Medicare's preventive services represent one of the program's most valuable yet underutilized benefits. These services—including wellness visits, screenings, and vaccines—are covered at 100% with no deductible, copay, or coinsurance when provided by Medicare-participating providers who use the correct billing codes. Taking advantage of these free preventive benefits helps you stay healthy, detect problems early when they're most treatable, and potentially avoid expensive medical care down the road.
Welcome to Medicare Preventive Visit
The Welcome to Medicare preventive visit is a one-time initial review available during your first 12 months of Medicare Part B coverage. This comprehensive visit establishes a baseline of your health status and creates a prevention plan personalized to your needs and risk factors. When you schedule this appointment, specifically tell your doctor's office you want to schedule your Welcome to Medicare preventive visit to ensure proper billing.
During this visit, your provider reviews your medical and social history, including risk factors for depression and other mood disorders. You'll receive a review of your current medications and supplements, along with education about their proper use. Your provider discusses advance directives and end-of-life planning if you wish. You'll receive a written prevention plan outlining recommended screenings and preventive services based on your health status and risk factors.
The visit includes measuring your height, weight, blood pressure, body mass index, and vision screening. You'll undergo a simple cognitive impairment assessment. Your provider screens for safety issues including fall risk. Education and counseling about preventive services are also included.
This visit is covered at 100% when your doctor accepts Medicare assignment and doesn't perform other services during the same visit. If your provider performs additional tests or services not covered under the Welcome to Medicare visit, you may owe deductibles, coinsurance, or copays for those additional services. Always clarify exactly what will be included in your visit and whether additional services might generate separate charges.
Annual Wellness Visits: Free Yearly Check-Ups
After your first year on Medicare Part B, you're eligible for an Annual Wellness Visit every 12 months. Unlike the Welcome to Medicare visit, you can have an Annual Wellness Visit every year throughout your time on Medicare. This visit focuses on prevention and helping you stay healthy rather than diagnosing or treating illness.
Your first Annual Wellness Visit cannot occur within 12 months of your Welcome to Medicare visit, but subsequent Annual Wellness Visits can occur every 12 months thereafter. These visits include updating your health risk assessment, reviewing your medical and family history, creating or updating a personalized prevention plan, listing current providers and medications, and measuring height, weight, blood pressure, and other routine vital signs.
The visit includes cognitive impairment detection through direct observation and a brief cognitive assessment, falls risk screening, depression screening, and functional ability and safety assessments. Your provider discusses advance care planning if desired and provides education and counseling about preventive services you should receive.
Annual Wellness Visits are covered at 100% with no cost-sharing when provided by Medicare-participating providers. However, these visits don't include physical examinations or diagnostic services. If during your Annual Wellness Visit your provider detects a problem and performs diagnostic services or treatment, those additional services aren't covered under the Annual Wellness Visit benefit and may result in charges subject to your Part B deductible and 20% coinsurance.
To maximize value from Annual Wellness Visits, come prepared with questions about your health and prevention strategies, bring an updated list of all medications and supplements, discuss any health concerns or changes since your last visit, and ask about recommended screenings based on your age and risk factors. Schedule your Annual Wellness Visit as a standalone appointment, not combined with sick visits or problem-focused appointments, to avoid confusion about billing and potential charges for services beyond the wellness visit.
Cancer Screenings Covered by Medicare
Medicare covers numerous cancer screenings at 100% with no cost-sharing, helping detect cancer early when treatment is most effective. Mammograms for breast cancer screening are covered annually for women age 40 and older, with no cost-sharing for the screening mammogram itself. Baseline mammograms are covered once for women ages 35-39. If a mammogram finds an abnormality requiring a diagnostic mammogram, the diagnostic test is subject to Part B deductible and coinsurance.
Cervical and vaginal cancer screening includes Pap tests and pelvic exams covered once every 24 months for all women, or annually for women at high risk for cervical or vaginal cancer or women of childbearing age who've had abnormal Pap tests in the prior three years. Human papillomavirus (HPV) testing is covered every five years with Pap tests for women ages 30-65 without symptoms.
Colorectal cancer screening is covered beginning at age 45 through several methods: colonoscopy every 10 years (every 24 months if high risk), flexible sigmoidoscopy every 48 months, screening barium enema as alternative every 48 months, or fecal occult blood test annually. Medicare also covers multi-target stool DNA tests every three years and computed tomography colonography every five years in certain circumstances. These screenings are covered at 100% when properly billed as preventive services.
Prostate cancer screening for men includes digital rectal examinations and prostate-specific antigen (PSA) tests covered once every 12 months for men over age 50. These tests are covered at 100% with no deductible or coinsurance when billed correctly as preventive services.
Lung cancer screening with low-dose computed tomography (LDCT) is covered annually for adults aged 50-77 who have a 20 pack-year smoking history and currently smoke or have quit within the last 15 years, with a written order following a counseling and shared decision-making visit. This screening can detect lung cancer early in high-risk individuals.
Cardiovascular and Metabolic Health Screenings
Medicare covers comprehensive screening for cardiovascular disease and metabolic conditions. Cardiovascular disease screening includes blood tests checking cholesterol, lipid, and triglyceride levels once every five years. These tests help identify heart disease risk factors early, enabling preventive interventions.
Cardiovascular behavioral therapy is covered for adults with risk factors like high blood pressure, high cholesterol, diabetes, or obesity. Medicare covers one face-to-face visit annually with a primary care provider in a primary care setting for intensive behavioral counseling to reduce cardiovascular disease risk.
Diabetes screening is covered for adults at risk for diabetes, including those with high blood pressure, history of high cholesterol or triglycerides, obesity, or history of high blood sugar. Screening includes fasting glucose tests and is covered twice per year for pre-diabetic individuals. Early detection enables lifestyle interventions or treatment to prevent or delay type 2 diabetes.
Diabetes self-management training is covered for beneficiaries with diabetes. Medicare covers up to 10 hours of initial training and two hours of follow-up training each year to help you learn how to manage your diabetes, including dietary changes, exercise, blood sugar monitoring, and medication management.
Medical nutrition therapy services are covered for people with diabetes or kidney disease. Medicare covers three hours of nutrition counseling the first year and two hours annually thereafter, provided by a registered dietitian or nutrition professional.
Bone Health, Depression, and Other Screenings
Bone mass measurement (bone density testing) is covered once every 24 months, or more frequently if medically necessary, for people at risk for osteoporosis. This includes women age 65 and older, men with clinical osteoporosis risk, people with vertebral abnormalities, those receiving long-term steroid therapy, and people with primary hyperparathyroidism. Early detection of bone loss helps prevent fractures.
Depression screening is covered annually in primary care settings that can provide follow-up treatment and referrals. Given depression's prevalence among seniors and its impact on health outcomes, this screening provides important mental health support.
Alcohol misuse screening and counseling is covered annually in primary care settings for adults with Medicare, including pregnant women. Those screening positive for alcohol misuse can receive up to four brief face-to-face behavioral counseling sessions annually if competent and alert during counseling.
Glaucoma screening is covered once every 12 months for people at high risk for glaucoma, including those with diabetes, a family history of glaucoma, African Americans age 50 and older, and Hispanic Americans age 65 and older. Early detection of glaucoma can prevent vision loss.
Hepatitis B virus (HBV) infection screening is covered for adults at increased risk, including people with end-stage renal disease, HIV infection, or high-risk factors. Medicare also covers hepatitis C screening for adults at increased risk and one-time screening for those born between 1945 and 1965.
Vaccines Covered by Medicare
Medicare covers numerous vaccines at little or no cost, helping prevent serious infectious diseases. Influenza (flu) vaccines are covered once per flu season, typically fall through early spring, at 100% with no cost-sharing. Getting your annual flu shot helps prevent influenza and its potentially serious complications.
Pneumococcal vaccines (pneumonia shots) are covered at 100% to prevent pneumococcal disease, which can cause pneumonia, meningitis, and bloodstream infections. Medicare covers all recommended pneumococcal vaccines without cost-sharing.
COVID-19 vaccines are covered at 100% under Medicare Part B, with no cost-sharing regardless of whether you receive your primary series or booster doses. Medicare covers all FDA-approved and FDA-authorized COVID-19 vaccines.
Hepatitis B vaccines are covered for people at medium to high risk for hepatitis B, including people with end-stage renal disease, hemophilia, or who receive immunosuppressive therapy.
Some vaccines may be covered under Part B (like flu, pneumonia, and COVID-19) while others are covered under Part D (like shingles vaccine). Check with your provider about which part of Medicare covers specific vaccines to understand any potential costs.
Maximizing Your Preventive Benefits
To get the most from Medicare's preventive services, schedule your Annual Wellness Visit every year to update your prevention plan and discuss recommended screenings. Follow through on recommended screenings based on your age, sex, and risk factors. Always verify that your provider accepts Medicare assignment and confirm they'll bill the service as a preventive service covered at 100%.
Keep a personal calendar of when you're due for various screenings, as different services have different frequency limits. Come prepared to wellness visits with health questions and concerns. Maintain a complete list of all medications, supplements, and health conditions to share with your provider.
If you receive a bill for services you thought should be covered at 100%, verify with your provider that the service was billed correctly with preventive codes. Sometimes services are billed incorrectly, leading to unexpected charges that can be corrected upon appeal.
Medicare's preventive services provide tremendous value at no cost to you. By taking advantage of these benefits, you invest in your health, catch problems early, and potentially avoid serious illness and expensive treatment. Make preventive care a priority throughout your time on Medicare.