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MAke the Most of Medicare's Covered Screenings and Shots (online only)

November 2010

By Bob Moos

Medicare covers a broad range of exams, lab tests and screenings to detect health problems early, when they’re most treatable or curable. It also pays for a number of immunizations to help beneficiaries avoid diseases or illnesses and stay healthy.  Prevention is becoming a bigger part of Medicare.

Beneficiaries are entitled to a preventive physical exam during the first 12 months they’re enrolled in the Part B medical insurance program.  It’s known as a “Welcome to Medicare” exam.

Beneficiaries can make the most of their visit by coming prepared. That means bringing a complete list of their prescription and over-the-counter drugs and their medical records, including their immunizations. They should also have their family health history, with any details that would suggest risks for certain conditions.

During the exam, the physician evaluates the patient’s health, discusses any preventive services that may be needed, such as shots or screenings, and makes referrals for more care if required. The doctor also measures height, weight and blood pressure. The exam doesn’t include lab tests.

Beneficiaries on original Medicare pay 20 percent of the Medicare-approved amount for their Welcome to Medicare visit, but the annual Part B deductible is waived for this one-time exam.

Keeping up-to-date with screenings and immunizations is important, so Medicare encourages beneficiaries to visit mymedicare.gov and sign up. There, they can see a description of their covered preventive services, the last date they had a particular test and the next date they’re eligible for it again.

Here’s a rundown of some of Medicare’s preventive services and how original Medicare and its beneficiaries divide the cost.  Medicare Advantage plans may pay differently.

Cardiovascular screenings check cholesterol and other blood fat levels. Medicare pays for the test once every five years. There’s no out-of-pocket expense.

n  Blood sugar screenings check for diabetes. Based on their health, beneficiaries may be eligible for up to two screenings per year. Medicare covers the full Medicare-approved amount for the test.

Glaucoma tests are available for people at high risk for the eye disease. Medicare pays 80 percent of the approved amount for an annual test. Beneficiaries are responsible for the other 20 percent, after meeting their deductible.

Immunizations. Medicare covers flu, pneumococcal and Hepatitis B shots. Beneficiaries pay nothing for the flu or pneumococcal shots. People at risk for Hepatitis B pay 20 percent, after the deductible, for those immunizations.

Mammograms check for breast cancer. Medicare covers a screening every 12 months for women  40 and older and one baseline screening for women 35 to 39. Beneficiaries pay 20 percent of the approved amount.

Prostate cancer screenings consist of a yearly digital rectal exam and PSA test for men 50 and older. Beneficiaries are responsible for 20 percent for the rectal exam, after meeting their deductible. There are no out-of-pocket costs for the PSA test.

In addition to these tests and shots, Medicare covers eight counseling sessions each year for beneficiaries with a smoking-related disease or on medications affected by tobacco use. During the one-on-one sessions, a physician or other qualified practitioner helps the smoker quit.

For more about Medicare’s preventive services, visit the Medicare Web site at medicare.gov or call Medicare’s 24-7 customer service line at 1-800-633-4227. A Medicare publication, titled “Medicare’s Preventive Services,” can also be downloaded from the Web site or requested by phone.

Bob Moos is the Southwest regional public affairs officer for the Centers for Medicare & Medicaid Services