Preventive care

Preventive care and early detection are important for your health and well-being. That's why 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. This is the standard Original Medicare benefit and may not reflect your cost share responsibility. Refer to the Evidence of Coverage (EOC) for your plan benefits.

Preventive care service	When it is covered for people with Medicare
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 have had Part B for longer than 12 months. Note: You cannot 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: You are a woman whose health care provider says you're estrogen-deficient and at risk for osteoporosis, based your medical history and other findings You have vertebral abnormalities as shown by an X-ray You are receiving steroid treatments You have hyperparathyroidism (an excess of a hormone that can weaken your bones due to calcium loss) You are taking an osteoporosis drug
Breast cancer screening	Once every 12 months if you are 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: Screening fecal occult blood test: Once every 12 months Screening flexible sigmoidoscopy: Once every 48 months after the last flexible sigmoidoscopy or barium enema, or 120 months after a previous screening colonoscopy Screening colonoscopy: Once every 120 months (every 24 months if you are at high risk) or 48 months after a previous flexible sigmoidoscopy Screening barium enema: Once every 48 months (every 24 months if you are at high risk) when used instead of sigmoidoscopy or colonoscopy Multi-target stool DNA test: Once every 3 years if you are between 50-85 years of age, show no signs of colorectal disease, you are at average risk for colorectal cancer, and you have no family history of it Note: If a polyp or other tissue is found and removed during the colonoscopy, you may pay 20% of the Medicare-approved amount for the doctor's services and a copay in a hospital outpatient setting. For barium enemas, you may pay 20% of the Medicare-approved amount for the doctor's services. The Part B deductible doesn't apply. If it's done in a hospital outpatient setting, you may have to pay a copay.
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. Note: If you have a Medicare Supplement (Medigap) plan, you may pay 20% of the Medicare-approved amount after the yearly Part B deductible.
Glaucoma screening	Every 12 months if your doctor says you are at high risk for glaucoma. Note: If you have a Medicare Supplement (Medigap) plan, you may pay 20% of the Medicare-approved amount after the yearly Part B deductible.
Hepatitis C screening test	A one-time hepatitis C screening test if one of these things are true: You are at high risk because you use illegal injectable drugs or you did in the past. You are at high risk because you had a blood transfusion before 1992. You were born between 1945 and 1965. 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: Are age 50–77. Are not showing signs or symptoms of lung cancer. Are either a current smoker or have quit smoking within the last 15 years. Have smoked an average of one pack a day for 20 years. Get a written order from your doctor or a qualified provider. You use an appropriate radiology imaging center and a reading radiologist that meets Medicare standards. 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, renal kidney disease (but are not 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 are covered for intensive obesity counseling conducted in a primary care setting.
Prostate cancer screening	All men over 50 with Medicare. Digital rectal examination: Every 12 months PSA test: Every 12 months Note: If you have a Medicare Supplement (Medigap) plan, you may pay 20% of the Medicare-approved amount for the digital rectal exam after the yearly Part B deductible.
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 20-30 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. All people 65 and older should get flu shots. 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 shot. Pneumonia (pneumococcal infection): There are two different pneumococcal shots that are given only once, at least 11 months apart. All people 65 and older should get pneumococcal shots. Hepatitis B: Certain people at medium or high risk for hepatitis B are eligible for hepatitis B shots. Check with your doctor about when to get hepatitis B shots if you qualify to get them. You will need three shots for complete protection against hepatitis B. Note: Other vaccines may be covered under your Medicare Part D prescription drug plan. Deductibles, copays and coinsurance may apply. For more information, visit the Pharmacy page 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.

Last updated 02/17/2023
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