Medicare Preventive Services: Free Screenings and Wellness Visits

One of the most valuable but underused benefits of Medicare is its preventive care coverage. Medicare Part B covers a wide range of screenings, vaccinations, and wellness visits at no cost to you. These services are designed to catch health problems early, when they are easier and less expensive to treat.

Many Medicare beneficiaries do not realize how many preventive services they can receive at no cost. This guide explains what is covered, how often you can get each service, and how to make sure you do not accidentally get charged for something that should be free.

The Welcome to Medicare Preventive Visit

The Welcome to Medicare visit is a one-time preventive visit available within the first 12 months after your Part B coverage starts. Think of it as a baseline check-up. It is not a full physical exam, but it gives your doctor a starting point for your care.

During this visit, your doctor will generally:

• Review your medical and family health history
• Take your height, weight, blood pressure, and body mass index (BMI) measurements
• Perform a simple vision test
• Review your risk factors for depression and other mood disorders
• Discuss your current prescriptions and over-the-counter medications
• Create a written prevention plan with recommended screenings and services

This visit is covered at no cost. There is no deductible, copay, or coinsurance. However, if your doctor orders additional tests or treats a problem during the visit, those services may be billed separately.

You can only get the Welcome to Medicare visit once, so do not skip it. If you miss the 12-month window, you cannot go back and get it later. Schedule it early in your first year of Medicare coverage.

The Annual Wellness Visit

After your first 12 months on Part B, you can get an Annual Wellness Visit (AWV) once every 12 months at no cost. This is different from the Welcome to Medicare visit and different from a traditional physical exam.

The Annual Wellness Visit focuses on prevention planning. During this visit, your doctor will generally:

• Update your medical and family history
• Review your current medications, supplements, and vitamins
• Take routine measurements like height, weight, blood pressure, and BMI
• Screen for cognitive impairment
• Screen for depression
• Assess your risk for falls and provide safety advice
• Update your personalized prevention plan with a schedule of screenings and services

The AWV is covered at no cost, but it is not a head-to-toe physical exam. If you ask your doctor to check a specific complaint or order tests beyond the wellness visit scope, those additional services may result in charges. Let your doctor know at the start of the visit that you are there for your annual wellness visit.

Free Cancer Screenings

Medicare covers several cancer screenings at no cost when they are used for routine screening in people without symptoms. Here are the key cancer screenings covered under Part B.

• Mammograms: Medicare covers one screening mammogram every 12 months for women age 40 and older. There is no cost-sharing for a screening mammogram. If a mammogram is ordered because of symptoms or a previous abnormal result, it becomes a diagnostic mammogram and cost-sharing may apply.
• Colorectal cancer screening: Medicare covers several types of colorectal cancer screening at no cost, including colonoscopy, flexible sigmoidoscopy, and stool DNA tests. For people at average risk, a screening colonoscopy is covered once every 10 years. For those at higher risk, it is covered once every 2 years.
• Lung cancer screening: Medicare covers a low-dose CT scan once per year for eligible beneficiaries. To qualify, you must be between 50 and 77 years old, have a 20 pack-year smoking history, and currently smoke or have quit within the past 15 years. You must also get a written order from your doctor.
• Cervical and vaginal cancer screening: Medicare covers Pap tests and pelvic exams once every 24 months for most women, or once every 12 months for women at high risk. Human papillomavirus (HPV) testing is also covered.
• Prostate cancer screening: Medicare covers a prostate-specific antigen (PSA) blood test once every 12 months for men age 50 and older. A digital rectal exam is also covered once every 12 months.

Early detection saves lives and money. These cancer screenings are among the most important preventive services Medicare offers. Talk to your doctor about which screenings are appropriate for you based on your age, gender, and risk factors.

Cardiovascular and Diabetes Screenings

Heart disease and diabetes are two of the most common health conditions among older adults. Medicare covers several screenings to help detect these conditions early.

• Cardiovascular disease screenings: Medicare covers blood tests for cholesterol, lipid, and triglyceride levels once every 5 years at no cost. These tests help assess your risk for heart attack and stroke.
• Diabetes screenings: Medicare covers fasting blood glucose tests and other diabetes screening tests up to twice per year if you have certain risk factors. Risk factors include high blood pressure, obesity, a history of high blood sugar, or a family history of diabetes.
• Abdominal aortic aneurysm screening: Medicare covers a one-time ultrasound screening if you have a family history of abdominal aortic aneurysms, or if you are a man between 65 and 75 who has smoked at least 100 cigarettes in your lifetime. You need a referral from your doctor.

If you are diagnosed with diabetes, Medicare also covers diabetes self-management training, medical nutrition therapy, and some diabetes supplies. These ongoing services help you manage the condition after it is detected.

Vaccinations Covered by Medicare

Vaccinations are a key part of Medicare's preventive care coverage. Some vaccines are covered under Part B and others under Part D. Here is what you need to know about each.

Vaccines covered under Part B at no cost include:

• Flu (influenza) shot: Covered once per flu season with no copay. You can get your flu shot at your doctor's office, a pharmacy, or other locations that accept Medicare.
• Pneumococcal (pneumonia) vaccine: Medicare covers both doses of the pneumococcal vaccine at no cost. These vaccines protect against pneumonia, meningitis, and bloodstream infections caused by pneumococcal bacteria.
• COVID-19 vaccine: Medicare Part B covers COVID-19 vaccines and boosters at no cost. You do not need to pay a deductible, copay, or coinsurance.
• Hepatitis B vaccine: Covered at no cost for people at medium to high risk. Risk factors include diabetes, end-stage renal disease, living with someone who has Hepatitis B, and certain occupational exposures.

Vaccines covered under Part D include the shingles vaccine, Tdap (tetanus, diphtheria, and pertussis), and other commercially available vaccines recommended by your doctor. Thanks to the Inflation Reduction Act, all Part D-covered vaccines are now available at no cost to you starting in 2023.

Other No-Cost Preventive Services Under Part B

Beyond cancer screenings, cardiovascular tests, and vaccinations, Medicare Part B covers a number of additional preventive services at no cost. Here are some of the most commonly used.

• Bone density test (DEXA scan): Covered once every 24 months for people at risk for osteoporosis. This includes women with estrogen deficiency, people with spinal abnormalities, or those on long-term steroid therapy.
• Depression screening: Covered once per year in a primary care setting. The screening uses a standardized questionnaire to assess your mental health.
• Alcohol misuse screening and counseling: Medicare covers an annual screening and up to 4 brief counseling sessions per year if misuse is detected.
• Obesity screening and counseling: If your BMI is 30 or higher, Medicare covers behavioral counseling sessions to help with weight loss. You can receive up to 22 sessions over 12 months in a primary care setting.
• Tobacco cessation counseling: Medicare covers up to 8 face-to-face counseling sessions per year to help you quit smoking or using tobacco products.
• HIV screening: Covered once every 12 months, or up to 3 times during pregnancy. People at increased risk may get more frequent screening.
• Hepatitis C screening: Covered once for adults born between 1945 and 1965, and annually for people at high risk.
• Glaucoma test: Covered once every 12 months for people at high risk, including those with diabetes, a family history of glaucoma, or African Americans age 50 and older.

Preventive vs. Diagnostic: Why It Matters

One of the most important things to understand about Medicare preventive services is the difference between preventive and diagnostic care. This distinction determines whether you pay nothing or owe cost-sharing.

A service is preventive when it is used to screen for a condition before you have any symptoms. A service is diagnostic when it is ordered because you have symptoms, an abnormal test result, or a known condition. The exact same test can be classified as either preventive or diagnostic depending on the reason it is ordered.

For example, a screening mammogram for a woman with no symptoms is preventive and covered at no cost. But if a woman has a breast lump and her doctor orders a mammogram to investigate, it becomes diagnostic. The diagnostic mammogram may require paying the Part B deductible and 20% coinsurance.

Similarly, if you go in for a screening colonoscopy and a polyp is found and removed during the procedure, the colonoscopy may be reclassified from preventive to diagnostic. This can result in unexpected cost-sharing. Legislation has been working to address this issue so that removing polyps during a screening does not trigger additional charges.

To protect yourself, always ask your doctor whether the service is being ordered as preventive or diagnostic. Make sure the office codes the claim correctly. If you receive a surprise bill for a service you believed was preventive, contact your doctor's billing office and ask them to review the coding.

When Cost-Sharing Applies

While many preventive services are free, it is important to know when you might still owe money. Here are the most common situations where cost-sharing applies.

• Your doctor treats a problem during a preventive visit: If your doctor discovers and treats a health issue during your Annual Wellness Visit, the treatment portion may be billed separately as a regular office visit with standard cost-sharing.
• A screening becomes diagnostic: If a screening test reveals a problem and additional testing or treatment is done during the same visit, the additional services may be billed as diagnostic.
• Your provider does not accept Medicare assignment: If your doctor does not accept Medicare assignment, they may charge more than the Medicare-approved amount. Using providers who accept assignment ensures you pay no more than the standard cost.
• You get a service more often than covered: Each preventive service has a specific frequency. For example, cardiovascular screening is covered once every 5 years. If you get it more often, you may owe the full cost of the extra test.

How to Maximize Your Free Preventive Benefits

Getting the most from Medicare's preventive services takes a little planning. Here are practical steps to make sure you receive every benefit available to you.

• Schedule your Annual Wellness Visit every year: This visit is free and helps you stay on track with recommended screenings. Your doctor will create or update your prevention plan, so you know exactly which services to schedule.
• Keep your Welcome to Medicare visit: Do not skip this one-time visit during your first 12 months on Part B. It establishes a baseline for your health and cannot be rescheduled once the window closes.
• Tell your doctor you want a preventive visit: When scheduling, be clear that you are coming for your annual wellness visit or a specific screening. This helps the office code the visit correctly and avoid unexpected charges.
• Use providers who accept Medicare assignment: This ensures you pay the Medicare-approved amount for any services that do have cost-sharing, and guarantees that preventive services are truly free.
• Keep track of your screening schedule: Some screenings are covered annually, others every 2 years, and some every 5 or 10 years. Keeping a record helps you use every benefit at the right time.
• Stay up to date on vaccines: Get your annual flu shot, stay current on pneumococcal and COVID-19 vaccines, and ask about the shingles vaccine under Part D. All of these are now available at no cost.

The Bottom Line

Medicare's preventive services are among the most valuable benefits in the program. They help you catch health problems early, when treatment is most effective and least expensive. From annual wellness visits to cancer screenings to free vaccinations, these benefits are available at no cost when you use them correctly.

The key is understanding the difference between preventive and diagnostic services. Preventive services screen for problems before symptoms appear and are generally free. Diagnostic services investigate known symptoms or conditions and usually involve cost-sharing. Make sure your doctor codes your visits correctly to avoid surprise bills.

Do not leave these benefits on the table. Schedule your Annual Wellness Visit every year, keep up with recommended screenings, and stay current on vaccinations. These simple steps can help you stay healthier and reduce your healthcare costs over time. If you have questions about which preventive services are right for you, talk to your doctor or call Medicare at 1-800-633-4227.