What Does ‘Preventive Services’ Mean for Medicare Coverage?
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Medicare doesn’t only cover the medically necessary services you need when you’re sick. It also covers a range of preventive services that can prevent or detect early-stage medical issues.
Medicare Part B covers most Medicare preventive services, such as screenings, tests and vaccines. And most preventive services are covered with no out-of-pocket costs.
Here’s what you need to know about Medicare coverage for preventive services.
What are Medicare preventive services?
“Preventive services help you stay healthy, detect health problems early, determine the most effective treatments and prevent certain diseases,” according to Medicare.gov.
Most preventive services fall under Medicare Part B, which generally covers outpatient health care.
Under Original Medicare, you’ll need to sign up and pay for Medicare Part B to be covered for preventive services. If you have Medicare Advantage, plans are required to cover at least as much as Original Medicare, so you’re also covered for preventive care.
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What preventive services are covered by Medicare?
Medicare preventive services can include, for example, certain vaccines, exams, screenings, laboratory tests, health monitoring and counseling.
Medicare also covers a one-time Welcome to Medicare doctor’s office visit in the first 12 months after you get Medicare Part B.
Here are some examples of preventive services covered by Medicare Part B:
Screening colonoscopies (you may need to pay coinsurance for additional services like polyp removal or barium enemas).
Certain preventive services are covered only for people that meet certain criteria for risk, such as a certain biological sex or risk factors for a condition. For example, glaucoma tests are covered only for people at high risk for glaucoma, and annual mammograms are covered for women age 40 or older.
The Centers for Medicare & Medicaid Services (CMS) publishes a Guide to Medicare Preventive Services that describes whether and for whom Medicare covers individual preventive services.
What do Medicare preventive services cost?
Whether you have Original Medicare or Medicare Advantage, you’re responsible for the Medicare Part B premium: $174.70 per month in 2024. (You might pay more than this standard premium if your income exceeds certain thresholds.)
But for most preventive services, you won’t have any additional out-of-pocket costs, as long as you get services from a health care provider who accepts Medicare assignment, according to Medicare.gov.
Preventive services are a special case. If you have Medicare Part B, most other covered services generally have a 20% coinsurance. You’d be responsible for that 20% unless you have a Medicare Supplement Insurance (Medigap) plan to cover it for you.
If you have Medicare Advantage, out-of-pocket costs vary by plan. Check your plan materials to see what you might owe for covered services.
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