Important Medicare Preventive Services and Benefits

Medicare Part B provides several preventive benefits to help Medicare beneficiaries get the support and care they need to stay healthy, manage existing health conditions and prevent illness.

Below, we look at several important Medicare benefits that are often overlooked.

Note: Typically, the following services are covered 100 percent by Medicare if your health care provider accepts assignment. Providers that accept Medicare assignment agree to accept the Medicare-approved amount as full payment for covered services. Medicare providers that do not accept assignment can charge up to 15 percent more than the Medicare-approved amount, which could mean higher out-of-pocket costs for you. Be sure to find out if your health care provider accepts assignment before getting any of the following services.

1. Screenings and tests

Medicare Part B covers numerous screenings and tests, including but not limited to:

Depression screenings

Medicare Part B covers one depression screening per year. The screening must occur in a primary care setting that can provide follow-up treatment and referrals. You do not have to show signs or symptoms of depression to qualify for a depression screening.

If you’re enrolled in Medicare Part B and your doctor accepts Medicare assignment, your yearly depression screening is covered 100 percent.

Alcohol misuse screenings

Medicare Part B covers an annual alcohol misuse screening to help identify, manage and treat alcohol misuse. You do not have to show signs of alcohol misuse to be eligible for a yearly alcohol misuse screening.

If your primary care doctor determines that you’re misusing alcohol, he or she may refer you to alcohol misuse counseling. Medicare Part B typically covers 4 face-to-face alcohol misuse counseling sessions per year to people who qualify.

Bone density tests

Medicare Part B covers one bone density test every 24 months if you are:

  • A woman whose doctor determines she is estrogen deficient and at risk for osteoporosis
  •  
  • A person whose x-rays show possible osteoporosis, osteopenia or vertebral fractures
  •  
  • A person taking prednisone or steroid-type drugs or is planning to begin this type of treatment
  •  
  • A person who has been diagnosed with primary hyperparathyroidism
  •  
  • A person who is being monitored to see if your osteoporosis drug therapy is working

If your doctor accepts Medicare assignment and you meet one or more of the above qualifications, Medicare Part B usually covers your bone density test 100 percent.

Mammograms

Mammograms help detect early breast cancer in women who show no signs of the disease.

  • Medicare typically covers yearly mammograms for women age 40 and older, and one baseline mammogram for women between the ages of 35 and 39. Annual mammograms for women age 40 and older are covered 100 percent by Medicare as long as your health care provider accepts Medicare.
  •  
  • Medicare typically covers diagnostic mammograms that are considered medically necessary by a doctor. Diagnostic mammograms usually require you to meet your Part B deductible before Medicare will pay its share. Once your deductible is met, you typically pay 20 percent of the Medicare-approved amount for your mammogram.

2. Counseling and therapy

Medicare Part B covers some counseling and therapy services to help Medicare beneficiaries maintain their physical and mental health. Some of the counseling and therapy services covered by Medicare Part B include:

Tobacco cessation counseling

Medicare Part B covers up to 8 face-to-face counseling sessions per year to help people top smoking or using tobacco products.

If you qualify and your doctor accepts Medicare assignment, Medicare Part B covers smoking cessation counseling 100 percent.

Weight loss counseling

If you have a body mass index (BMI) of 30 or higher, Medicare Part B may cover weight loss counseling. For your weight loss counseling to be covered by Medicare, you must receive counseling in a primary care setting and be diagnosed as obese by a doctor.

Once your doctor diagnoses you as obese, Medicare Part B typically covers 1 face-to-face visit per week for the first month, and 1 face-to-face visit every other week for the next 5 months.

Medical nutrition therapy

Medical nutrition therapy services include:

  • Individual and group nutrition therapy services
  • An initial nutrition and lifestyle assessment
  • Follow-up visits to check on your progress in managing your diet

Medical nutrition therapy is generally covered by Medicare Part B for people who have kidney disease, have had a kidney transplant in the last 36 months and people with diabetes.

Typically, you need a referral from your primary care physician for your medical nutrition therapy to be covered by Medicare.

Doctor talking with her patient

3. Welcome to Medicare Visit

This one-time preventive visit is available to anyone who is enrolled in Medicare Part B, and typically involves:

  • A doctor’s evaluation of your medical history, current health conditions and any prescription drugs you’re taking
  •  
  • Any necessary preventive screenings and shots
  •  
  • Blood pressure, vision, height and weight measurements
  •  
  • Further testing if necessary*

You must schedule your Welcome to Medicare Visit within the first year of enrolling in Medicare Part B.

Medicare covers the Welcome to Medicare Visit at 100 percent of the Medicare-approved amount when you receive the services from participating provider.

* Additional testing may fall outside of the scope of the Welcome to Medicare Visit and there may be out-of-pocket costs associated with such tests.

4. Annual Wellness Visit

The Medicare Annual Wellness Visit is a yearly visit with your doctor where the two of you create or update a personalized health care plan tailored to your specific health care needs.

You are typically eligible for a Medicare Annual Wellness Visit if:

  • You have been enrolled in Medicare Part B for 12 months or longer
  •  
  • You have not received an Annual Wellness Visit within the past 12 months
  •  
  • You have not received your Welcome to Medicare visit in the past 12 months

Some examples of services you may receive at your Annual Wellness Visit include:

  • BMI calculation
  •  
  • Height, weight and blood pressure measurements
  •  
  • A review of your medical and family history
  •  
  • A review of the medications you’re currently taking
  •  
  • A screening schedule for preventive services appropriate to your unique needs

The Annual Wellness Visit does not typically evaluate your vision or dental health.

Some Medicare Advantage plans offer some vision and dental benefits that may include routine vision and dental checkups.

Medicare Advantage vs. Original Medicare

Medicare Advantage plans are an alternative to Original Medicare that sometimes provide additional benefits.

Every Medicare Advantage plan must provide the same hospital and medical benefits as Medicare Part A and Part B, which means that the benefits listed in this article are covered by Medicare Advantage.

In addition to these benefits, most Medicare Advantage plans cover prescription drugs, and some plans cover vision, dental and hearing care, none of which are typically covered by Medicare Part A or Part B.

Find a Medicare Advantage Plan

Speak with a licensed insurance agent at TTY Users: 711 (24 hours a day, 7 days a week) to find Medicare Advantage plans in your area and to enroll in a plan that works for you.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.