Preventive care helps prevent illness, detect medical conditions, and keep you healthy. A service is considered preventive if you have no prior symptoms of the disease. In contrast, diagnostic services address symptoms or conditions that you already have. Let’s discuss how Medicare covers preventive care.

Medicare Part B covers many preventive services, such as screenings, vaccines, and counseling. 

To find out if Medicare covers your test, service, or item you can visit www.medicare.gov, call 1-800-MEDICARE, or read your Medicare & You handbook. If you meet the eligibility requirements and guidelines for a preventive service, the service is covered whether you have Original Medicare or a Medicare Advantage Plan, although a plan’s network rules may apply. You should pay nothing for most preventive services so long as you see the right provider. 

During your preventive visit, your provider may discover and need to investigate or treat a new or existing problem. This additional service may be diagnostic or treatment. Medicare covers diagnostic and treatment services differently than preventive services, and you may be charged coinsurances or copays. You also may be responsible for paying a facility fee, depending on where you receive the service. 

Prepare for your Welcome to Medicare and Annual Wellness Visits. 

Medicare covers one Welcome to Medicare preventive visit in your first year of having Medicare Part B, then one Annual Wellness Visit per year after that, with zero cost-sharing as long as you see the appropriate providers. Keep in mind that these visits are not head-to-toe physicals. 

• During the Welcome to Medicare Visit, your provider will review your medical and social history as well as your health status and risk factors. Your provider will then give you resources related to your risk factors and health needs and will give you a checklist or written plan with information about other preventive services you may need. 
• Annual Wellness Visits, which Medicare will cover once you have had Part B for 12 months, are yearly appointments with your primary care provider to create or update a personalized prevention plan. This plan can help prevent illness based on your current health and risk factors. For both kinds of preventive visit, be prepared with information about your medical history, family history, doctors, medications, and durable medical equipment you use. 

Make sure you see the right types of providers for lowest costs.

You pay nothing for most preventive services if you see the right type of provider. If you see other types of providers, then charges may apply to preventive care services that otherwise would not have cost you anything.  

• If you have Original Medicare, you should receive preventive services from providers who accept assignment. These providers accept Medicare’s approved amount for a service as payment in full. For preventive services that Medicare covers at 100%, you owe no deductible or coinsurance when you see a provider who accepts assignment. And if you receive services that do have a cost, these providers cannot charge you more than the Medicare-approved deductible and coinsurance. 
• If you are in a Medicare Advantage Plan, you should not be charged for preventive care services that are free for people with Original Medicare, if you see providers who are in-network for your plan. 

Still have questions?   

Your SHIP is here for you! You can contact your SHIP for any Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP. 
 

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