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Staying Healthy Medicare’s Preventive Services

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An easy and important way to stay healthy is to get disease prevention and early detection services. Disease prevention and early detection services can keep you from getting certain diseases or illnesses, or can find health problems early which is when treatment works best. Talk with your doctor or health care provider to find out what tests you need and how often you need them to stay healthy.

Heart disease, cancer, stroke and diabetes cause the most deaths of people with Medicare, but each disease can be prevented or treated more effectively when found earlier. The Centers for Medicare & Medicaid Services has joined the American Cancer Society, the American Diabetes Association, and the American Heart Association to help get the word out about the prevention and early detection services covered by Medicare. These groups have also joined together to start a public awareness campaign, “Everyday Choices for a Healthier Life,”™ which is focused on helping all Americans lower their risk of cancer, diabetes, heart disease, and stroke by taking charge of their everyday choices. To find out more about the “Everyday Choices” campaign or how to lower your risk for these four diseases, visit www.everydaychoices.org or call 1-866-399-6789.

Centers for Medicare & Medicaid Services

Medicare covers...
One-time “Welcome to Medicare” Physical Exam

Medicare covers a one-time review of your health, as well as education and counseling about the preventive services you need, including certain screenings and shots. Referrals for other care if you need it will also be covered.

You must have the exam within the first six months you have Medicare Part B.

Cardiovascular
Screenings

Ask your doctor to test your cholesterol, lipid and triglyceride levels so he or she can help you prevent a heart attack or stroke.

Medicare covers tests for cholesterol, lipid, and triglyceride levels every five years.

Screening Mammograms These tests check for breast cancer before you or your doctor may be able to feel it. Medicare covers mammograms once every 12 months for all women with Medicare age 40 and older.
Pap Test and Pelvic Exam (includes clinical breast exam) These exams check for cervical and vaginal cancers. Medicare covers these exams every 24 months for all women with Medicare and once every 12 months for women with Medicare at high risk.
Smoking Cessation (counseling to stop smoking) Provided at any provider site if ordered by your doctor. It includes up to eight face-to-face visits during a 12-month period if you are diagnosed with a smoking-related illness or are taking medicine that may be affected by tobacco.
Colorectal Cancer Screening

These tests help find colorectal cancer early, when treatment is most effective.

If you are age 50 or older, or are at high risk for colorectal cancer, one or more of the following tests is covered: Fecal Occult Blood Test, Flexible Sigmoidoscopy, Screening colonoscopy, and/or barium enema. How often Medicare pays for these tests is different depending on the test you and your doctor decide is best and your level of risk for this cancer.

Flu Shots

These shots help prevent influenza, or flu virus.

Medicare covers these shots once a flu season in the fall or winter for all people with Medicare.

Prostate Cancer
Screening

These tests help find prostate cancer.

Medicare covers a digital rectal exam and Prostate Specific Antigen (PSA) test once every 12 months for all men with Medicare over age 50.

Pneumococcal Shot This shot helps prevent pneumococcal infections. Medicare covers this shot for all people with Medicare. Most people only need this shot once in their lifetime. Talk with your doctor.
Hepatitis B Shots

These three shots help protect people from getting Hepatitis B.

Medicare covers these shots for people with Medicare at high or medium risk for Hepatitis B.

Bone Mass Measurements

These measurements help determine if you are at risk for broken bones.

Medicare covers these measurements once every 24 months (more often if medically necessary) for people with Medicare at risk for osteoporosis.

Diabetes Screenings

Medicare covers tests to check for diabetes. These tests are available if you have any of the following risk factors: high blood pressure, dyslipidemia (history of abnormal cholesterol and tryglyceride levels), obesity, or a history of high blood sugar. Medicare also covers these tests if you have two or more of the following characteristics:

• age 65 or older,
• overweight,
• family history of diabetes (parents, brothers, sisters), and
• a history of gestational diabetes (diabetes during pregnancy), or delivery of a baby weighing more than 9 pounds.

Based on the results of these tests, you may be eligible for up to two diabetes screenings every year. Talk to your doctor for more information.

Glaucoma Tests These tests help find the eye disease glaucoma. Medicare covers these tests once every 12 months for people with Medicare at high risk for glaucoma.

For some of these services, you might have to pay a deductible, coinsurance and/or copayment. These amounts vary depending on the type of services you need and the kind of Medicare health plan you have.

For more details about Medicare’s coverage of these preventive services, including your costs in the Original Medicare Plan, get a free copy of the Guide to Medicare’s Preventive Services (CMS Pub. No. 10110) at www.medicare.gov on the web. Select “Publications.” Or, call 1-800-MEDICARE (1-800-633-4227) and ask for a copy. TTY users should call 1-877-486-2048.

This publication was developed in cooperation with the American Cancer Society, American Diabetes Association and American Heart Association.

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CMS Pub. No. - 11100 Revised September 2006

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