When it comes to staying healthy, Medicare has your back with a range of preventive and screening services. However, it’s important to note that not all services are fully covered.
Here’s a comprehensive guide to help you navigate Medicare’s preventive care offerings and potential costs.
Free Preventive Services Through Medicare Part B
For most beneficiaries, Medicare’s preventive services offered through Part B come completely free of charge – no copays or deductibles.
These services, which include a wide range of health exams and immunizations, are accessible to everyone who qualifies. Mammograms, colonoscopies, flu shots, pneumonia shots, COVID-19 vaccinations, hepatitis B vaccinations, screenings for diabetes, depression, osteoporosis, HIV, different cancers, and cardiovascular disease, as well as counseling for obesity, alcoholism, and smoking, are all part of this extensive list.
To avail of these services at no cost, it’s essential to visit a doctor who accepts Medicare on assignment. This means the healthcare provider agrees to the Medicare-approved rate as full payment.
However, there’s a caveat. These tests are free only when administered at specific intervals. For instance, cardiovascular screening blood tests are recommended once every five years, while colonoscopies are advised every 10 years, or every two years if you’re at high risk.
Medicare also offers a complimentary “Welcome to Medicare” exam in your first year of enrollment, along with annual “Wellness” visits thereafter.
It’s crucial to differentiate these from comprehensive physical examinations; they focus primarily on prevention and provide an overview of your health and medical risk factors, acting as a foundation for future care.
While most preventive services are covered without cost sharing, a handful of services do require some out-of-pocket expenses.
For these services, you’ll be responsible for paying 20% of the service’s cost after meeting the $226 Part B yearly deductible.
These services include glaucoma tests, diabetes self-management trainings, barium enemas for colon cancer detection, and digital rectal exams for prostate cancer detection.
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Medicare Advantage Plans and Preventive Services
If you’re enrolled in a Medicare Advantage (Part C) plan, your plan is obligated to cover the same preventive services as original Medicare, as long as you seek treatment from in-network providers.
Potential Costs and Facility Fees
It’s important to understand that while most preventive services are cost-free, you might incur charges for certain diagnostic services or additional tests related to the preventive service.
For instance, if your doctor identifies and removes a polyp during your preventive colonoscopy screening, you’ll be responsible for 15% of the doctor’s service fee.
Similarly, if your annual wellness visit results in the need for further investigation or treatment, you might face additional charges.
Moreover, depending on where you receive the service, a facility fee might apply. Certain hospitals, for instance, often impose separate facility fees for preventive services.
Additionally, if you meet with a physician before or after the service, you could incur charges for the doctor’s visit.
To avoid unexpected bills, it’s advisable to consult your doctor before undergoing any preventive service procedure.
Discuss whether there might be charges and what those charges could entail. Being well-informed can help you make the most of Medicare’s preventive services while minimizing any financial surprises.
For a comprehensive list of services and their eligibility requirements, you can visit Medicare.gov/coverage/preventive-screening-services.
By understanding Medicare’s preventive care offerings and potential costs, you can prioritize your health while making informed decisions about your medical care.
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