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Savvy Living
Does Medicare Cover Preventive Health Services?
Does Medicare cover preventive health screenings? I am scheduled for a physical and colonoscopy this year and want to determine the anticipated costs before my appointment.
Medicare covers a wide array of preventive and screening services to help individuals stay healthy, but not all services are completely covered. Here is what you should know.
Medicare's preventive services are available to beneficiaries through Part B completely free without copays or deductibles, as long basic eligibility standards are met. Some of Medicare's covered services include: mammograms, colonoscopies, certain vaccines and screenings for diabetes, depression, osteoporosis, various cancers and cardiovascular disease. Medicare also covers counseling to combat obesity, alcohol abuse and smoking. To obtain these services for free, however, see a doctor who accepts Medicare "on assignment," which means he or she has agreed to accept the Medicare approved rate as full payment.
Additionally, the tests are free only if they are used at specified intervals. For example, cardiovascular screening blood tests are covered once every five years and colonoscopies, once every ten years. If you are at high risk for colorectal cancer, more frequent intervals may be covered, such as screenings every two years.
Medicare also offers a free "Welcome to Medicare" exam with your doctor in your first year, along with annual "Wellness" visits thereafter. These visits should not be confused with full physical examinations as they are prevention-focused visits that provide only an overview of your health and medical risk factors to establish a baseline for future care.
There are a few Medicare preventive services that require some out-of-pocket cost sharing. With these tests, you will pay 20% of the cost of the service after you have met your $226 Part B yearly deductible. The services include glaucoma tests, diabetes self-management training and prostate cancer detection. For a complete list of services along with their eligibility requirements, visit Medicare.gov/coverage/preventive-screening-services.
If you are enrolled in a Medicare Advantage (Part C) plan, your plan is required to cover the same preventive services as original Medicare, but each plan's rules can vary and the availability of some services and supplies will depend on where you live.
While most of the previously listed Medicare services are free, you can be charged for certain diagnostic services or additional tests or procedures related to the preventive service. For example, if your doctor finds and removes a polyp during your preventive care colonoscopy screening, you will pay 15% of the doctor's service fee. You may also be charged if during your annual wellness visit, your doctor needs to investigate or treat a new or existing problem.
In some cases, you will be charged for a doctor's visit if you meet with them before or after receiving services. Moreover, the location where you obtain these services could also entail a facility fee. Certain hospitals, for example, will often charge separate facilities fees for preventive services. To eliminate any unforeseen billing fees, talk to your provider before any preventive service procedure to find out if you are subject to a charge and what it would be.
If you receive an unexpected medical bill, you can always call the billing department and see if there is a way to negotiate a payment plan that fits your budget. In some cases, providers and facilities may be willing to provide credits or reductions based on your income.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.
Medicare covers a wide array of preventive and screening services to help individuals stay healthy, but not all services are completely covered. Here is what you should know.
Free Preventive Benefits
Medicare's preventive services are available to beneficiaries through Part B completely free without copays or deductibles, as long basic eligibility standards are met. Some of Medicare's covered services include: mammograms, colonoscopies, certain vaccines and screenings for diabetes, depression, osteoporosis, various cancers and cardiovascular disease. Medicare also covers counseling to combat obesity, alcohol abuse and smoking. To obtain these services for free, however, see a doctor who accepts Medicare "on assignment," which means he or she has agreed to accept the Medicare approved rate as full payment.
Additionally, the tests are free only if they are used at specified intervals. For example, cardiovascular screening blood tests are covered once every five years and colonoscopies, once every ten years. If you are at high risk for colorectal cancer, more frequent intervals may be covered, such as screenings every two years.
Medicare also offers a free "Welcome to Medicare" exam with your doctor in your first year, along with annual "Wellness" visits thereafter. These visits should not be confused with full physical examinations as they are prevention-focused visits that provide only an overview of your health and medical risk factors to establish a baseline for future care.
Cost Sharing Services
There are a few Medicare preventive services that require some out-of-pocket cost sharing. With these tests, you will pay 20% of the cost of the service after you have met your $226 Part B yearly deductible. The services include glaucoma tests, diabetes self-management training and prostate cancer detection. For a complete list of services along with their eligibility requirements, visit Medicare.gov/coverage/preventive-screening-services.
If you are enrolled in a Medicare Advantage (Part C) plan, your plan is required to cover the same preventive services as original Medicare, but each plan's rules can vary and the availability of some services and supplies will depend on where you live.
Hidden Costs
While most of the previously listed Medicare services are free, you can be charged for certain diagnostic services or additional tests or procedures related to the preventive service. For example, if your doctor finds and removes a polyp during your preventive care colonoscopy screening, you will pay 15% of the doctor's service fee. You may also be charged if during your annual wellness visit, your doctor needs to investigate or treat a new or existing problem.
In some cases, you will be charged for a doctor's visit if you meet with them before or after receiving services. Moreover, the location where you obtain these services could also entail a facility fee. Certain hospitals, for example, will often charge separate facilities fees for preventive services. To eliminate any unforeseen billing fees, talk to your provider before any preventive service procedure to find out if you are subject to a charge and what it would be.
If you receive an unexpected medical bill, you can always call the billing department and see if there is a way to negotiate a payment plan that fits your budget. In some cases, providers and facilities may be willing to provide credits or reductions based on your income.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.
Published August 18, 2023
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