Preventive Services: What’s Covered Under Original Medicare and Medicare Advantage Plans?Posted by Medicare Made Clear
Preventive services are health care services designed to prevent illness or detect illness at an early stage, when treatment is likely to work best. Examples of preventive services include Pap tests, flu shots, and screening mammograms.
Both Original Medicare and Medicare Advantage (Part C) plans cover some preventive services. In fact, Medicare Advantage plans are required to cover everything that Original Medicare covers, and some offer additional benefits as well. Original Medicare Part B helps you pay for doctor visits and outpatient care, including preventive services. Original Medicare Part A helps pay for inpatient care. You must have both Part A and Part B in order to enroll in a Medicare Advantage plan.
When comparing the preventive services covered by Medicare Advantage plans in your area with those covered by Original Medicare, it’s important to remember that Original Medicare provides the same benefits to all beneficiaries nationwide. Medicare Advantage plans are offered by private insurance companies. Covered services (beyond what Medicare requires), the costs for services and sometimes which providers are covered to perform the services can vary from plan to plan.
“Welcome to Medicare” Exam
When you first join Medicare Part B, you will receive a “Welcome to Medicare” exam. This is a one-time exam and is free of charge if your doctor accepts Medicare assignment. During your “Welcome to Medicare” visit, your doctor will:
- Record your medical history.
- Check your height, weight and blood pressure.
- Calculate your body mass index.
- Give you a simple vision test.
Your doctor will also counsel you about what you can do to improve your health and to help prevent disease. You will receive a checklist that will tell you what screenings and preventive services you need.
Yearly Wellness Visit
Starting in 2011, if you have had Medicare Part B for longer than 12 months, you will be able to have a yearly wellness visit free of charge. This visit is a time for you and your doctor to develop, review or update your personal prevention plan based on your current health status and needs. If you just joined Part B and had a “Welcome to Medicare” exam, you must wait a full 12 months before your first wellness visit. If you have Part B and have never had a “Welcome to Medicare” exam, you can still have yearly wellness visits.
Covered Preventive Services
Medicare covers many screenings and other preventive services and each is available on a particular schedule. For example, you can get a flu shot every year. Yearly mammograms and prostate cancer screenings are also covered. Coverage for some screenings requires a doctor’s recommendation. Examples include glaucoma tests and bone mass measurements. Also, you may have to pay a copay or coinsurance for certain preventive services.
You can see the entire list of Medicare-covered preventive services in Your Guide to Medicare’s Preventive Services. This guide also explains who is covered, how often you can have each service and how much you have to pay, if anything. There is also a helpful Preventive Services Checklist in the back that you can use to prepare for your doctor visits.
You may want to check into Medicare Advantage plans offered in your area to see what preventive services are offered beyond what Medicare Part B covers. You can also look into Medicare Supplement Insurance plans that may help pay for services that Original Medicare doesn’t.
For more information contact the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact UnitedHealthcare® Medicare Made Clear to learn more at 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, 7 days a week.
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