News & Events

Preventative Services Covered By Medicare


Elder Law Associates Newsletter dated July 25, 2018

Understanding what coverages are included in your Medicare plan can help you better understand your options and help you take advantage of preventative care health services that will help you lead a healthier life. Part B of Medicare is the portion that covers preventative care, whether you have Original Medicare or Advantage Medicare. Understanding the preventative services covered by Medicare is an important way to maintain and manage your health as well as avoid some health problems and save money on your health insurance costs by avoiding larger medical problems down the line. 

What Is Preventative Care?
Preventative care or preventative services involve health and medical services whose purpose is to prevent certain health conditions or diseases and help people live healthier lives through planning, early detection, management and medical guidance.
Preventative services may include things like:
  • shots
  • health screenings
  • lab exams
  • doctors visits
  • x-ray services or other preventative health services.
Health plans usually include some sort of preventative care in their policy because prevention of disease and medical conditions is an important part of maintaining health. Preventative services provide the opportunity to identify potential health risks before they become critical. Like many health plans, there are several preventative care services covered by Medicare. Medicare preventative care services vary depending on the type of Medicare plan you have. Preventive services are covered under Medicare Part B or a Medicare Advantage Plan. 
How to Check If Something Is Covered by Medicare Preventative Services
Below is a list of the Preventative care services covered by Original Medicare. If you are unsure if you will have fees or charges related to the preventative care coverages listed, you can also use this tool to check how Medicare covers different preventative care services. 
Original Medicare vs. Medicare Advantage Preventative Service Coverage
When you qualify for Medicare, you have the option to get it either through private insurance or the government. "Original" Medicare is the Medicare you get through the government. People also have the option to purchase Medicare through private insurance, this is known as Medicare Advantage and the preventative care options may be different. Both Medicare Original and Medicare Advantage Plans cover Part A and Part B. 
For example, Medicare through the government includes Medicare Part A and Part B. Medicare Part B is the portion of Medicare that relates to the preventative services. There is a monthly premium for part B in most cases. With Original Medicare, you have your choice of doctors and hospitals that accept Medicare. 
Medicare Advantage Plans are also known as Medicare Part C, includes Part A and B but often requires you to use a provider inside the private health plan providers network. Therefore you may see additional costs if you go outside your provider network, or if your specific plan has additional conditions, co-pays, deductibles or other conditions within their preventative care services guidelines. It is important to speak to your Medicare Advantage Plan insurance company to ask how their coverage varies from the basic preventative care provided by Original Medicare.
 You may have additional costs.

Wellness Visits Covered by Medicare Preventative Services:
During your first 12 months of being covered under Medicare Part B, you are eligible to a “Welcome to Medicare” preventive care visit. During this visit, you will have a review of your health as well as counseling on preventative services you may need. This first wellness visit provides you with an opportunity to find out about Medicare's preventative care services.
After your first 12 months on Medicare Plan B, you can have one "Annual Wellness Visit", this visit will help you keep up to date on your current health needs, and look at what screenings, shots, or preventative services you should have. 
Charges for Medicare Preventative Care Wellness Visits
Even though your wellness visit is covered by Medicare and you will not be charged for it, if there are additional tests ordered, or screenings that are not included by Medicare you may have charges to pay. You may also have to pay your Part B deductible or coinsurance in some circumstances.  
Screenings Covered by Medicare Preventative Services
Medicare covers a variety of different screenings to help you prevent disease and maintain your health, here is a list of some of the screenings normally covered:
  • Abdominal aortic aneurysm  
  • Alcohol misuse 
  • Cardiovascular disease  
  • Cervical & vaginal cancer  
  • Colorectal cancer  
  • Depression  
  • Diabetes  
  • Glaucoma tests
  • Hepatitis C  
  • HIV  
  • Lung cancer  
  • Mammograms  
  • Obesity  
  • Prostate cancer  
  • Sexually transmitted infections  
  • Shots Covered by Medicare Preventative Services
  • Flu Shots
  • Hepatitis B Shots
  • Pneumococcal Shots
Medicare Preventative Care and Counseling Coverage
Mental health care is an important part of staying healthy. Medicare may provide various types of counseling services under Part B if the professional accepts the Medicare assignment, including visits with certain types of professionals like: 
  • Psychiatrists and clinical psychologists
  • Clinical social workers
  • Clinical nurse specialists, nurse practitioners and physician assistants
  • Types of Counseling Covered by Medicare Preventative Services:
  • Tobacco use cessation counseling
  • Diabetes self-management training 
  • Nutrition therapy services
  • Alcohol counseling
  • Obesity counseling
  • Bone mass measurements (bone density)
  • Cardiovascular disease (behavioral therapy)
  • Sexually transmitted infections counseling
When Can You Be Charged for Medicare Preventative Care?
Although Original Medicare may cover a large list of preventative care services as listed above, you may be charged for services related to the preventative care. This can be confusing because when you think something is covered you would probably assume everything related to it is covered too. Unfortunately, this is wrong. Be careful when planning preventative care visits "covered by Medicare" and find out if there will be any charges for related services like: 
  • the doctors visit prior to the preventative services visit
  • facility fees for the preventative services, tests or screenings
  • diagnostic care received during a preventative care visit
Medicare Advantage Plans are run through private insurance, so each insurance company will be different. It is important to find out what your plan covers specifically to avoid surprise costs. 
Article Source: TheBalance