While most services come with a cost, some preventive screenings, vaccines and counseling are covered without charge
We worry a lot about what Medicare beneficiaries must for pay out of pocket, such as monthly premiums, annual deductibles, and copays for doctor visits and prescription drugs. But what many enrollees may not realize is that there are services that won’t cost them a cent.
You can get vaccines and screenings for a number of illnesses and see your doctor each year for a wellness visit. You can also get counseling to help you kick smoking or manage your diabetes. You won’t be subject to any out-of-pocket charges for these services as long as you use a health care provider who participates in Medicare or, if you get your health care through a Medicare Advantage plan, an in-network medical professional.
Here’s a look at a dozen things you can get for free from Medicare. For a full list of the program’s preventive and screening services, go to Medicare.gov.
1. A onetime “Welcome to Medicare” visit
This visit must be made within the first 12 months of signing up for Medicare Part B, the part of Medicare that covers doctor visits and other outpatient services.
Think of this initial visit as a baseline check-in. Your provider will review your medical and personal history, see what medications you are taking, give you a flu and pneumococcal shot, take your vital signs (height, weight and blood pressure), do a simple vision test, ask some mental and behavioral health questions, and offer to help you create any advance directives you might not yet have. And all this will be free.
But note that if after this general check-in, your doctor wants to order some diagnostic tests or perform some other services, the rules governing Part B will apply and you’ll be responsible for 20 percent of the costs. Your coinsurance or copay may be different if you are enrolled in a Medicare Advantage plan or if you have supplemental, or Medigap, insurance.
2. A yearly wellness visit
The first thing to know about this is what it isn’t: a physical. According to Medicare, this is a once-a-year visit to “update your personalized plan to help prevent disease or disability.” Your doctor will probably take your vital signs (height, weight and blood pressure) and review your medical history and the medications you are taking. Providers are also expected to do a cognitive assessment to look for any signs of dementia. If during this visit your doctor needs to order some tests, such as blood work or an actual physical exam, then as with that first welcome Medicare visit, the rules governing your coinsurance under Medicare Part B will apply.
3. Vaccines
Thanks to a federal law passed in 2022, Medicare now covers most vaccines at no cost to enrollees with prescription drug coverage under Medicare Part D or as part of their Medicare Advantage plan. This includes inoculations recommended by the Centers for Disease Control and Prevention, such as the shots for shingles and RSV. Medicare Part B had already covered other vaccines, such as seasonal flu and COVID-19 shots, at no charge.
4. Diabetes screenings
Medicare Part B will cover up to two diabetes screenings each year, including blood glucose tests, if your doctor determines you are at risk for developing diabetes and you have risk factors such as high blood pressure, a history of abnormal cholesterol levels, are obese or have a history of high blood sugar. Part B will also cover these screenings if two or more of the following conditions apply: you are 65 or older, you’re overweight, you have a family history of diabetes or you’ve had gestational diabetes (diabetes while you were pregnant).
5. Depression screening
Medicare covers one depression screening per year that must happen in a primary care setting, like a doctor’s office. If a provider recommends follow-up treatment or other mental health and behavioral services, then the coinsurance rules under Part B would apply. In a crisis, people can contact the free and confidential Suicide & Crisis Lifeline by calling or texting 988 24 hours a day, seven days a week.
6. Mammograms
Medicare will pay for a screening mammogram every 12 months if you are a woman age 40 or older. Be advised that if you get a diagnostic mammogram, which a doctor typically will order after a screening mammogram shows some suspicious results and they want to take a closer look, then the rules governing Part B will apply and you will be responsible for 20 percent of the cost. That would also apply if, for example, a doctor orders a breast ultrasound because the Medicare enrollee has dense breasts. Medicare will cover diagnostic mammograms more often than once a year if a doctor says they are medically necessary.
7. Colorectal cancer screenings
Four separate screening tests for colorectal cancer are covered for free:
- A fecal occult blood test every 12 months, starting at age 45. This will detect blood in the stool.
- A flexible sigmoidoscopy every 48 months, also starting at age 45, with the proviso that you haven’t had a colonoscopy in the past 10 years.
- A stool DNA test every three years for people between 45 and 85 who are not at high risk for colon cancer and don’t have any symptoms of colorectal disease.
- A screening colonoscopy every 10 years if you are not at high risk for colon cancer, or every two years if you’ve had a history of colon problems or there’s a family history of colon cancer.
8. Lung cancer screenings
Medicare will cover a lung cancer screening using low-dose computed tomography once a year if all these conditions apply:
- You’re between 50 and 77.
- You don’t have any signs or symptoms of lung cancer.
- You either smoke now or quit smoking within the past 15 years.
- You have a history of having smoked one pack a day for a 20-year period.
- You get an order from your doctor or other health care provider.
9. Prostate cancer
Staring the day after a man turns 50, Medicare will cover a prostate specific antigen (PSA) blood test every 12 months. If you also need a digital rectal exam or other follow-up services, then the 20 percent coinsurance rules under Medicare Part B will apply.
10. Smoking counseling
Medicare will pay for up to eight counseling sessions over a 12-month period to help you stop smoking or using tobacco.
11. Alcohol counseling
Medicare will cover one annual alcohol misuse screening. In addition, the program will cover up to four brief face-to-face counseling sessions each year if you are someone who uses alcohol but doesn’t meet the medical criteria for being alcohol dependent. You must get the counseling at a primary care setting, such as a doctor’s office or clinic.
12. Nutrition therapy
Medicare will cover some nutrition services if you have diabetes or kidney disease or have received a kidney transplant in the past 36 months. These services can include an initial nutrition and lifestyle assessment, individual or group sessions, help managing the lifestyle factors that affect your diabetes, and follow-up visits to check on your progress.
https://www.aarp.org/health/medicare-insurance/info-2023/free-medicare-services.html
