Key Takeaways

• Medicare covers a wide range of preventive services, but not all are automatically provided. You often need to request them or meet certain eligibility criteria.

• Knowing which preventive services are available—and when to ask for them—can help you avoid unnecessary health issues and long-term costs.

What Preventive Care Really Means Under Medicare

Preventive care focuses on keeping you healthy before problems develop. Medicare recognizes the importance of early detection and routine monitoring by covering many preventive services. However, you might miss out on these benefits if you don’t know to ask.

These services are intended to catch health conditions early, when they’re easier and less expensive to treat. This includes everything from screenings and counseling to vaccinations and wellness visits.

Annual Wellness Visit: Your Medicare Check-In

Every 12 months, you’re entitled to a free Annual Wellness Visit. It’s not a physical exam, but a review of your health that includes:

• A health risk assessment

• Review of your medical and family history

• List of current providers and prescriptions

• Personalized prevention plan

Your doctor will use this visit to create or update a roadmap for your care. But it’s up to you to schedule it. Medicare doesn’t automatically remind you.

Preventive Screenings You Should Know About

Medicare covers several screening services, many of which are fully covered if your provider accepts assignment. Some are based on age, gender, or risk factors, so you may need to meet specific requirements.

1. Cardiovascular Screenings

• Once every 5 years

• Includes blood tests to check cholesterol, lipid, and triglyceride levels

2. Diabetes Screenings

• Up to 2 times per year if you’re at risk

• Based on factors like high blood pressure, obesity, or a history of high blood sugar

3. Colorectal Cancer Screenings

Medicare covers several types:

• Fecal Occult Blood Test – once a year if you’re 50+

• Flexible Sigmoidoscopy – once every 4 years or 10 years after a colonoscopy

• Colonoscopy – every 10 years, or every 2 years if you’re high-risk

4. Breast Cancer Screening (Mammogram)

• One mammogram every 12 months for women age 40+

5. Cervical and Vaginal Cancer Screening

• Pap test and pelvic exam every 24 months

• Annually if you’re at high risk

6. Prostate Cancer Screening

• PSA test covered once a year for men age 50+

7. Lung Cancer Screening

• Annually with low-dose CT for those aged 50-77 who are current or former heavy smokers

Immunizations That Medicare Covers

Vaccinations are part of preventive care and can protect you from serious illnesses. Medicare covers several vaccines, including:

• Flu shot – once per flu season

• COVID-19 vaccines – as recommended

• Pneumococcal shot – one to two doses, depending on your risk and health status

• Hepatitis B vaccine – for high-risk individuals

Always ask your provider whether a particular shot is covered and whether you meet the criteria.

Behavioral and Mental Health Preventive Services

Mental and behavioral health are vital to overall wellness. Medicare includes certain services to support your emotional and psychological health:

• Depression Screening – once a year

• Alcohol Misuse Screening and Counseling – annually, and up to 4 counseling sessions if you’re identified as at-risk

• Smoking Cessation Counseling – up to 8 sessions per year

• Obesity Behavioral Therapy – if you have a BMI of 30 or higher

These services are designed to prevent conditions from worsening and help you adopt healthier behaviors.

Preventive Services for Bone Health

Medicare covers bone mass measurements to check for osteoporosis or determine your risk. This is usually covered once every 24 months, or more frequently if medically necessary.

You’re typically eligible if you:

• Are a woman whose doctor believes you’re estrogen-deficient

• Have X-ray evidence of vertebral fractures

• Are on steroid therapy

Talk to your provider about your risk and whether you qualify.

Screenings for Infectious Diseases

Preventing the spread of infections is a growing concern, especially for older adults. Medicare covers certain screenings, including:

• HIV Screening – once a year for those at increased risk

• Hepatitis C Screening – one-time for individuals born between 1945 and 1965, and more often if at risk

• STI Screenings and Counseling – annually for those at risk, including chlamydia, gonorrhea, syphilis, and Hepatitis B

Counseling Services You Should Request

In addition to screenings, Medicare includes counseling to promote healthier choices and lifestyle adjustments:

• Nutrition Therapy Services – for those with diabetes or kidney disease

• Cardiovascular Behavioral Therapy – to help manage blood pressure and improve diet

• HIV Prevention Counseling – for those at risk of infection

These services are generally covered when provided by qualified professionals who accept Medicare assignment.

When Preventive Services Aren’t Covered

Some preventive services are only covered under specific conditions. You may be responsible for costs if:

• The service is performed more frequently than Medicare allows

• The provider doesn’t accept Medicare assignment

• The service is part of a diagnostic workup instead of preventive care

Ask in advance if the service is preventive or diagnostic. Diagnostic services usually include cost-sharing.

How to Ensure You Receive Covered Preventive Services

Medicare doesn’t automatically enroll you for every preventive benefit. You have to be proactive. Here’s how:

• Schedule your Annual Wellness Visit each year

• Request specific screenings based on your age, health history, and risk factors

• Ask your provider whether a service is considered preventive under Medicare

• Use your Medicare Summary Notice (MSN) to check which services were billed and paid for

By planning ahead and speaking up, you can get access to services that help you stay healthy.

What You Can Expect to Pay

Most covered preventive services have no deductible or coinsurance if you meet the criteria and your provider accepts Medicare. However, any follow-up services deemed diagnostic may involve out-of-pocket costs.

Always verify ahead of time:

• If the provider accepts Medicare assignment

• If the service is preventive or diagnostic

• Whether you meet eligibility conditions

Staying Healthy Starts With Knowing What’s Available

Preventive care is one of the most valuable benefits under Medicare, but many people miss out simply because they’re unaware. By asking for the right services at the right time, you give yourself the best chance at avoiding more serious health conditions later.

To ensure you’re getting the care you need, reach out to a licensed agent listed on this website. They can walk you through your Medicare benefits and help you take full advantage of the preventive services you’re entitled to.