Preventive care for MPSERS Medicare members
Here's a summary of the preventive tests, screenings, vaccinations and exams that Medicare covers at no cost to you. For complete details, Medigap members should reference your Certificate of Coverage.
Preventive vs. diagnostic tests
Remember, the services listed here are only preventive when you have no symptoms—if your doctor orders a test or screening because you are having symptoms, the test is "diagnostic." That means you will have to pay a share of the cost.
Abdominal aortic aneurysm (AAA) screening
Who is covered: Medicare members with certain risk factors for AAA.
When: Once in a lifetime, with a referral from your doctor.
Alcohol misuse screening and counseling
Who is covered: All Medicare members
When: Annually
If you screen positive for alcohol misuse, you can get up to four in-person counseling visits per year (you must be alcohol free during counseling).
Annual Wellness Visit
Who is covered: All Medicare members; If you've had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly "Wellness" visit to develop or update a personalized prevention plan based on your current health and risk factors
When: Annually
Bone mass measurement
Who is covered: Medicare members who are at risk of losing bone mass or at risk of osteoporosis
When: Once every 24 months or more frequently if medically necessary
Breast cancer screening (breast exams and mammograms)
Who is covered: All female Medicare members
When: Breast exams: Every 24 months
Screening mammograms: One baseline at 35-39 years old, annually 40+
Cardiovascular disease risk reduction visit
Who is covered: All Medicare beneficiaries without apparent signs or symptoms of cardiovascular disease
When: Annually
Cardiovascular disease screening
Who is covered: All Medicare members
When: Once every 5 years, when ordered by a doctor
Cervical (Pap test) and vaginal (pelvic) cancer screening
Who is covered: All female Medicare members
When: Pap test & pelvic screenings: Every 2 years
Pap test 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 is covered: All Medicare members age 50 and older, but there is no minimum age for having a covered screening colonoscopy.
When: 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 is covered: All Medicare members
When: Annually
Diabetes screening
Who is covered: Medicare members at risk
When: Up to 2 tests per year with referral from your doctor
Diabetes self-management training (DSMT)
Who is covered: Medicare members with diabetes
When: As prescribed by your doctor
Frequency: Initial year: Up to 10 hours of initial training within a continuous 12-month period
Subsequent years: Up to 2 hours of follow-up training each calendar year after the initial 10 hours of training has been completed
Glaucoma screening
Who is covered: Medicare members with diabetes or a family history of glaucoma, African-Americans age 50 or older, and Hispanic-Americans age 65 or older
When: Annually
Hepatitis B Virus (HBV) infection screening
Who is covered: Medicare covers HBV infection screenings if you meet certain conditions
When: Annually
Hepatitis C (HCV) screening
Who is covered: Medicare members at high risk due to: Current or past history of illicit drug use, or blood transfusions prior to 1992, or born between 1945-1965
When: Once per lifetime, or annually for certain people at risk
HIV screening
Who is covered: All Medicare members between the ages of 15 and 65. Those at an increased risk less than age 15 or older than age 65.
When: Annually or up to 3 times during a pregnancy
Immunizations (flu, pneumococcal, and Hepatitis B)
Flu shots
Who is covered: All people with Medicare
When: Once each flu season
Pneumococcal shots
Who is covered: All people with Medicare
When: Most people only need one shot once in their lifetime. A different, second shot, is covered 11 months after you get the first shot. Talk with your doctor or other qualified health care provider to see if you need these shots.
Hepatitis B shots
Who is covered: Members who are at medium or high risk for Hepatitis B
When: Three shots are needed for complete protection. Check with your doctor about when to get these shots if you qualify to get them.
Lung cancer screening
Who is covered: Medicare members who meet all of these criteria:
- Age 55-77
- Asymptomatic and do not have symptoms of lung cancer
- Current smoker/quit smoking in the last 15 years
- Have a 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 (MNT)
Who is covered: Medicare members diagnosed with diabetes or a renal disease or who have had a kidney transplant within the last 3 years
When: As ordered by your physician
Medicare Diabetes Prevention Program (MDPP)
Who is covered: Medicare members that could prevent or delay type II diabetes.
When: Once per lifetime
Obesity screening and therapy to promote sustained weight loss
Who is covered: Medicare members with BMI greater than 30
When: Consult with your physician; Medicare covers behavioral therapy sessions to help you lose weight. This counseling may be covered if you get in a primary care setting (like a doctor's office), where it can be coordinated with your other care and a personalized prevention plan.
Prostate cancer screening
Who is 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 and counseling
Who is covered: Medicare members at increased risk for STIs, or pregnant women
When: Every 12 months, or at certain times during pregnancy
Smoking and tobacco use cessation (quit) counseling
Who is covered: All Medicare members who use tobacco
When: Up to 8 visits in a 12-month period
Welcome to Medicare preventive visit
Who is covered: All Medicare members
When: Within the first 12 months you have Medicare Part B
Priority Health has HMO-POS and PPO plans with a Medicare contract. Enrollment in Priority Health Medicare depends on contract renewal. This information is not a complete description of benefits. Call 888.389.6648, option 3 (TTY users call 711) for more information.
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