Medicare Screenings And Preventive Care
Keeping you healthy is in Medicare’s best interest as well as your own. After all, the less care you need, the less Medicare has to pay. Here is a brief overview of the screening procedures that Medicare covers.
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Keeping you healthy is in Medicare’s best interest as well as your own. After all, the less care you need, the less Medicare has to pay. Here is a brief overview of the screening procedures that Medicare covers.
Cancer Screenings
Medicare screens for vaginal and cervical cancers using Pap tests and pelvic exams. The pelvic exam includes a clinical breast exam. For women of childbearing age, it also includes Human Papillomavirus (HPV) testing once every five years as part of the Pap test procedure.
Medicare recipients qualify for screenings every 24 months or, for patients at high risk, every 12 months.
Colorectal cancer screenings
Colorectal cancer is the third most common cancer in adults and the second most common cause of cancer-related fatalities nationwide. To minimize the number of deaths, Medicare covers several different tests, including:
Barium enemas
The barium enema is an X-ray procedure that uses a chemical called barium sulfate. When introduced into your bowel, the barium helps your doctor to see abnormalities in your bowel. The procedure now less common than the colonoscopy, but it is indicated under certain clinical conditions. This procedure does involve an out-of-pocket cost, even with Original Medicare coverage.
Colonoscopies
A colonoscopy uses a flexible tube with a light and camera attached to get a clear image of your colon. It enters the body via the anus and rectum before passing into the large intestine, then transmits images to a monitor. The procedure may be diagnostic only, or it may include the removal of abnormal tissue. If the doctor does remove tissue during the procedure, an out-of-pocket cost may apply.
Fecal occult blood tests
This simple at-home test requires you to collect samples from two to three of your bowel movements and send them into a laboratory or doctor’s office via a special test card. If the results indicate bleeding in your digestive tract, your doctor will probably order follow-up testing.
Flexible sigmoidoscopies
Like a colonoscopy, this procedure uses a flexible tube to take images of the inside of your lower large intestine. It is a less invasive and shorter procedure than the colonoscopy, though your doctor might order a follow-up colonoscopy if there are any abnormal findings.
Multi-target stool DNA testing
From the patient’s perspective, this test is very similar to the fecal occult blood test. You collect a sample and send it to a laboratory, which looks for signs of polyps and/or bleeding in the colon.
Lung cancer screenings
Medicare covers annual lung cancer screenings if you meet specific conditions. The approved test uses Low Dose Computed Tomography (LDCT), a CT scan that can detect abnormalities with 90 percent less radiation than a traditional CT (CAT) scan.
Mammograms
Medicare covers annual mammography screenings for women 40 and older and diagnostic mammograms when medically necessary. There is an out-of-pocket cost associated with the diagnostic mammogram, which is a longer procedure and requires imaging from multiple angles.
Prostate cancer screenings
Medicare covers prostate-specific antigen (PSA) blood tests and digital rectal exams annually for men 50 years old and older. The blood tests cost nothing; the rectal exam usually carries an additional cost.
Behavioral Health Screenings
Alcohol misuse screenings and counseling
Alcohol misuse is not the same as alcoholism, clinically known as an alcohol dependency. You would be considered to be misusing alcohol if you experience social or legal problems as a result of your drinking but choose to continue drinking. If you show signs of a mental or physical need to drink, you are considered dependent.
Medicare covers misuse screenings and counseling for adults who use alcohol but do not meet medical criteria for dependency. If your doctor believes that you are misusing alcohol, Medicare can cover up to four brief counseling sessions in a primary care setting.
Depression screenings
The US Preventive Services Task Force recommends routine depression screenings for all adult patients, combined with follow-up treatment as appropriate. These screenings usually take the form of a patient health questionnaire and are performed annually under normal circumstances.
Other Covered Screenings and Preventive Care
Abdominal aortic aneurysm screenings
An abdominal aortic aneurysm is an enlargement or swelling of the main vessel that carries blood to the lower body. If left untreated, it can rupture and potentially cause death. For this reason, Medicare covers screenings for patients who are at higher-than-average risk.
Bone mass (bone density) testing
A bone mineral density (BMD) test is a painless screening procedure that can identify osteoporosis and measure your risk of breaking a bone. Medicare covers this test every two years if you have certain indications of risk.
Cardiovascular disease screenings and behavioral therapy
Cardiovascular screenings involve basic blood tests that measure cholesterol levels as well as levels of lipids and triglycerides (fats found in the blood).
If your doctor perceives a cardiovascular disease risk, cardiovascular behavioral therapy can help you to stay healthy. Your doctor will evaluate your habits and recommend any changes you might need to make. Medicare covers this once per year.
Diabetes screenings and self-management training
Estimates suggest that one-third of patients with diabetes don’t know that they have it. If you are at risk of diabetes or have pre-diabetes, Medicare will cover up to two screenings per year. The process usually involves a blood test.
If your doctor diagnoses you with diabetes, you can qualify for up to 10 hours of self-management training and up to 2 hours of follow-up training annually. An out-of-pocket cost may apply.
Glaucoma tests
A glaucoma test has two parts, the tonometry test which measures pressure in the eye and the ophthalmoscopy which lets the doctor visually examine your optic nerve. If these findings are abnormal, your doctor might order other tests.
Medicare covers testing for patients at high risk of glaucoma, but there is an out-of-pocket cost.
Does Medicare Cover Coronavirus Testing? Read more here.
Hepatitis B Virus (HBV) and Hepatitis C infection screenings
Medicare covers HBV and Hepatitis C screenings for patients at high risk. Both involve blood tests, but the Hepatitis B screening tends to be more reliable in determining current infection status.
HIV screenings
Medicare covers annual HIV screenings if you are 15 to 65 years of age, or if you are outside this age range and are at higher risk for infection. You can get a laboratory blood test or do an at-home test, which may involve a saliva sample or fingertip blood test.
Nutrition therapy
Medicare may cover medical nutrition therapy (MNT) and related services if you have diabetes or kidney disease or have had a kidney transplant in the past three years. A registered dietitian or nutrition professional will evaluate your eating habits and issue recommendations to help you manage your condition.
Obesity screenings and counseling
Medicare covers obesity screenings and behavioral counseling for patients with a body mass index of at least 30.
STI screenings and counseling
If you are at risk of sexually transmitted infections (STIs), Medicare covers regular screenings assuming that your doctor orders the tests and assuming that the test is not conducted while you are in an inpatient facility. Screenings exist for gonorrhea, chlamydia, syphilis, and Hepatitis B.
Tobacco use cessation counseling
Medicare covers as many as eight visits per year for counseling related to tobacco cessation. Counseling approaches may include motivational interviewing and/or pharmaceutical assistance.
Routine visits and vaccinations
One-time “Welcome to Medicare” visit
You are covered for a one-time preventive visit within 12 months of when you sign up for Part B. It includes a basic review of your vital health information and history, as well as patient education, referrals, and a written plan with recommendations for any preventive services the doctor believes that you need.
If the physician performs other services at this visit, additional fees may apply.
Immunizations
Medicare covers one flu shot per season and up to two pneumococcal shots, one initial shot and one at least one year later. Hepatitis B shots are available for patients at medium to high risk of developing the condition.
Annual wellness visit
Once you’ve had Medicare for a year or more, you qualify for a “wellness” visit every 12 months. The visit evaluates and, if necessary, adjusts a personal prevention plan that includes screening recommendations and cognitive impairment evaluation.
A Final Word
As is the case with any health insurance, your coverage may vary, especially if your doctor's recommendations differ from the baseline. Always consult your physician or insurer to determine your eligibility.