Loading...Loading...Even if you’re healthy and feeling good, it’s important to keep up with your preventive care. Periodic health exams, cancer screenings, vaccines and other recommended preventive care services help prevent or detect problems early on when they’re easier to treat. For example, you may be due for a mammogram, bone density test or annual flu vaccine.
When you see a participating provider, you’ll pay nothing for the preventive services listed here. To easily find participating providers, sign in and find a doctor.
You may be responsible for an out-of-pocket expense if:
- You see a non-participating provider
- Your doctor provides medical services outside of Medicare covered preventive care
Some plans may have limitations or may not cover all of these services. Sign in to review your benefits.
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We cover a wide variety of preventive services with no copay and no deductible, meaning no out-of-pocket costs to you. Check the list below to see which preventive services are covered on your Medicare plan (some services may apply to certain ages or if you’re at high risk). Refer to your Evidence of Coverage (EOC), check your benefits or call Customer Service at the number on the back of your member ID card for more details and to confirm any cost-share responsibility. You can also refer to the table below to learn more about Medicare preventive care coverage.
Preventive care service | When it is covered for people with Medicare Advantage |
|---|---|
Abdominal aortic aneurysm screening (screening for a weak area or bulge in the aorta, the body's main artery) | A one-time screening ultrasound for people at risk; a referral from your doctor is required. |
Alcohol misuse screening and counseling | One alcohol misuse screening per year for adults who use alcohol but don't meet the medical criteria for alcohol dependency. Also, up to four counseling sessions per calendar year from a qualified primary care doctor in a primary care setting. |
Annual wellness visit | Once every 12 months after you've had Part B for longer than 12 months. Note: You can't have your first yearly wellness visit within 12 months of enrolling in Part B or having your Welcome to Medicare preventive visit. However, you don't need to have had a Welcome to Medicare preventive visit to in order to have a yearly wellness visit. |
Bone mineral density test | Once every 24 months (more often if medically necessary) if you are at risk for osteoporosis (bone weakening) and have one of these medical conditions:
|
Breast cancer screening | Once every 12 months if you're a woman age 40 and older. Women 35-39 qualify for one baseline mammogram. |
Cardiovascular behavioral therapy and screenings | Once each year. However, screening tests for cholesterol, lipid and triglyceride levels are covered once every 5 years. |
Cervical and vaginal cancer screening | Pap test and pelvic exam once every 24 months, or once every 12 months for women at high risk and for women of child-bearing age who have had an exam that indicated cancer or other abnormalities in the past 36 months. |
Colorectal cancer screening | If you are 45 or older, these screenings are covered at these times:
Note: If a polyp or other tissue is found and removed during the colonoscopy, you may have out-of-pocket costs. |
Depression screening | One depression screening per year; screening must be done in a primary care setting. |
Diabetes screening (fasting blood glucose test) | Up to two diabetes screenings per year, based on the results of your screening tests. |
Diabetes self-management training | For people with diabetes, Medicare covers educational training to help manage their diabetes and prevent complications. You must have a written order from a doctor or other health care provider. |
Glaucoma screening | Every 12 months if your doctor says you're at high risk for glaucoma. |
Hepatitis C screening test | A one-time hepatitis C screening test if one of these things are true:
Certain people at high risk are covered for repeat screening each year. A primary care doctor or practitioner must order the screening tests. |
HIV screening | Once every 12 months if you are at increased risk (or if you ask for the test), or up to three times during a pregnancy. |
Lung cancer screening | Once every 12 months with low dose computed tomography (LDCT) if you meet all of these conditions:
Before your first lung cancer screening, you need to schedule an appointment with your doctor to discuss the benefits and risks of lung cancer screening. You and your doctor can decide if lung cancer screening is right for you. |
Nutrition therapy, medical | Three hours of one-on-one counseling the first year, and two hours each year after that if you have diabetes or renal kidney disease (but aren't on dialysis) or after a kidney transplant. Your doctor must refer you for this service. If your condition, treatment or diagnosis changes, you may be able to receive more hours of treatment with a doctor's referral. |
Obesity screening and counseling | All people with Medicare may be screened for obesity. If you have a body mass index (BMI) of 30 or more, you're covered for intensive obesity counseling conducted in a primary care setting. |
Prostate cancer screening | All men over 50 with Medicare.
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Sexually transmitted infection screening and counseling | Screenings for chlamydia, gonorrhea, syphilis and hepatitis B once every 12 months or at certain times during pregnancy. Also, up to two individual 20-to-30-minute, face-to-face behavioral counseling sessions each year for sexually active adults at increased risk for sexually transmitted infections. Your primary care doctor or other primary care practitioner must order the screening tests and provide the counseling. |
Tobacco use cessation counseling | Up to eight face-to-face visits during a 12-month period if you use tobacco. These visits must be provided by a qualified primary care doctor or practitioner in a primary care setting. |
Vaccinations | Flu: Once per flu season. Everyone 65 and older should get the flu vaccine. People who are under 65 but have a chronic illness, including heart disease, lung disease, diabetes or end-stage renal disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant), should get a flu vaccine. Pneumonia (pneumococcal infection): There are two different pneumococcal vaccines that are given only once, at least 11 months apart. All people 65 and older should get the pneumococcal vaccine. Hepatitis B: Certain people at medium or high risk for hepatitis B are eligible for the hepatitis B vaccine. Check with your doctor about when to get the hepatitis B vaccine if you qualify to get it. You'll need three shots for complete protection against hepatitis B. COVID-19: Everyone should get a COVID-19 vaccine. Talk to your health care provider about which vaccine and booster is right for you. Note: Other vaccines like respiratory syncytial virus vaccine (RSV) and shingles, may be covered under your prescription drug plan. Deductibles, copays and coinsurance may apply. For more information, visit the Pharmacy page, sign in to your account or call us at the number on the back of your member ID card. |
Welcome to Medicare preventive visit | Once in your lifetime within the first 12 months of your Medicare eligibility. |
Preventive care vs. diagnostic care
Preventive care is precautionary and routine, like an annual physical.
Diagnostic care diagnoses or treats new symptoms or existing problems.
Why does it matter? When you see a participating provider, preventive care is generally covered in full at no cost to you. Diagnostic care may come with costs like copays or deductibles.
Your doctor wants you to get a colonoscopy. Is it preventive or diagnostic care? It depends!
Preventive colonoscopy: A screening as a precaution due to your age.
Diagnostic colonoscopy: A screening because of symptoms you're having.
If your doctor recommends a specific test or procedure, you can ask if it’s for preventive or diagnostic purposes—that way you’ll know what type of coverage to expect.
Need help finding participating providers? Sign in and chat online or call us at the number on the back of your member ID card.
Last updated 10/01/2024
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