Abdominal aortic aneurysm screening

Medicare covers an abdominal aortic screening ultrasound once if you’re at  risk. You’re considered at risk if you have a family history of abdominal aortic aneurysms, or you’re a man 65-75 and have smoked at least 100 cigarettes in  your lifetime. You pay nothing for the test as long as the provider accepts assignment. 

Alcohol misuse screenings & counseling

Medicare covers an alcohol misuse screening once per year if you’re an adult (including pregnant women) who uses alcohol, but you don’t meet the medical criteria for alcohol dependency. If your primary care doctor or other primary care practitioner determines you’re misusing alcohol, you can get up to 4 brief face-to-face counseling sessions each year (if you’re competent and alert during counseling). You pay nothing for the test as long as the provider accepts assignment. 

Bone mass measurements (bone density)

Medicare covers this test once every 24 months (or more often if medically necessary) if you meet one of more of these conditions: 

• You’re a woman whose doctor determines you’re estrogen deficient and at risk for osteoporosis, based on your medical history and other findings.
• Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures.
• You’re taking prednisone or steroid-type drugs or are planning to begin this treatment.
• You’ve been diagnosed with primary hyperparathyroidism.
• You’re being monitored to see if your osteoporosis drug therapy is working.

You pay nothing for the test as long as the provider accepts assignment. 

Cardiovascular disease screenings

Medicare covers cardiovascular screening blood tests once every 5 years. You pay nothing for the test as long as the provider accepts assignment.

Cardiovascular disease (behavioral therapy)

Medicare covers a cardiovascular behavioral therapy visit one time each year with your primary care doctor or other qualified provider in a primary care setting (like a doctor’s office). You pay nothing for the test as long as the provider accepts assignment.

Cervical & vaginal cancer screening

Medicare covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the pelvic exam, Medicare also covers a clinical breast exam to check for breast cancer. Medicare covers these screening tests once every 24 months. If you’re at high risk for cervical or vaginal cancer, or if you’re of child-bearing age and had an abnormal Pap test in the past 36 months, Medicare covers these screening tests once every 12 months. You pay nothing for the lab Pap test, the lab HPV with Pap test, the Pap test specimen collection, and the pelvic and breast exams if your doctor or other qualified health care provider accepts assignment.

Part B also covers Human Papillomavirus (HPV) tests (as part of a Pap test) once every 5 years if you’re age 30-65 without HPV symptoms.

Colorectal cancer screenings

Multi-target stool DNA tests:

Medicare covers this at-home multi-target stool DNA lab test once every 3 years if you meet all of these conditions:

• You’re age 50-85.
• You show no symptoms of colorectal disease including, but not limited to one of these:
  • • • • Lower gastrointestinal pain o Blood in stool
        • Positive guaiac fecal occult blood test or fecal immunochemical test
• You’re at average risk for developing colorectal cancer, meaning:
• You have no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.
• You have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

You pay nothing for this test if your doctor or other qualified health care provider accepts assignment.

Screening barium enemas:

Medicare covers this test if you’re age 50 or older. When this test is used instead of a flexible sigmoidoscopy or colonoscopy, Medicare covers the test once every 48 months if you’re age 50 or older and once every 24 months if you’re at high risk for colorectal cancer. You pay 20% of the Medicare-approved amount for your doctor’s services. In a hospital outpatient setting, you also pay a copayment. The Part B deductible doesn’t apply.

Screening colonoscopies:

Medicare covers screening colonoscopies 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 the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy. There’s no minimum age requirement.

You pay nothing for this test if your doctor or other qualified health care provider accepts assignment. However, if a polyp or other tissue is found and removed during the colonoscopy, you may pay 20% of the Medicare-approved amount of your doctor’s services and a copayment in a hospital setting. The Part B deductible doesn’t apply.

Screening fecal occult blood tests:

Medicare covers screening fecal occult blood tests once every 12 months if you’re 50 or older, if you get a referral from your doctor, physician assistant, nurse practitioner or clinical nurse specialist. You pay nothing for this test if your doctor or other qualified health care provider accepts assignment.

Screening flexible sigmoidoscopies:

Medicare covers screening flexible sigmoidoscopies 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. You pay nothing if your doctor or other qualified health care provider accepts assignment.

If a screening flexible sigmoidoscopy results in the biopsy or removal of a lesion or growth during the same visit, Medicare considers the procedure diagnostic and you may have to pay coinsurance and/or a copayment, but the Part B deductible doesn’t apply.

Depression screenings

Medicare covers one depression screening per year. You pay nothing for this screening if your doctor accepts assignment.

Diabetes screenings

Medicare covers glucose laboratory test screenings (with or without a carbohydrate challenge) if your doctor determines you’re at risk for developing diabetes. You may be eligible for up to 2 screenings each year. Part B covers these lab tests if you have any of these risk factors:

• High blood pressure (hypertension)
• History of abnormal cholesterol and triglyceride levels (dyslipidemia)
• Obesity
• A history of high blood sugar (glucose)

You pay nothing for these tests if your doctor or other qualified health care provider accepts assignment.

Medicare also covers these screenings if 2 or more of these apply to you:

• You’re age 65 or older.
• You’re overweight.
• You have a family history of diabetes (parents or siblings).
• You have a history of gestational diabetes (diabetes during pregnancy) or delivery of a baby weighing more than 9 pounds.

You pay nothing for these tests if your doctor or other qualified health care provider accepts assignment.

Diabetes self-management training

Medicare covers outpatient diabetes self-management training (DSMT) if you’ve been diagnosed with diabetes.

Medicare may cover up to 10 hours of initial DSMT – 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.

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Flu shots

Medicare covers one flu shot per flu season. You pay nothing for a flu shot if your doctor or other qualified health care provider accepts assignment for giving the shot.

Glaucoma tests

Medicare covers glaucoma tests once every 12 months if you’re at high risk for the eye disease glaucoma. You’re at high risk if one or more of these applies to you:

• You have diabetes.
• You have a family history of glaucoma.
• You’re African American and age 50 or older.
• You’re Hispanic and age 65 or older.

You pay 20% of the Medicare-approved amount and the Part B deductible applies.

In a  hospital outpatient setting , you also pay a copayment .

Hepatitis B shots

Medicare covers these shots if you’re at medium or high risk for Hepatitis B. Your risk for Hepatitis B increases if one of these applies:

• You have hemophilia.
• You have End-Stage Renal Disease (ESRD) .
• You have diabetes.
• You live with someone who has Hepatitis B.
• You're a health care worker and have frequent contact with blood or bodily fluids.

Other factors may also increase your risk for Hepatitis B. Check with your doctor to see if you're at high or medium risk for Hepatitis B.

You pay nothing for the shot if your doctor or other qualified health care provider accepts assignment.

Hepatitis B Virus (HBV) infection screening

Medicare covers a Hepatitis B Virus (HBV) infection screening if your primary care provider orders it and you're at high risk or pregnant.

You pay nothing for the screening test if your doctor or other qualified health care provider accepts assignment.

Your primary care doctor must order the HBV infection screening.

Medicare covers these tests:

• Once a year if you’re at continued high risk and don’t get a Hepatitis B shot
• If you’re pregnant:
• At the first prenatal visit for each pregnancy
• At the time of delivery if you have new or continued risk factors.
• At the first prenatal visit for future pregnancies, even if you previously got the Hepatitis B shot or had negative HBV screening results.

Hepatitis C screening test

Medicare covers a screening test if your primary care doctor or other qualified health care provider orders one and you meet one or more of these conditions:

• You’re at high risk because you use or have used illicit injection drugs.
• You had a blood transfusion before 1992.
• You were born between 1945-1965.

You pay nothing for the screening test if your doctor or other qualified health care provider accepts assignment.

Medicare will only cover Hepatitis C screening tests if your primary care doctor or other primary care provider orders them.

HIV screening

Medicare covers an HIV (Human Immunodeficiency Virus) screening once per year if you meet one of these conditions:

• You’re age 15-65.
• You’re younger than 15 or older than 65 and are at an increased risk for HIV.

If you’re pregnant, you can get the screening up to 3 times during your pregnancy.

You pay nothing for the test if your doctor or other qualified health care provider accepts assignment.

Lung cancer screening

Medicare covers lung cancer screenings with Low Dose Computed Tomography (LDCT) once each year if you meet all of these conditions:

• You’re age 55-77.
• You don’t have signs or symptoms of lung cancer (asymptomatic).
• You’re either a current smoker or have quit smoking within the last 15 years.
• You have a tobacco smoking history of at least 30 “pack years” (an average of one pack (20 cigarettes) per day for 30 years).
• You get a written order from your doctor.

You pay nothing for this service if your doctor accepts assignment.

Before your first lung cancer screening, you’ll need to schedule a lung cancer screening counseling and shared decision-making visit with your doctor to discuss the benefits and risks of lung cancer screening. You and your doctor can decide whether lung cancer screening is right for you.

Mammograms (screening)

Medicare covers:

• One baseline mammogram if you’re a woman between ages 35-39.
• Screening mammograms once every 12 months if you’re a woman age 40 or older.
• Diagnostic mammograms more frequently than once a year, if medically necessary .
• Screening mammogram: You pay nothing for the screening test if your doctor or other qualified health care provider accepts assignment .
• Diagnostic mammogram: You pay 20% of the Medicare-approved amount , and the Part B deductible applies.

Nutrition therapy services

Medicare may cover medical nutrition therapy (MNT) services and certain related services if you have diabetes or kidney disease, or you’ve had a kidney transplant in the last 36 months.

You pay nothing for these preventive services because the Part B deductible and coinsurance don’t apply.

Obesity screenings & counseling

Medicare covers obesity screenings and behavioral counseling if you have a body mass index (BMI) of 30 or more. Medicare covers this counseling if your primary care doctor or other qualified provider gives the counseling in a primary care setting (like a doctor's office), where they can coordinate your personalized prevention plan with your other care.

You pay nothing for this service if your primary care doctor or other qualified primary care practitioner accepts assignment.

One-time “Welcome to Medicare” preventive visit

Medicare covers a “Welcome to Medicare” preventive visit once within the first 12 months you have Part B.

You pay nothing for the “Welcome to Medicare” preventive visit if your doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply.

However, you may have to pay coinsurance, and the Part B deductible may apply if:

• Your doctor or other health care provider performs additional tests or services during the same visit.
• The preventative benefits don't cover these additional tests or services.

Pneumococcal shots

Medicare covers 2 different pneumococcal shots. Part B covers the first shot at any time and a different, second shot if it’s given at least one year after the first shot.

You pay nothing for pneumococcal shots if your doctor or other qualified health care provider accepts assignment for giving the shots.

Prostate cancer screenings

Medicare covers digital rectal exams and prostate specific antigen (PSA) blood tests once every 12 months for men over 50 (starting the day after your 50th birthday).

• Digital rectal exam: You pay 20% of the Medicare-approved amount for a yearly digital rectal exam and for your doctor's services related to the exam. The Part B deductible applies. In a hospital outpatient setting , you pay a copayment .
• PSA test: You pay nothing for a yearly PSA blood test. If you get the test from a doctor that doesn’t accept assignment , you may have to pay an additional fee for the doctor’s services, but not for the test itself.

Sexually transmitted infections screening & counseling

Medicare covers sexually transmitted infection (STI) screenings for chlamydia, gonorrhea, syphilis, and/or Hepatitis B if you’re pregnant or at increased risk for an STI.

Medicare also covers up to 2 individual 20-30 minute, face-to-face, high-intensity behavioral counseling sessions if you’re a sexually active adolescent or adult at increased risk for STIs.

Medicare covers these tests once every 12 months or at certain times during pregnancy. Medicare covers behavioral counseling sessions once each year.

You pay nothing for STI screenings and counseling if your doctor accepts assignment.

Covid Shot

Medicare covers FDA-authorized COVID-19 vaccines. You pay nothing for the COVID-19 vaccine. You won’t pay a deductible or copayment, and your provider can’t charge you an administration fee to give you the shot.

Tobacco use cessation counseling

Medicare covers up to 8 visits of smoking and tobacco-use cessation counseling visits in a 12-month period smoking if you use tobacco.

You pay nothing for the counseling sessions if your doctor or other qualified health care provider accepts assignment.

Yearly “Wellness” visit

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit once every 12 months to develop or update a personalized prevention plan to help prevent disease and disability, based on your current health and risk factors. Your provider may also perform a cognitive impairment assessment.

You pay nothing for this visit if your doctor or other qualified health care provider accepts assignment.

The Part B deductible doesn’t apply.

However, you may have to pay coinsurance and the Part B deductible may apply if:

• Your doctor or other health care provider performs additional tests or services during the same visit.
• These additional tests or services aren't covered under the preventive benefits.

What is it?

The cognitive impairment assessment is performed to look for signs of Alzheimer's disease or dementia and check for depression and other mood disorders. Your provider may order other tests, if necessary, depending on your general health and medical history.

The personalized prevention plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include:

• A review of your medical and family history.
• Developing or updating a list of current providers and prescriptions.
• Height, weight, blood pressure, and other routine measurements.
• Detection of any cognitive impairment.
• Personalized health advice.
• A list of risk factors and treatment options for you.
• A screening schedule (like a checklist) for appropriate preventive services.