Preventative Services

Preventative Services

Medicare pays for many preventive services to keep you healthy. Preventive services can find health problems early and can keep you from getting certain diseases. Preventive services include exams, shots, lab tests, and screenings. They also include programs for health monitoring, counseling, and education to help you take care of your own health.

The Affordable Care Act makes many improvements to Medicare. If you have Original Medicare, you can get a yearly “Wellness” visit and many other covered preventive services.

Below is a list of preventive services that are covered by Medicare Part B. The costs will depend on whether your benefits are through Original Medicare or through a Medicare Advantage Plan (like an HMO or PPO).

Note: This information was current and correct as of this writing. Changes may occur. Visit medicare.gov or call 1-800-Medicare to get the most current information.

  • Alcohol Misuse Screening & Counseling
    Who's covered?
    Adults with Medicare (including pregnant women) who use alcohol, but don't meet the medical criteria for alcohol dependency.

    How often is it covered?
    1 screening per year. Additional sessions available depending on situation.

    Your costs if you have Original Medicare
    Nothing, if qualified primary care doctor / practitioner accepts assignment.
  • Bone Mass Measurements
    Who's covered?
    Bone mass measurements are covered if medically necessary for certain people with Medicare whose doctors say they’re at risk for osteoporosis, and have one of these medical conditions:
    • A woman whose doctor or health care provider says she’s estrogen-deficient and at risk for osteoporosis, based on her medical history and other findings
    • A person with vertebral abnormalities as demonstrated by an X-ray
    • A person receiving steroid treatments
    • A person with hyperparathyroidism
    • A person taking an osteoporosis drug

    How often is it covered?
    Once every 24 months (more often if medically necessary).

    Your costs if you have original Medicare
    You pay nothing for this if your doctor accepts assignment.
  • Breast Cancer Screenings (Mammograms)
    Who's covered?
    Women 40 and older are eligible for a screening mammogram every 12 months. Medicare also covers one baseline mammogram for women between 35–39.

    How often is it covered
    Once every 12 months.

    Your costs if you have Original Medicare
    You pay nothing for the test if the doctor accepts assignment.

    Am I at high risk for breast cancer?
    Your risk of developing breast cancer increases if any of these are true:
    • You had breast cancer in the past.
    • You have a family history of breast cancer (like a mother, sister, daughter, or 2 or more close relatives who have had breast cancer).
    • You had your first baby after age 30.
    • You’ve never had a baby.
  • Cardiovascular Disease Screeening
    Who's covered?
    All people with Medicare.

    What's covered?
    A cardiovascular disease risk reduction visit that includes:
    • Encouraging aspirin use when benefits outweigh risks
    • Screening for high blood pressure
    • Counseling to promote a healthy diet


    How often is it covered
    Once each year.

    Your costs if you have Original Medicare
    You pay nothing if your doctor or health care provider accepts assignment.
  • Cervical and 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.

    Who's covered?
    All women with Medicare.

    How often is it covered
    Medicare covers these screening tests once every 24 months, or once every 12 months for women at high risk, and for women of child-bearing age who have had an exam that indicated cancer or other abnormalities in the past 3 years.

    Your costs if you have Original Medicare
    You pay nothing for Pap test. You pay nothing for the pelvic exam (including a clinical breast exam) if the doctor accepts assignment.

    Am I at high risk for cervical cancer?
    Your risk for cervical cancer increases if any of these are true:
    • You’ve had an abnormal Pap test.
    • You’ve had cervical or vaginal cancer in the past.
    • You have a history of sexually transmitted disease (including HIV infection).
    • You began having sex before age 16.
    • You’ve had 5 or more sexual partners.
    • Your mother took DES (Diethylstilbestrol), a hormonal drug, when she was pregnant with you.
  • Colorectal Cancer Screening
    Medicare covers colorectal cancer screening tests to help find pre-cancerous polyps (growths in the colon) so they can be removed before they become cancerous and to help find colorectal cancer at an early stage when treatment works best. Treatment works best when colorectal cancer is found early.

    Who's covered?
    All people with Medicare 50 and older, but there’s no minimum age for having a screening colonoscopy.

    How often is it covered
    • • Screening fecal occult blood test—Once every 12 months.
    • • Screening flexible sigmoidoscopy—Once every 48 months after the last flexible sigmoidoscopy or barium enema, or 120 months after a previous screening colonoscopy.
    • • Screening colonoscopy—Once every 120 months (high risk every 24 months) or 48 months after a previous flexible sigmoidoscopy.
    • • Screening barium enema—Once every 48 months (high risk every 24 months) when used instead of sigmoidoscopy or colonoscopy.

    Your costs if you have Original Medicare
    You pay nothing for the fecal occult blood test. You pay nothing for the flexible sigmoidoscopy or screening colonoscopy if your doctor accepts assignment.

    Note: If a polyp or other tissue is found and removed during the colonoscopy, you may have to pay 20% of the Medicare-approved amount for the doctor’s services and a copayment in a hospital outpatient setting.

    For barium enemas, you pay 20% of the Medicare-approved amount for the doctor’s services. The Part B deductible doesn’t apply. If it’s done in a hospital outpatient setting, you pay a copayment.

    Am I at high risk for colorectal cancer?
    Risk for colorectal cancer increases with age. It’s important to continue with screenings, even if you were screened before you had Medicare. Your risk for colorectal cancer increases if any of these are true:
    • You’ve had colorectal cancer before.
    • You have a close relative who had colorectal polyps or colorectal cancer.
    • You have a history of polyps.
    • You have inflammatory bowel disease (like ulcerative colitis or Crohn’s disease).
  • Despression Screening
    Who's covered?
    All people with Medicare.

    How often is it covered
    Medicare covers one depression screening per year. The screening must be done in a primary care setting (like a doctor’s office) that can provide followup treatment and referrals.

    Your costs if you have Original Medicare
    You pay nothing for this test if your doctor or other qualified health care provider accepts assignment.
  • Diabetes Screening & Self-Management Training
    Diabetes is a medical condition in which your body doesn’t make enough insulin, or has a reduced response to insulin. Diabetes causes your blood sugar to be too high because insulin is needed to use sugar properly. A high blood sugar level isn’t good for your health. Medicare covers a blood screening test to check for diabetes for people at risk. For people with diabetes, Medicare covers educational training to help manage their diabetes.

    Diabetes screening (Fasting blood glucose test)
    Who's covered?
    People who are at risk for diabetes.

    How often is it covered
    Based on the results of your screening tests, you may be eligible for up to 2 diabetes screenings per year.

    Your costs if you have Original Medicare
    You pay nothing for this screening.

    Are you at high risk for diabetes?
    You’re considered at high risk if you have high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar (glucose). Medicare also covers these tests if you answer “yes” to 2 or more of the following questions:
    • Are you 65 or older?
    • Are you overweight?
    • Do you have a family history of diabetes (parents, brothers, or sisters)?
    • Do you have a history of gestational diabetes (diabetes during pregnancy), or have you had a baby weighing more than 9 pounds?

    Diabetes self-management training
    Who's covered?
    This training is for people with diabetes to teach them to manage their condition and prevent complications. You must have a written order from a doctor or other health care provider.

    Your costs if you have Original Medicare
    You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
  • Glaucoma Tests
    Glaucoma is an eye disease caused by high pressure in the eye. It can develop gradually without warning and often without symptoms. The best way for people at high risk for glaucoma to protect themselves is to have regular eye exams.

    Who's covered?
    People with Medicare whose doctor says they’re at high risk for glaucoma.

    How often is it covered
    Once every 12 months.

    Your costs if you have Original Medicare
    You pay 20% of the Medicare-approved amount after the yearly Part B deductible.

    Am I at high risk for glaucoma?
    Your risk for glaucoma increases if any of these are true:
    • You have diabetes.
    • You have a family history of glaucoma.
    • You’re African-American and 50 or older.
    • You’re Hispanic and 65 or older.
  • HIV Screening
    Medicare covers voluntary HIV (Human Immunodeficiency Virus) screenings for people at increased risk for the infection, including anyone who asks for the test and pregnant women.

    How often is it covered
    Medicare covers this test once every 12 months, or up to 3 times during a pregnancy.

    Your costs if you have Original Medicare
    You pay nothing for this test.
  • Medical Nutrition Therapy
    Medicare may cover medical nutrition therapy if you have diabetes or kidney disease, and your doctor refers you for this service. These services can be given by a registered dietitian or Medicare-approved nutrition professional, and include a nutritional assessment and counseling to help you manage your diabetes or kidney disease.

    Who's covered?
    Certain people who have any of these:
    • Diabetes
    • Renal disease (people who have kidney disease, but aren’t on dialysis)
    • Have had a kidney transplant within the last 3 years
    Your doctor needs to refer you for this service.

    How often is it covered
    Medicare covers 3 hours of one-on-one counseling services the first year, and 2 hours each year after that. If your condition, treatment, or diagnosis changes, you may be able to get more hours of treatment with a doctor’s referral. A doctor must prescribe these services and renew your referral yearly if continuing treatment is needed into another calendar year.

    Your costs if you have Original Medicare
    You pay nothing for these services if the doctor accepts assignment.

    For more information about diabetes and medical nutrition therapy
    Visit www.medicare.gov/publications to view the booklet “Medicare Coverage of Diabetes Supplies & Services.” You can also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • Obesity Screening & counseling
    Medicare covers intensive behavioral therapy for people with obesity, defined as a body mass index of 30 or more.

    Who's covered?
    All people with Medicare may be screened for obesity. Counseling is covered for anyone found to have a body mass index of 30 or more.

    How often is it covered
    This counseling may be covered if you get it in a primary care setting (like a doctor’s office). Talk to your primary care doctor or primary care practitioner to find out more.

    People with a body mass index of 30 or more are eligible for:
    • One face-to-face visit each week for the first month
    • One face-to-face visit every other week for months 2–6
    • One face-to-face visit every month for months 7–12, if you lose 6.6 pounds during months 1–6

    Your costs if you have Original Medicare
    You pay nothing for this service if your primary care doctor or other qualified primary care practitioner accepts assignment.
  • Prostate Cancer Screening
    Prostate cancer may be found by testing the amount of PSA (Prostate Specific Antigen) in your blood. Another way prostate cancer may be found is when your doctor performs a digital rectal exam. Medicare covers both of these tests.

    Who's covered?
    All men with Medicare over 50 (coverage for this test begins the day after your 50th birthday).

    How often is it covered
    • Digital rectal examination—Once every 12 months.
    • PSA test—Once every 12 months.

    Your costs if you have Original Medicare Generally, you pay 20% of the Medicare-approved amount for the digital rectal exam after the yearly Part B deductible. There’s no coinsurance and no Part B deductible for the PSA test.

    Am I at high risk for prostate cancer?
    Talk to your doctor or practitioner about whether you’re at risk for prostate cancer.
  • Sexually Transmitted Infections Screening & Counseling
    Medicare covers sexually transmitted infection (STI) screenings for chlamydia, gonorrhea, syphilis, and/or Hepatitis B.

    Who's covered?
    People with Medicare who are pregnant and/or 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.

    How often is it covered
    Medicare covers these tests 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 for sexually active adults at increased risk for STIs. Medicare will only cover these counseling sessions if they’re provided by a primary care doctor or other primary care practitioner and take place in a primary care setting (like a doctor’s office). Counseling conducted in an inpatient setting, like a skilled nursing facility, won’t be covered as a preventive service.

    Your costs if you have Original Medicare
    You pay nothing for these services if your primary care doctor or other qualified primary care practitioner accepts assignment.
  • Shots (Flu, Pneumococcal, Hepititis B)
    Medicare covers flu, pneumococcal, and Hepatitis B shots. Flu, pneumococcal infections, and Hepatitis B can be life threatening to an older person. All people 65 and older should get flu and pneumococcal shots. People with Medicare who are under 65 but have chronic illness, including heart disease, lung disease, diabetes, or End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) should get a flu shot. People at medium to high risk for Hepatitis B should get Hepatitis B shots.

    Flu shot
    Who's covered?
    All people with Medicare.

    How often is it covered
    Once a flu season.

    Your costs if you have Original Medicare
    You pay nothing if your doctor or health care provider accepts assignment for giving the shot.

    Pneumococcal shot
    Who's covered?
    All people with Medicare.

    How often is it covered
    Most people only need this shot once in their lifetime.

    Your costs if you have Original Medicare
    You pay nothing if your doctor or health care provider accepts assignment for giving the shot.

    Hepatitis B shots
    Who's covered?
    Certain people with Medicare whose doctor says they’re at medium or high risk for Hepatitis B.

    How often is it covered
    Three shots are needed for complete protection. Check with your doctor about when to get these shots if you qualify to get them.

    Your costs if you have Original Medicare
    You pay nothing if your doctor or health care provider accepts assignment.

    Am I at medium or high risk for Hepatitis B?
    These are some of the factors that put you at medium or high risk for Hepatitis B:
    • Hemophilia
    • ESRD (End-Stage Renal Disease)
    • Diabetes
    • Certain other conditions that increase your risk for infection, like if you live with someone who has Hepatitis B, or if you’re a health care worker and have frequent contact with blood or body fluids.

    Other factors may increase your risk for Hepatitis B. Check with your doctor to see if you’re at medium or high risk for Hepatitis B.
  • Tobacco Use Cessation Counseling
    The U.S. Surgeon General has reported that quitting smoking and stopping tobacco use leads to significant risk reduction for certain diseases and other health benefits, even in older adults who have smoked for years. Any person who uses tobacco can get counseling from a qualified doctor or other Medicare-recognized practitioner who can help them stop using tobacco.

    Who's covered?
    Medicare covers these counseling sessions as a preventive service if you haven’t been diagnosed with an illness caused by tobacco use.

    How often is it covered
    Medicare will cover up to 8 face-to-face visits during a 12-month period. These visits must be provided by a qualified doctor or other Medicare-recognized practitioner.

    Your costs if you have Original Medicare
    You pay nothing for the counseling sessions.

    Ask your doctor about Medicare-covered tobacco cessation programs near you, or visit www.nih.gov for more information about stopping tobacco use.
  • Welcome to Medicare Preventive Visit
    This visit is only covered one time. You must have the visit within the first 12 months you’re enrolled in Part B..

    What happens during the visit?
    During the visit, your doctor will:
    • Record your medical and social history (like alcohol or tobacco use, your diet, and your activity level).
    • Check your height, weight, and blood pressure.
    • Calculate your body mass index.
    • Give you a simple vision test.
    • Review your potential risk for depression and your level of safety.
    • Offer to talk with you about creating advance directives. Advance directives are legal documents that allow you to put in writing what kind of health care you would want if you were too ill to speak for yourself.

    Depending on your general health and medical history, you’ll get advice, education, and counseling to help you prevent disease, improve your health, and stay well. You’ll also get a written plan (like a checklist) letting you know which screenings, shots, and other preventive services you need.

    People at risk for abdominal aortic aneurysms may get a referral for a one-time screening ultrasound at their “Welcome to Medicare” preventive visit. If you have a family history of abdominal aortic aneurysms, or you’re a man 65 to 75 and you have smoked at least 100 cigarettes in your lifetime, you’re considered at risk. You pay nothing for this screening ultrasound.

    What should I bring to the visit?
    When you go to your “Welcome to Medicare” preventive visit, bring these items:
    • Your medical records, including immunization records (if you’re seeing a new doctor). Call your old doctor to get copies of your medical records.
    • Your family health history—try to learn as much as you can about your family’s health history before your appointment. Any information you can give your doctor can help determine if you’re at risk for certain diseases.
    • A list of prescription and over-the-counter drugs that you currently take, how often you take them, and why.


    Who's covered and how often is it covered?
    This visit is only covered one time, and you must have the visit within the first 12 months you’re enrolled in Part B.

    Your costs if you have Original Medicare
    You pay nothing if your doctor accepts assignment.
  • Yearly Wellness Visit
    If you’ve had Part B for longer than 12 months, you can get a yearly “Wellness” visit to develop or update a personalized prevention plan based on your current health and risk factors. This includes:
    • Health risk assessment (Your doctor or health professional will ask you to answer some questions before or during your visit, which is called a health risk assessment. Your responses to the questions will help you and your health professional get the most from your yearly “Wellness” visit.)
    • Review of medical and family history.
    • Develop or update 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.

    How often is it covered?
    Once every 12 months.

    Your costs if you have Original Medicare
    You pay nothing for this visit if your doctor accepts assignment.

    You don’t need to have had a “Welcome to Medicare” preventive visit before getting a yearly “Wellness” visit. If you do get the “Welcome to Medicare” preventive visit during your first year with Part B, you’ll have to wait 12 months before you can get your first yearly “Wellness” visit.

Information contained above was taken from “Your Guide To Medicare’s Preventive Services” booklet produced by Centers For Medicare & Medicaid Services, the official government booklet regarding Medicare’s Preventive Services.