Preventive services covered by Medicare plans

A summary of the preventive health care services that are covered for Priority Health Medicare members. See your Evidence of Coverage document for complete details.

Abdominal aortic aneurysm (AAA) screening

Who's covered: Medicare members with certain risk factors for AAA

When: Once in a lifetime, with a referral from your doctor

Alcohol screening and counseling

Who's covered: All Medicare members

When: Annually

If you screen positive for alcohol misuse, you can get up to 4 brief face-to-face counseling visits per year (you must be competent and alert during counseling).

Annual preventive physical exam

Who's covered: All Medicare members

When: Annually

Annual wellness visit

Who's covered: All Medicare members

When: Annually

Bone mass measurements

Who's covered: Medicare members at risk of losing bone mass or for developing osteoporosis

When: Every 2 years, or more often if medically necessary

Breast cancer screening (clinical breast exams & mammograms)

Breast exams & mammograms

Who's covered: All female Medicare members age 35 and older

When:

  • Breast exams - every 24 months
  • Screening mammograms - one baseline at 35-39 years old, annually 40+

Cardiovascular disease risk reduction visit

Who's covered: All Medicare members

When: Annually

Cardiovascular disease testing

Who's covered: All Medicare members

When: Once every 5 years, when ordered by a doctor

Cervical (Pap test) & vaginal (pelvic) cancer screening

Who's covered: All female Medicare members

When:

  • Pap tests & pelvic exams - every 2 years
  • Pap tests annually if at high risk of cervical cancer or if you've had an abnormal Pap test within the past 3 years and are of childbearing age

Colorectal cancer screening

Who's covered: All Medicare members age 50 and older, but there is no minimum age for having a covered screening colonoscopy

Consult with your physician on the screening you need: Guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), DNA-based colorectal screening, flexible sigmoidoscopy, colonoscopy, barium enema, Cologuard

Depression screening

Who's covered: All Medicare members

When: Annually

Diabetes screening

Who's covered: Medicare members at risk

When: Up to 2 tests per year with referral from your doctor

Diabetes self-management training (DSMT)

Who's covered: Medicare members with diabetes

When: As prescribed by your doctor

Glaucoma screening

Who's covered: Medicare members with diabetes or a family history of glaucoma, or who are African-Americans age 50 or older, or Hispanic-Americans age 65 or older

When: Annually

Hepatitis C screening test

Who's covered: Medicare members at high risk due to: current or history of illicit drug use or blood transfusions before 1992 or born between 1945-1965

When: Once per lifetime or annually for certain people at risk

HIV screening

Who's covered: All Medicare members who ask for an HIV screening test or who are at increased risk for HIV infection.

When: One screening exam every 12 months. For women who are pregnant, up to 3 times during a pregnancy.

Immunizations

Who's covered: All Medicare members. 

When:

  • Pneumococcal (pneumonia) - Two per lifetime
  • Influenza (flu) - Each flu season in the fall and winter, with additional flu shots if medically necessary
  • Hepatitis B - If you are at high or intermediate risk
  • Other vaccines if you are at risk and they meet Medicare Part B coverage

Lung cancer screening

Who's covered: Medicare members who meet all of these criteria:

  • Age 55-77
  • Asymptomatic and do not have symptoms of lung cancer
  • Current smoker or quit smoking in the last 15 years
  • Have tobacco smoking history of at least 30 "pack years" (average of 1 pack/day for 30 years)

When: Annually, when ordered by your doctor

Medical nutrition therapy

Who's covered: Medicare members who have a referral from their treating physician and have been diagnosed with diabetes or renal disease, or who have had a kidney transplant within the last three years.

When: 3 hours of one-on-one counseling the first year; 2 hours in subsequent years. 

Obesity screening & therapy to promote sustained weight loss

Who's covered: Medicare members with BMI greater than 30

When: Consult with your physician

Prostate cancer screening

Who's covered: All male Medicare members age 50 or older

When: Annually for a digital rectal exam and prostate specific antigen (PSA) test

Sexually transmitted infections (STIs), screening & counseling

Who's covered: Medicare members at risk for STIs, or pregnant women

When: Every 12 months or at certain times during pregnancy

Smoking & tobacco use cessation (quit) counseling

Who's covered: All Medicare members

When: Up to 8 visits in a 12-month period

Welcome to Medicare preventive visit

Who's covered: All Medicare members

When: Within the first 12 months you have Medicare Part B