Medicare Preventive Care

Published by Mike Lovell on May 18, 2020May 18, 2020

Medicare is very specific about how preventive care is covered.  So it’s important for you to know how it works so you don’t get surprised with a bill after you see a doctor.

There are 3 different types of visits:

• Welcome to Medicare
• Annual Wellness Visit
• Annual Physical

Welcome to Medicare

This visit is only available to people who have started Medicare (Part B) within the last 12 months.

This is not a routine physical.

The Welcome to Medicare is an introduction to Medicare and covered benefits.  It includes education and counseling about preventive services.  This includes screenings, shots, and vaccines.

When you call your doctor’s office to schedule this appointment, it’s important to ask for your “Welcome to Medicare” preventive visit.

You do not pay anything for the Welcome to Medicare visit as long as your doctor accepts Medicare.

Annual Wellness Visit

This is for people who have had Medicare for more than a year.  You can get an annual “Wellness” visit to develop or update your personalized health plan.

This visit is covered once every 12 months.

You pay nothing for your “Wellness” visit as long as your doctor accepts Medicare.

Covered Preventive Services

Medicare does cover a lot of things as preventive.  The covered preventive services are listed below.  Even though these are covered as preventive, most of them have guidelines about how often they are covered as preventive care.

Medicare Part B (Medical Insurance) covers:

• Abdominal aortic aneurysm screening
• Alcohol misuse screenings & counseling
• Bone mass measurements (bone density)
• Cardiovascular disease screenings
• Cardiovascular disease (behavioral therapy)
• Cervical & vaginal cancer screening
• Colorectal cancer screenings
• • Multi-target stool DNA tests
  • Screening barium enemas
  • Screening colonoscopies
  • Screening fecal occult blood tests
  • Screening flexible sigmoidoscopies
• Depression screenings
• Diabetes screenings
• Diabetes self-management training 
• Glaucoma tests
• Hepatitis B Virus (HBV) infection screening 
• Hepatitis C screening test
• HIV screening
• Lung cancer screening
• Mammograms (screening)
• Nutrition therapy services
• Obesity screenings & counseling
• One-time “Welcome to Medicare” preventive visit
• Prostate cancer screenings
• Sexually transmitted infections screening & counseling
• Shots:
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
• Tobacco use cessation counseling
• Yearly “Wellness” visit

Routine Physical Exam

The routine physical checkup applies to exams performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury.

That is a complicated way of saying that exams other than your Annual Wellness/Welcome to Medicare visits that are not treating for something specific will not be covered.

So if you see your doctor for something that isn’t covered under the preventive services listed above AND you don’t have any symptoms/complaints/etc. then it may not be covered by Medicare.

Here’s an example

High Cholesterol

Medicare generally covers routine high cholesterol screening blood tests once every five years at no cost to you as long as your provider accepts Medicare.

If you are diagnosed with high cholesterol, then blood work to monitor your condition becomes medically necessary.

So a doctor is doing an exam/lab work for a specific diagnosis.  That’s important!

What that means for you is medically necessary no longer means preventive.

So it will normally be covered under Medicare Part B.  This means it will apply toward your Medicare Part B deductible ($198 in 2020) and then co-insurance.

IMPORTANT NOTE

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

RECAP

Medicare covers many things as preventive.  When you schedule your preventive care, follow the tips above about requesting a specific appointment and not an annual physical.

I’ve been specializing in Medicare for more than 10 years, so if you have questions please reach out right away.

Mike Lovell
608-571-4461
Mike@AskMedicareMike.com