When it comes to Medicare, naturally, you may have a lot of questions, particularly about the types of preventive services that are covered. Many people may get confused about what is covered and where their coverage falls short.
Essentially, Medicare does offer preventive services to help beneficiaries stay healthy, detect medical conditions early, and reduce the need for extensive treatments down the road, however, more extensive treatment will remain excluded or only partially covered. Here is a breakdown of preventive services covered by Medicare and those that aren’t.
Preventive Services Covered by Medicare
Medicare Part B covers many preventive services at no cost to beneficiaries, meaning you usually won’t pay a deductible or copayment if you use a Medicare-approved provider. Here are a few examples of the types of services that will be covered:
Annual Wellness Visit
Medicare offers an initial “Welcome to Medicare” visit within the first 12 months of enrollment, followed by annual wellness visits each year. These visits help develop or update a personalized prevention plan based on your health status and risks.
Screening Tests
Medicare covers a variety of screenings to detect conditions early. These include:
- Colorectal cancer screening (colonoscopy or fecal occult blood tests)
- Mammograms (once every 12 months for women over 40)
- Pap smears and pelvic exams (every two years, or annually for high-risk women)
- Cardiovascular disease screenings (every five years)
- Diabetes screenings (up to two times per year for at-risk individuals)
Vaccinations & Immunizations
Vaccinations covered by Medicare Part B include:
- Flu shot (once annually)
- Pneumococcal vaccine
- Hepatitis B vaccine (for those at medium to high risk)
- COVID-19 vaccines
Bone Density Tests
These tests will be covered every two years for individuals at risk of osteoporosis.
Tobacco Cessation Counseling
This type of counseling is available for those who use tobacco, including up to eight counseling sessions per year.
Depression Screening
These screenings will be covered annually during a primary care visit, with referrals for follow-up care if needed.
Education & Support
Medicare covers diabetes education, nutrition therapy, and other health education programs.
Services Not Covered by Medicare
While Medicare offers extensive coverage for preventive care, some services remain excluded or only partially covered which may result in out-of-pocket costs, such as:
Routine Dental, Vision & Hearing Care
Medicare does not cover routine dental checkups, eyeglasses, contact lenses, or hearing aids. However, some Medicare Advantage plans may offer these services, so it’s essential to review individual plan benefits.
Long-Term Care
Medicare does not cover custodial care in nursing homes or assisted living facilities unless it’s part of a short-term rehabilitation program following a hospital stay.
Cosmetic Procedures
Services that are not deemed medically necessary, such as cosmetic surgeries, are not covered.
Acupuncture & Chiropractic Care
Medicare covers only limited chiropractic services for spinal subluxations, and acupuncture is only covered for chronic low back pain.
How to Maximize Medicare Preventive Benefits
It’s important to know your coverage limits – make sure to confirm whether your preventive service is fully covered before scheduling it. Before your visit, you also need to ensure that they are a Medicare-approved provider. Preventive services will only be free if you visit a doctor or healthcare provider who accepts Medicare.If you need coverage for dental, vision, or hearing care, consider enrolling in a Medicare Advantage plan that offers additional benefits.
Medicare Aims to Encourage You to Prioritize Your Health & Well-Being
Preventive care plays a vital role in maintaining health and preventing serious conditions from developing. Medicare provides a broad range of preventive services to help beneficiaries manage their health proactively, but, gaps exist, particularly in areas like routine dental, vision, and hearing care. By staying informed and exploring options like Medicare Advantage, you can ensure you receive the care you need with minimal out-of-pocket expenses.
For more information on coverage details or if you require help choosing the best Medicare policy for you, contact a Medicare agent. Working with a Medicare agent such as those at Wise Insurance can be incredibly beneficial when it comes to navigating the complexities of Medicare coverage. They are knowledgeable and experienced in all aspects of Medicare, including understanding different plan options, coverage details, and enrollment procedures. Ultimately, they can provide you with peace of mind and assurance that your healthcare needs are properly addressed.
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
