Medicare Coverage for Preventive Screening

Mon, Apr 12, 2021 6:22 PM Medicare

Most health insurance providers have started to cover a range of preventive screenings and programs in recent years, mostly at no expense to the beneficiary. The explanation is simple: prevention is much less expensive than treatment. Medicare and other insurers teamed up with healthcare providers to enable patients to be more engaged in their own wellbeing.

The objective was to cut healthcare expenses while also promoting public health and wellbeing. In this article, we'll go over which preventive screenings are covered by Medicare and why you should use them.

 

Welcome to Medicare and Annual Wellness Visits

A health appointment is covered by Medicare every 12 months. If your provider accepts the assignment, there is no charge for this service.

The Welcome to Medicare visit is your annual test within the first 12 months of Medicare Part B. This preventive service is an excellent way to establish a healthy baseline for your overall health. It includes vitals checks including height, weight, and blood pressure, as well as a rundown of your medical background and information on Medicare and other preventive services. In addition, your exam will cover the following topics:

 

• A body mass index calculation

• Flu and pneumococcal shots as needed

• A discussion about advance directives

• Cognitive assessment

• A depression assessment

• A basic vision test

 

Your doctor will also give you a written schedule outlining the scans and other preventive services that are needed for the coming year.

The annual health test is almost identical. Every 12 months, you will receive one wellness appointment.

 

Also Read: Annual Wellness Visit Medicare Checklist

 

Cancer Checkups and Screenings

Medicare Part B covers a number of cancer scans that have been shown to aid in the early detection of cancer. There are some of them:

 

Screenings for cervical and vaginal cancer

Pap tests and pelvic examinations are included in Part B. A clinical breast exam is also included in the pelvic exam. If you're deemed high risk or have had an irregular Pap test in the previous three years, screenings are covered every 24 months. Those between the ages of 30 and 65 are also eligible for a human papillomavirus (HPV) test every five years.

 

Screenings for colorectal cancer

Part B includes a number of colorectal cancer diagnostic examinations, including:

 

• Barium enemas for screening every 48 months (for those over 50) or every 24 months (for those under 50). (high risk)

• Versatile sigmoidoscopies for screening every 48 months (for most people over 50) and 120 months after a screening colonoscopy

• Every three years, multi-target stool DNA tests

• Every 12 months, screening fecal occult blood tests

• Colonoscopies every 24 months for high-risk patients, every 120 months for normal-risk patients, and every 48 months after a versatile sigmoidoscopy for normal-risk patients.

 

Screenings for lung cancer

Low-dose computer tomography (LDCT) screenings are covered once a year for beneficiaries who meet any of the following criteria:

 

• Have a smoking history of 30 or more pack-years (averaged one pack per day for 30 years)

• Your doctor has written you a prescription for the screening

• Age 55 to 77

• No signs of lung cancer

• Smoke now or have quit within the last 15 years

 

Also Read: Understanding Medicare Part A and Part B (Original Medicare)

 

Mammograms

Part B includes a baseline mammogram for women aged 35 to 39, as well as annual diagnostic mammograms for women over 40. Diagnostic mammograms are covered more often if they are considered medically essential. However, you are responsible for 20% of the Medicare-approved number, as well as the Part B yearly deductible.

 

Screenings for prostate cancer

Prostate cancer scans are available to men over the age of 50 who meet the following criteria:

 

• The prostate-specific antigen (PSA) blood test is free of charge to you.

• If you get the automated rectal exam in your doctor's office, it will cost you 20% of the Medicare-approved amount plus the Part B deductible. You must pay a co-payment if you receive the screening in a hospital outpatient setting.

 

Screenings for Chronic Conditions

The earlier you discover chronic conditions, the easier they are to treat. In addition, treatment is typically more successful, too.

If you’re eligible, Medicare Part B covers a wide array of screenings to detect chronic conditions.

• Bone mass measurements: are more often ordered when your doctor believes you have osteoporosis or are at risk of developing it.

• HIV screenings: Whether you're 15 to 65 years old or at high risk for HIV, you're eligible for annual HIV tests. Throughout their pregnancy, pregnant women are compensated for three screenings.

• Cardiovascular disease screenings: Every five years, all Part B recipients are eligible for blood testing to assess cholesterol, lipid, and triglyceride levels. If your doctor recommends these tests, it means he or she is looking for a condition that puts you at risk of a heart attack or stroke.

• Abdominal aortic aneurysm screening: If you are a male aged 65 to 75 who has smoked at least 100 cigarettes during your lifetime, you qualify for this screening. Aortic aneurysms are most common in patients with cardiovascular disease.

• Screening for depression: This screening is included in your yearly health appointment and is covered annually. It needs to happen in a primary care environment.

 

Also Read: Tips on How To Choose A Primary Care Doctor

 

• Hepatitis C screenings: Whether you had a blood transfusion before 1992, were born between 1945 and 1965, or are at high risk for Hepatitis C due to intravenous drug use, Medicare would cover a single screening.

• Diabetes screenings: Whether you've been diagnosed with pre-diabetes or your doctor thinks you're at risk for diabetes, Part B includes up to two screenings a year. High blood pressure, a history of elevated cholesterol or triglyceride levels, historically high blood sugar, and obesity are all qualifying risk factors. In addition, delivering a baby weighing 9 pounds or more counts, as does having a family history or personal history of gestational diabetes.

• Glaucoma screenings: If you match at least one of the following, you're eligible for annual glaucoma testing: diabetic, have a family history of glaucoma, are African American or Hispanic, and are 50 years or older.

 

Preventive Shots Covered by Medicare Part B

In addition to preventive screenings, Part B covers certain immunizations. These include:

 

• Pneumococcal vaccinations: You are eligible for two pneumococcal vaccinations if the second one is provided at least 12 months after the first.

• Flu shots: You get one flu shot per flu season under Medicare Part B.

• Hepatitis B shots: You qualify for Hepatitis B shots if you’re either medium or high risk for the disease. To qualify, one of the following must be true for you: You have diabetes, hemophilia, or End-Stage Renal Disease (ESRD). You also qualify if you live with someone who has Hepatitis B or is a healthcare worker in frequent contact with bodily fluids.

 

Screenings and Counseling for a Healthy Lifestyle

Finally, Medicare Part B pays for a variety of programs aimed at assisting you in making lifestyle improvements that will enhance your overall health and wellbeing.

 

• If you have diabetes and have a written order from your doctor, you could be eligible for 10 sessions in a calendar year.

• If you have diabetes, renal failure, or have undergone a kidney transplant within the last three years, you might be eligible for nutrition therapy services.

• Obesity screenings and therapy: If your BMI is 30 or higher, you may be eligible for a dietary evaluation and counseling.

• Part B of the smoking and tobacco use prevention therapy program comprises eight sessions over the course of a year.

• Screenings and counseling for sexually transmitted infections (STIs) include chlamydia, gonorrhea, syphilis, and Hepatitis B whether you are pregnant or at high risk for an STI.

• Adults who use alcohol but are not alcohol-dependent are eligible for annual alcohol dependence screenings and therapy.

• Cardiovascular behavioral treatment: This appointment is usually covered once a year and requires a blood pressure check as well as general recommendations from the doctor on aspirin therapy and nutrition tips.

 

As always, call us to talk with a licensed agent if you have any concerns about your Medicare coverage.

 

 

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