Medicare Preventive Services

After you have enrolled with Medicare, your coverage includes a one-time intial physical exam. You are also entitled to screening test for diabetes and heart disease.

Medicare Initial Physical Exam:
If your Medicare Part B coverage began on or after January 1, 2005, Medicare will cover a one-time initial preventive physical exam. This "Welcome to Medicare" exam must occur within the first six months that you have coverage.

The exam will include:
A health evaluation
Information about the preventive services you may need like screenings, tests and shots
 Additional care referrals, if you need it. (You will need to pay 20% of the Medicare-approved amount after your yearly Part B deductible for this service.)

Your doctor will review your medical history, record your weight and height and check your blood pressure. You may also be given an electrocardiogram that records the condition of your heart. Your vision may be checked and your doctor will make sure that you are current with all your shots.

You will also be given information on how to maintain and improve your health and how to prevent heart disease. If your doctor believes that you need additional care, you will be given information so that you will know what additional tests or health services you might need.

To be prepared for your exam, you should take the following items to your appointment:
A list of prescription drugs that you currently take
Medical records (if you are seeing a new doctor)
Family health history information and any details you can give your doctor to help determine if you are at risk for specific diseases

Screenings for Heart Disease:
Medicare covers screenings for heart disease, also known as a cardiovascular screenings, which check your cholesterol level and other blood fat (lipid) levels. Medicare will pay for these tests every five years. You do not have to pay coinsurance or the Part B deductible for this screening.

Diabetes Screening:
 If you are at risk for getting diabetes, Medicare also covers a blood sugar screening to check for diabetes.

 You are considered at risk for diabetes if you have any of the following:
High blood pressure
Dyslipidemia (history of abnormal cholesterol and triglyceride levels)
Obesity or a history of high blood sugar

Depending on your health, Medicare may pay for up to two screenings each year. Also, you will not have to pay coinsurance or the Part B deductible for this screening. Medicare may also cover certain supplies (for example, glucose testing monitors and strips) and training so that you can better manage self-administered treatments (for example, insulin shots).

Cancer Tests:
Breast Cancer Screening (Mammograms): Breast cancer is the most common non-skin cancer in women and the second leading cause of cancer death in women in the United States. Every woman is at risk, and this risk increases with age. Breast cancer can usually be successfully treated when found early. Medicare covers screening mammograms and digital technologies for screening mammograms to check for breast cancer before you or a doctor may be able to feel it.

Cervical and Vaginal Cancer Screening (Pap Test and Pelvic Exam): Medicare covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer.

A Pap test and pelvic exam are covered by Medicare once every 24 months. However, if you are of childbearing age and have had an abnormal Pap test within the past 36 months, or if you are at high risk for cervical or vaginal cancer, Medicare will cover a Pap test and pelvic exam every 12 months.

Colon Cancer Screening (Colorectal): Colorectal cancer is usually found in people age 50 or older, and the risk of getting it increases with age. Medicare covers colorectal screening tests to help find pre-cancerous polyps (growths in the colon) so they can be removed before they turn into cancer. Treatment works best when colorectal cancer is found early.

Prostate Cancer Screening (PSA): Prostate cancer can often be found early by testing the amount of PSA (Prostate Specific Antigen) in your blood. Another way prostate cancer is found early is when your doctor performs a rectal exam. Medicare covers both of these tests so that prostate cancer can be detected and treated early. PSA and rectal exams are covered yearly.

Shots:
Flu: The flu can cause fever, chills, headache, dry cough, runny or stuffy nose, sore throat, and muscle aches. Unlike other common respiratory infections such as the common cold, influenza can cause extreme fatigue lasting several days to more than a week. Although nausea, vomiting and diarrhea can sometimes accompany influenza infection, especially in children, gastrointestinal symptoms are rarely prominent. The illness that people often call "stomach flu" is not influenza.

Pneumococcal Pneumonia: The groups at higher risk for invasive pneumococcal disease include those over 64 years old and others with increased susceptibility to this infection, such as patients with HIV, splenectomy, sickle cell disease, diabetes mellitus, chronic disorders of the lungs or heart, and cirrhosis. You can receive this vaccination on the same day that you get the flu shot, and for those covered under Medicare Part B, it is also free when ordered by a physician. However, the pneumococcal vaccine can be given at any time of year and is a once-in-a-lifetime vaccination for most people.

Hepatitis B: Three shots are needed for complete protection. Check with your doctor about when to get these shots if you qualify to get them. Common risk factors for Hepatitis B are hemophilia, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) or a condition that lowers your resistance to infection.

Measurement of Bone Mass: Medicare covers bone mass measurements to determine whether you are at risk for a fracture (broken bone). People are at risk for fractures because of osteoporosis. Osteoporosis is a disease in which your bones become weak. The lower your bone density, the higher your risk is for a fracture. Bone mass measurement test results will help you and your doctor choose the best way to keep your bones strong. Typical coverage is for tests every 2 years.

Glaucoma Tests: Glaucoma is an eye disease caused by high pressure in the eye. It can cause you to gradually lose sight without warning and often without symptoms. The best way for people at high risk for glaucoma to protect themselves is to have regular eye exams. Medicare covers a glaucoma exam once a year.

Help to Quit Smoking: People with Medicare who are diagnosed with a smoking-related disease, including heart disease, cerebrovascular disease (stroke), multiple cancers, lung disease, weak bones, blood clots, and cataracts can get coverage for smoking and tobacco use cessation counseling. These diseases account for the bulk of Medicare spending today. People with Medicare who take any of the many medications whose effectiveness is complicated by tobacco use including - insulin and some medicines for high blood pressure, blood clots, and depression are also eligible for the counseling. Medicare will cover up to eight face-to-face visits during a 12-month period. These visits must be ordered by your doctor and provided by a qualified doctor or other Medicare-recognized practitioner.

Medical Nutrition Therapy: Medical nutrition therapy services are also covered for people with diabetes or renal disease when referred by a doctor. These services can be given by a registered dietitian or Medicare-approved nutrition professional and include a nutritional assessment and counseling to help you manage your diabetes or kidney disease.

Abdominal Aortic Aneurysm (AAA): Abdominal Aortic Aneurysm (AAA) is a vascular disease with life-threatening implications. If you have a family history of abdominal aortic aneurysm or have smoked at least 100 cigarettes in your lifetime, you are considered at risk.