Medicare’s Preventive Services

2017 Medicare and You Booklet

When you enroll in Medicare you will receive the Medicare and You booklet outlining the services that are available to you. A list of Medicare’s preventive services can be found in section 3. We encourage you to use this list to keep track of the services you have received. Medicare provides you with services that will keep you healthy and help you manage your existing health concerns. The majority of Medicare’s preventive services, including “Wellness” visits are covered at little to no cost to you.

What’s Covered

We recommend that you speak with your primary care physician during your annual “Wellness” visit to discuss which of these services, screenings, or counseling sessions are most appropriate for managing your health. We have indicated any services that are only available if you are considered “at risk,” or if you meet specific health criteria. Please refer to your handbook and your doctor for more details.

• Vaccinations
  • Flu Shot – received 1 time per season
  • Hepatitis B shots – 1 time
  • Pneumococcal shot – 1 time
  • NOTE: Shingles shots are not covered by Parts A or B. In some cases, your Part D Prescription coverage may cover this vaccine. Please check with your prescription coverage provider.
• Routine screenings for:
  • Abdominal Aortic Aneurysm – 1 time for high risk patients
    • Ultrasound assessment
  • Bone Density – 1 time every 24 months
    • Radiology assessment
  • Breast Cancer – 1 time every 12 months
    • Mammography
  • Cardiovascular Disease – 1 time every 5 years
    • Blood test
  • Cervical and Vaginal Diseases – 1 time every 24 months
    • Pap tests and pelvic exams (includes clinical breast exam)
  • Colorectal Cancer
    • Multi-target Stoll DNA – 1 time every 3 years
    • Fecal Occult – 1 time every 12 months
    • Flexible Sigmoidoscopy – 1 time every 4 years, or every 10 years after first exam if low risk
    • Colonoscopy – 1 time every 10 years or 48 months after first sigmoidoscopy
    • Barium Enemas – 1 time every 4 years, or every 2 years for high risk patients who do not receive a colonoscopy or sigmoidoscopy
      • Patients are responsible for paying 20% of the Medicare-approved amount for this service, plus the Part B deductible
  • Diabetes – 2 times per year if at risk
    • Blood test
  • EKG or ECG – 1 time as part of “Welcome to Medicare Preventive Visit”
    • Patients are responsible for paying 20% of the Medicare-approved amount for this service, plus the Part B deductible
  • Glaucoma – 1 time every 12 months for high risk patients
    • Eye exam
    • Patients are responsible for paying 20% of the Medicare-approved amount for this service, plus the Part B deductible
  • Human Immunodeficiency Virus (HIV) – 1 time every 12 months
    • Blood test
  • Lung Cancer – 1 time every 12 months for at risk patients
    • LDCT (Low Dose Computed Tomography)
  • Sexually Transmitted Diseases (STD) – 1 time every 12 months for at risk patients
    • Blood test and physical exam
  • Prostate Cancer – 1 time every 12 months
    • Blood test and Digital Rectal Exam
      • Patients are responsible for paying 20% of the Medicare-approved amount for the rectal exam, plus the Part B deductible
• Behavioral and Mental Illness Screening and Counseling for:
  • Alcohol Misuse – 1 time every 12 months
    • 4 counseling sessions per year with a primary care physician
  • Cardiovascular Disease (behavioral therapy) – 1 time every 12 months
    • 1 to 1 discussion with your physician
  • Depression – 1 time every 12 months
    • Screening test performed by your doctor
  • Diabetes Self-maintenance – 1 time
    • Outpatient program
    • Patients are responsible for paying 20% of the Medicare-approved amount for this service, plus the Part B deductible
  • Medical Nutrition Therapy – 1 time
    • Counseling and nutrition assessment
    • Available for patients with diabetes, kidney disease, or who have undergone a kidney transplant in the last 36 months
  • Obesity – 22-fifteen minute counseling sessions every 12 months
    • Available for individuals with a Body Mass Index (BMI) at or above 30
  • Sexually Transmitted Diseases – 2-twenty to thirty minute sessions every 12 months
    • Behavioral and disease management counseling performed by your primary care physician
  • Smoking and Tobacco Cessation – 8 counseling sessions every 12 months

Reducing the Costs of Medicare’s Preventive Services

Many of the above services are provided at no cost to you. However, some tests and counseling sessions require that patients pay 20% of the Medicare-approved amount for the service, plus the Part B deductible. In addition, your physician may suggest that you receive a service that is not fully covered by Medicare. We advise that you speak with your healthcare provider about these other services, and discover why he or she believes they are medically necessary, and if there are alternatives that Medicare will cover.

The Wooten Agency recommends that you speak with our agents about Medigap  options that will pay the remaining 20% of Medicare-approved costs, of which you are responsible.  We are happy to provide you with a free consultation and answer all of your health insurance questions.