high risk for colorectal cancer. If you aren’t at high risk for colorectal cancer, Medicare covers this test once every 120 months, or 48 months after a previous flexible sigmoidoscopy.

Screening fecal occult blood test: Medicare covers this lab test once every 12 months if you’re 50 or older.

Multi-target stool DNA test: Medicare covers this at-home test once every 3 years for people who meet all of these conditions:

They’re between 50–85.

They show no signs or symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test.

They’re at average risk for developing colorectal cancer, meaning:

They have no personal history of adenomatous polyps, colorectal cancer, inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.

They have no family history of colorectal cancers or adenomatous polyps, familial adenomatous  polyposis, or hereditary nonpolyposis colorectal cancer.

Screening flexible sigmoidoscopy: Medicare covers this test once every 48 months for most people 50 or older. If you aren’t at high risk, Medicare covers this test 120 months after a previous screening colonoscopy.

7. Depression screenings

Medicare Part B (Medical Insurance) covers one depression screening per year.

8. Diabetes screenings

Medicare Part B (Medical Insurance) covers screenings to check for diabetes. You may be eligible for 2 diabetes screenings each year.

9. Diabetes self-management training

Medicare Part B (Medical Insurance) covers outpatient diabetes self-management training (DSMT) to teach you to cope with and manage your diabetes. It includes tips for eating healthy, being active, monitoring blood sugar, taking drugs, and reducing risks. Medicare may cover up to 10 hours of initial DSMT. This training may include 1 hour of individual training and 9 hours of group training. You may also qualify for up to 2 hours of follow-up training each year if it takes place in a calendar year after the year you got your initial training. 

10. Glaucoma tests

Medicare Part B (Medical Insurance) covers a glaucoma test once every 12 months for people at high risk for glaucoma. The screening must be done or supervised by an eye doctor who’s legally allowed to do this test in your state.

11. Hepatitis C screening test

Medicare covers one Hepatitis C screening test. Medicare also covers yearly repeat screening for certain people at high risk.

12. HIV screening

Medicare Part B (Medical Insurance) covers HIV (Human Immunodeficiency Virus) screenings. HIV is the virus that can lead to AIDS (Acquired Immunodeficiency Syndrome). Medicare covers this test once every 12 months for people who meet the guidelines below. Medicare also covers this screening up to 3 times during a pregnancy.

13. Lung cancer screening

Medicare Part B (Medical Insurance) covers a lung cancer screening with Low Dose Computed Tomography (LDCT) once per year.

14. Mammograms (screening)

Medicare Part B (Medical Insurance) covers a:

Screening mammogram once every 12 months (11 full months must have passed since 

  the last screening)

Diagnostic mammogram when medically necessary

15. Nutrition therapy services

Medicare Part B (Medical Insurance) covers medical nutrition therapy (MNT) services and certain related services. A Registered Dietician or nutrition professional who meets certain requirements can provide these services, which may include:

An initial nutrition and lifestyle assessment

One-on-one nutritional counseling

•  Follow-up visits to check on your progress in managing your diet

If you’re in a rural area, a Registered Dietician or other nutritional professional in a different location may be able to provide MNT to you through telehealth. 

If you get dialysis in a dialysis facility, Medicare covers MNT as part of your overall dialysis care.

16. Obesity screenings & counseling

Medicare covers behavioral counseling sessions to help you lose weight. This counseling may be covered if you get it in a primary care setting (like a doctor’s office). You need to get it in this setting so it can be coordinated with your other care and a personalized prevention plan. Talk to your primary care doctor or practitioner to find out more.

17. One-time “Welcome to Medicare” preventive visit

A “Welcome to Medicare” preventive visit: You can get this introductory visit only within the first 12 months you have Part B. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including these:

Certain screenings, shots, and referrals for other care, if needed

Height, weight, and blood pressure measurements

A calculation of your body mass index

A simple vision test

A review of your potential risk for depression and your level of safety

An offer to talk with you about creating advance directives.

A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.

18. Prostate cancer screenings

Medicare Part B (Medical Insurance) covers:

Digital rectal exam: Once every 12 months

Prostate specific antigen (PSA) test: Once every 12 months

19. Sexually transmitted infections screening & counseling

Medicare Part B (Medical Insurance) covers sexually transmitted infection (STI) screenings for chlamydia, gonorrhea, syphilis and/or Hepatitis B once every 12 months or at certain times during pregnancy.

Medicare also covers up to 2 individual 20 to 30 minute, face-to-face, high-intensity behavioral counseling sessions each year. These are covered for sexually active adolescents and adults at increased risk for STIs, if referred by a primary care physician or practitioner.

Who’s eligible?

People with Part B who are pregnant.

Certain people who are at increased risk for an STI when the tests are ordered by a primary care doctor or other primary care practitioner.

Sexually active adults who are at an increased risk for STIs are also eligible for behavioral counseling sessions.

20. Shots:

Flu shots - Medicare Part B (Medical Insurance) normally covers one flu shot per flu season.

Hepatitis B shots - Medicare Part B (Medical Insurance) covers Hepatitis B shots.

Pneumococcal shots -Medicare Part B (Medical Insurance) covers a pneumococcal shot to prevent    pneumococcal infections (like certain types of pneumonia). Part B also covers a different second shot one year later. Talk with your doctor or other health care provider to see if you need these shots.

21. Tobacco use cessation counseling

Medicare Part B (Medical Insurance) covers up to 8 face-to-face visits in a 12-month period. These visits must be provided by a qualified doctor or other Medicare-recognized practitioner.

22. Yearly “Wellness” visit

A “Welcome to Medicare” preventive visit: You can get this introductory visit only within the first 12 months you have Part B. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including these:

Certain screenings, shots, and referrals for other care, if needed

Height, weight, and blood pressure measurements

A calculation of your body mass index

A simple vision test

A review of your potential risk for depression and your level of safety

An offer to talk with you about creating advance directives.

A written plan letting you know which screenings, shots, and other preventive services you need.

        Get details about coverage for screenings, shots, and other preventive services. This visit is covered one time. You don’t need to have this visit to be covered for yearly “Wellness” visits.


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