First, check out Medicare's Checklist to see if these services are right for you.  You can download it here.

They say that an ounce of prevention is worth a pound of cure. Did you know that Medicare covers certain potentially life-saving preventive benefits? If you are eligible, Medicare will cover all or part of the cost of:

• Initial physical exam
• Screening tests for heart disease
• Screening mammograms
• Pap smears and pelvic exams
• Bone mass measurement
• Colon cancer screening
• Prostate screening
• Diabetes testing
• Diabetes self-management training, foot care and supplies
• Flu shot
• Pneumonia vaccine
• Hepatitis B vaccine
• Glaucoma screening
• Medical Nutritional Therapy

For further information on these benefits, please scroll down this page. Remember that your doctor may not always know what Medicare covers, so it is important to ask your doctor if you want any of these services. As long as you meet basic eligibility standards, you have the right to receive these services no matter which Medicare health plan you are enrolled in. However, be sure to follow the Medicare guidelines for receiving these services in order to ensure that Medicare will cover them. If your Medicare plan refuses to give you or pay for this care but your doctor says you are entitled, you should appeal their decision.

 

Note: If you would like detailed information about specific rules and policies for any of these services, call the National Medicare Hotline at 1-800-MEDICARE (1-800-633-4227).

Medicare-Covered Preventive Services

Initial Physical Exam
Medicare does not cover routine physical exams. However, beginning in 2005, Medicare will cover 80% of the Medicare-approved amount (after meeting the Part B deductible) of a one-time routine physical examination during the first six months after you enroll in Medicare Part B regardless of your age. The initial preventive physical exam includes:

• An electrocardiogram (EKG)
• Measurement of height, weight and blood pressure
• Education, counseling and referral related to other preventive services covered by Medicare

Note: The “welcome to Medicare” physical exam benefit does not include payment for clinical laboratory tests.

Screening Tests for Heart Disease
Heart disease and stroke are the first and third leading causes of death in the US. Heart screening can save your life and improve your quality of life by treating the condition before it results in more severe health problems. Beginning in 2005, Medicare will cover blood tests every five years to screen for cholesterol, lipid and triglyceride levels, and other signs of cardiovascular disease (or indications that you are at high risk for it). Medicare will pay 100% of its approved amount for these tests. No Part B deductible is required for these services.

Screening Mammograms
Mammograms can detect abnormal tissue and breast cancer in its early stages. Medicare covers 80% of the cost of one screening mammogram a year (every 12 months) for women 40 years and older. Medicare will also pay for one baseline mammogram for women 35 to 39 years of age. No Part B deductible is required for these services.

Medicare also pays for diagnostic mammograms. A diagnostic mammogram may be recommended when a screening mammogram shows an abnormality or when a physical exam reveals a lump. Medicare covers as many diagnostic mammograms as necessary for women and as many screening mammograms as necessary for both men and women.

Pap Smear
Pap smears can detect cervical or vaginal cancer in its early stages. Medicare covers 100% of the cost of one pap smear lab test every 2 years (24 months) for all women with Medicare (it covers the usual 80% of the doctor visit to collect the Pap smear). If you are considered at high-risk for cervical or vaginal cancer (e.g. have had a sexually transmitted disease, your mother was given the drug diethylstilbestrol (DES) during pregnancy), or are of child-bearing age and have had an abnormal Pap test in the past 36 months, Medicare will cover the cost of one pap smear a year (every 12 months). When you get your Pap smear, Medicare will cover the full cost of your Pap lab test, 80 percent of the cost of the Pap test collection, a pelvic exam (used to help find fibroids or ovarian cancers) and a clinical breast exam. Medicare will cover all of these services with no Part B deductible required.

Bone Mass Measurement
Bone mass measurements indicate whether you need medical treatment for osteoporosis, a condition that causes "brittle bones" in many women. If you are considered at risk for osteoporosis (e.g. have a family history of the disease, have spinal abnormalities, have certain conditions, such as thyroid disorders, have taken certain medications for a prolonged period of time, such as steroid anti-inflammatories, or are taking an approved osteoporosis drug), Medicare will cover 80% of the cost of one bone mass measurement every two years (24 months), after you pay your annual Part B deductible. Medicare will also cover follow-up measurements if you doctor prescribes them.

Colon Cancer Screening
Colon cancer is the third most common form of cancer for men and women in the United States, and regular screenings can help prevent serious illness. In Medicare, you must be 50 or older to be eligible for coverage of most colon cancer screenings, except a colonoscopy, for which there is no minimum age requirement.

Medicare covers the following screenings:

• Fecal occult blood test - once a year (every 12 months)
• Flexible sigmoidoscopy - once every four years (48 months)
• Colonoscopy - once every two years (24 months) if you are at high-risk for colorectal cancer (e.g. have a family history of the disease or have had colorectal polyps or colorectal cancer, or have had inflammatory bowel disease), or once every 10 years if you are not at high-risk (but not within 48 months of a screening flexible sigmoidoscopy)
• Barium enema - this service is not covered if performed in addition to the other tests

Medicare will cover these services with no Part B deductible required. Medicare will cover 100% of the cost of the fecal blood test. For the other tests, Medicare will pay 80% of the cost. Medicare will cover 75% of the cost of a colonoscopy or flexible sigmoidoscopy if the procedure is done in an ambulatory surgical center or hospital outpatient department.

 

Prostate Cancer Screening
Prostate cancer screenings can detect early prostate cancer, the second most common form of cancer in American men. Medicare covers one prostate screening a year (every 12 months) for men age 50 and older. This includes a Prostate-Specific Antigen (PSA) blood test and a Digital Rectal Exam. Medicare will cover these services more than once a year if your doctor says you need them for diagnostic purposes. Medicare covers 80% of the cost of the Digital Rectal Exam (after you pay your annual Part B deductible), and 100% of the cost of the PSA test (with no Part B deductible required).

Diabetes Testing
Beginning in 2005, Medicare will cover a blood test to screen people at risk for the disease. The diabetes screening test includes a fasting plasma glucose test. You are eligible for a Medicare-covered diabetes screening every 12 months if you have:

• hypertension;
• dyslipidemia (a metabolism disorder);
• high cholesterol;
• a prior blood test showing low glucose (sugar) tolerance; or
• at least two of the following:
  • being overweight;
  • having a family history of diabetes;
  • having a history of diabetes during pregnancy (gestational diabetes) or having had a baby over nine pounds; or
  • being 65 years of age or older.

Medicare will pay for 100% of its approved amount for the test even before you have paid the Part B deductible.

Diabetes Self-Management Training, Foot Care and Supplies
If you have diabetes and your doctor says that you need diabetes self-management training and education, Medicare will cover 80% of the cost of these services after you pay your annual Part B deductible. You can get up to 10 hours of self-management training for your first year, and 2 hours every year thereafter.

Medicare will also pay 80% of the cost for certain diabetic supplies, such as glucose monitors, lancets, and test strips, after you pay your annual Part B deductible. You can get these benefits even if you don't use insulin. If you do use insulin, you can get Medicare-coverage of insulin through the new Medicare outpatient prescription drug benefit (Part D).

Diabetics with peripheral neuropathy may also receive Medicare-covered foot care once every six months, as long as they have not seen a foot-care specialist for another reason between visits. Medicare will cover 80% of the Medicare-approved amount after the yearly Part B deductible.

People with diabetes may also qualify for Medicare-covered medical nutritional therapy.

Flu Shot
Medicare will cover 100% of the cost of an annual flu shot (every 12 months) in the fall or winter, with no Part B deductible required, if you go to a doctor who accepts assignment. If you are in a Medicare HMO, you must see your Primary Care Physician (PCP) for your flu shot, and you may have a copay for this service.

Pneumonia Vaccine
Medicare will cover 100% of the cost of your pneumonia vaccine with no Part B deductible required. You should only need this once in your lifetime. Ask your doctor.

Hepatitis B Vaccine
If you are at medium to high risk for Hepatitis B (e.g., you have kidney failure or travel to countries with high rates of the disease), Medicare will cover 80% of the cost of your Hepatitis B vaccine after you pay your annual Part B deductible. If you are in a Medicare HMO, you may have a copay for this service.

Glaucoma Screenings
Medicare covers 80% of the cost of an annual (every 12 months) glaucoma screening if you are at high-risk for glaucoma (if you have diabetes or high blood pressure, a family history of glaucoma, are an African American age 50 and older, or a Hispanic Americans age 65 and older), after you pay your annual Part B deductible. The screening must be done by an eye doctor who is legally allowed to do this service in your state.

Medical Nutritional Therapy
Medical nutritional therapy, which may include diet counseling, is designed to help you learn to eat right so you can better manage your illness. With a doctor’s referral, Medicare will cover 80% of the cost of medical nutritional therapy for people with diabetes, chronic renal disease, or who are post-kidney-transplant patients, after you pay your annual Part B deductible. Medicare will generally cover 3 hours of medical nutritional therapy for the first year and 2 hours every year thereafter, although it will cover more hours if your doctor says you need them. In order to have them covered by Medicare, you must get these services from a registered dietitian or other qualified nutrition professional. Talk to your doctor if you think you qualify for this benefit.