Medicare preventive service benefits
Benefit, description of coverage, coinsurnace/deductible
Flu, Pneumococcal and Hepatitis B Vaccinations
- Flu vaccines are covered annually.
- Pneumococcal vaccinations may only be needed once, but additional vaccinations may be covered if patient is at high risk.
- Hepatitis B vaccinations are covered for persons at medium to high risk (e.g., persons with end stage renal disease, hemophiliacs, etc.).
Flu and pneumococcal vaccinations: No Part B coinsurance or deductible. Hepatitis B vaccinations: Part B coinsurance and deductible are applicable.
Mammogram Screening
- Annual coverage for female Medicare beneficiaries 40 years and older.
- Medicare also covers new digital technologies for mammogram screening.
Part B coinsurance applies, but no deductible.
Pap Smear and Pelvic Examination (includes clinical breast exam)
- Covered once every 24 months for all female Medicare beneficiaries.
- Annual coverage for women who are at high risk for cervical or vaginal cancer, or if childbearing age and have had an abnormal pap smear in the past 36 months.
Pap smear (clinical lab analysis): No Part B coinsurance or deductible. Pelvic examination: Part B coinsurance applies, but no deductible.
Prostate Cancer Screening
- Annual coverage for men 50 years and older.
- Digital Rectal Exam is covered annually.
- Blood Test: Prostate-Specific Antigen is covered annually.
Digital Rectal exam: Part B deductible and coinsurance applies. PSA Test: No Part B deductible or coinsurance.
Colorectal Cancer Screening
- Coverage for all Medicare beneficiaries age 50 and older, except there is no minimum age for having a colonoscopy.
- Flexible Sigmoidoscopy is covered every 48 months.
- Fecal Occult Blood Test is covered annually.
- Colonoscopy is covered every 24 months for beneficiaries with high risk of colon cancer.
- Barium enema can be used instead of flexible sigmoidoscopy or colonoscopy.
Fecal Occult Blood Test: No Part B deductible or coinsurance. Flexible sigmoidoscopy or colonoscopy: Beneficiary pays 25 percent of the Medicare approved amount if the test is done in a hospital outpatient department. All other tests: Part B deductible and coinsurance applies.
Diabetes Self-management and Glucose Monitoring
- Coverage for some Medicare beneficiaries who are at risk for complications from diabetes.
- Self-management training services in certified outpatient hospital setting or facilities.
- Glucose Monitoring Equipment (blood sugar monitors, Lancets and testing strips)
Part B deductible and coinsurance applies.
Bone Mass Measurements
- Coverage once every 24 months to measure bone mass, loss or quality for women at clinical risk for osteoporosis and others at risk for losing bone mass.
- Coverage more frequently if medically necessary.
Part B deductible and coinsurance applies.
