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Does Medicare Cover Preventive Health Care? – Frequently Asked Questions

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Medicare Part B’s benefits include many preventive health-care services. To name just a few, these may include:

  • Flu shots
  • Colorectal cancer screenings
  • Diabetes screenings
  • Pneumococcal (pneumonia) shots

Part B is the medical insurance arm of Original Medicare, which also includes Part A (hospital insurance).

According to the Centers for Medicare & Medicaid Services, preventive health care is important to help avoid illness or manage a health problem before it becomes severe.

“Welcome to Medicare” preventive visit

Medicare begins your preventive health-care benefits when you’re first enrolled in Part B: you get a “Welcome to Medicare” preventive visit. Medicare Part B typically covers this visit once during the first 12 months you’re enrolled. This visit may include certain measurements and screenings, such as:

  • Blood pressure
  • Height and weight
  • Basic vision test
  • Certain vaccinations and screenings
  • A health-care plan from your doctor that lists the services you need, such as a colorectal cancer screening, mammogram or prostate test, and shots

Preventive health care: wellness visits

After your first year as a beneficiary, Medicare Part B also covers a wellness visit every year. Your doctor will review your health history, current health status, and create a personalized prevention plan that lists the screenings and other preventive health care you need.

Other Part B preventive health-care services

Part B generally also covers the following preventive health-care services when provided by a doctor that accepts Medicare assignment:

  • Screening for depression
  • Colonoscopy (or other colorectal cancer screening): there are several types of tests, and Part B may cover them at certain intervals depending on the type of test, your age, and your health history.
  • Bone density screening for people at risk for osteoporosis and meet certain conditions
  • Diabetes screenings for people at risk for diabetes (or diagnosed with pre-diabetes)
  • Obesity screening (to tell if you’re overweight) for anyone with a body mass index of 30 or higher

This is not a complete list – Part B generally covers a wide range of preventive health-care services. You might have to make a copayment or coinsurance payment, and the Part B deductible may apply.

Preventive health-care vaccinations

Medicare Part B may cover certain shots to help prevent diseases:

  • Flu shot (usually one shot per flu season)
  • Pneumococcal (pneumonia) shots
  • Hepatitis B shots for those at medium to high risk of the disease

You generally don’t have to pay for these shots, as long as the health-care provider who gives them to you accepts Medicare assignment.

Medicare Part D is optional prescription drug coverage. It’s available either through a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. If you have either type of Medicare Prescription Drug Plan, it may cover certain preventive vaccinations, such as

  • TDAP booster shot – to prevent tetanus, diphtheria, and pertussis (whooping cough)
  • Shingles shot – to prevent shingles, which is a painful skin rash, according to the Centers for Disease Control

Ask your Medicare Prescription Drug Plan for details about coverage.

Do you have questions about Medicare plan options and their coverage of preventive health-care services? You can ask me.

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