Abdominal Aortic Aneurysm Screening
A one-time screening ultrasound for people at risk. Medicare
only covers this screening if you get a referral for it as a
result of your one-time "Welcome to Medicare" physical exam.
Starting January 1, 2011, you pay nothing for the screening if
your doctor accepts assignment.
Bone Mass Measurement
Helps to see if you are at risk for broken bones. This service
is covered once every 24 months (more often if medically
necessary) for people who have certain medical conditions or
meet certain criteria. Starting January 1, 2011, you pay nothing
for this test if your
doctor accepts assignment.
Cardiovascular Screenings
Helps detect conditions that may lead to a heart attack or
stroke. This service is covered every 5 years to test your
cholesterol, lipid, and triglyceride levels. No cost for the
tests, but you generally have to pay 20% of the
Medicare-approved amount for the doctor's visit.
Colon Cancer Screening (Colorectal)
Colorectal cancer is usually found in people age 50 or older,
and the risk of getting it increases with age. Medicare covers
colorectal screening tests to help find pre-cancerous polyps
(growths in the colon) so they can be removed before they turn
into cancer. Treatment works best when colorectal cancer is
found early.
One or more of the following tests may be covered. Talk to your
doctor.
Fecal Occult Blood Test—Once every 12 months if 50 or older. You
pay nothing for the test, but you generally have to pay 20% of
the Medicare-approved amount for the doctor’s visit.
Flexible Sigmoidoscopy—Generally, once every 48 months if 50 or
older, or 120 months after a previous screening colonoscopy for
those not at high risk. Starting January 1, 2011, you pay
nothing for this test if your doctor accepts
assignment.
Colonoscopy—Generally, you can get this procedure once every 120
months, or 48 months after a previous flexible sigmoidoscopy. If
your doctor says you’re at high risk, you can get it every 24
months. There’s no minimum age required for you to get a
colonoscopy. If you get the
procedure on or after January 1, 2011, you’ll pay nothing for
the procedure if your doctor accepts assignment.
Barium Enema—Once every 48 months if 50 or older (high risk
every 24 months) when used instead of a sigmoidoscopy or
colonoscopy. You pay 20% of the Medicare approved amount for the
doctor’s services. In a hospital outpatient setting, you also
pay the hospital a co-payment.
Diabetes Screenings
Checks for diabetes. These screenings are covered if you have
any of the following risk factors: high blood pressure
(hypertension), history of abnormal cholesterol and triglyceride
levels (dyslipidemia), obesity, or a history of high blood sugar
(glucose). Tests are also covered if you answer yes to two or
more of the following questions:
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Are you age 65 or older?
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Are you overweight?
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Do you have a family history of diabetes (parents, siblings)?
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Do you have a history of gestational diabetes (diabetes during
pregnancy), or
did you deliver a baby weighing more than 9
pounds? |
Based on the results of these tests, you may be eligible for
up to two diabetes screenings every year. No cost for the test,
but you generally have to pay 20% of the Medicare-approved
amount for your doctor's visit.
Diabetes Self-Management Training
For people with diabetes. Your doctor or other health care
provider must provide a written order. You pay 20% of the
Medicare-approved amount, and the Part B deductible applies.
Flu Shots
Helps prevent influenza or flu virus. Generally covered once a
flu season in the fall or winter. You need a flu shot for the
current virus each year. No cost to you for the flu shot if the
doctor or other health care provider accepts assignment for
giving the shot. Note: Medicare Part B also covers
administration of the H1N1 flu shot. You pay nothing if your
doctor accepts assignment for giving the shot.
Glaucoma Tests
Helps find the eye disease glaucoma. Covered once every 12
months for people at high risk for glaucoma. You are considered
high risk for glaucoma if you have diabetes, a family history of
glaucoma, are African-American and age 50 or older, or are
Hispanic and age 65 or older. An eye doctor who is legally
authorized by the state must do the tests. You pay 20% of the
Medicare-approved amount, and the Part B deductible applies for
your doctor’s visit. In a hospital outpatient setting, you also
pay the hospital a co-payment.
Hepatitis B Shots
Helps protect people from getting Hepatitis B. This is covered
for people at high or medium risk for Hepatitis B. Your risk for
Hepatitis B increases if you have hemophilia, End-Stage Renal
Disease (ESRD), or a condition that increases your risk for
infection. Other factors may increase your risk for Hepatitis B,
so check with your doctor. Starting January 1, 2011, you pay
nothing for the shot if your doctor accepts assignment.
HIV Screening
Medicare covers HIV screening for people with Medicare who are
pregnant and people at increased risk for the infection,
including anyone who asks for the test. Medicare covers this
test once every 12 months or up to 3 times during a pregnancy.
You pay nothing for the test, but you generally have to pay the
doctor 20% of the Medicare approved amount for the doctor’s
visit.
Breast Cancer Screening (Mammograms)
A type of X-ray to check women for breast cancer before they or
their doctor may be able to find it. Medicare covers screening
mammograms once every 12 months for all women with Medicare age
40 and older. Medicare covers one baseline mammogram for women
between ages 35–39Starting January 1, 2011, you pay
nothing for the test if the doctor accepts assignment.
Medical Nutrition Therapy Services
Medicare may cover medical nutrition therapy and certain related
services if you have diabetes or kidney disease, or you have had
a kidney transplant in the last 36 months, and your doctor
refers you for the service. Starting January 1, 2011, you pay nothing for the test
if the doctor accepts assignment.
Pap Tests and Pelvic Exams (includes clinical breast exam)
Checks for cervical, vaginal, and breast cancers. Medicare
covers these screening tests once every 24 months, or once every
12 months for women at high risk, and for women of child-bearing
age who have had an exam that indicated cancer or other
abnormalities in the past 3 years. No cost to you for the Pap
lab test. Starting January 1, 2011, you pay
nothing for Pap test specimen collection, and pelvic and breast
exams if the doctor accepts assignment.
Pneumococcal Shot
Helps prevent pneumococcal infections (like certain types of
pneumonia). Most people only need this preventive shot once in
their lifetime. Talk with your doctor. No cost if your doctor accepts assignment for giving the shot.
Prostate Cancer Screenings
Helps detect prostate cancer. Medicare covers a digital rectal
exam and Prostate Specific Antigen (PSA) test once every 12
months for all men with Medicare over age 50 (coverage for this
test begins the day after your 50th birthday). You pay 20% of
the Medicare-approved amount, and the Part B deductible applies
for the doctor's visit. You pay nothing for the PSA test. In a
hospital outpatient setting, you also pay the hospital a co-payment.
Smoking Cessation (counseling to stop smoking)
Includes up to 8 face-to-face visits in a 12-month period if you
are diagnosed with an illness caused or complicated by tobacco
use, or you take a medicine that is affected by tobacco. You pay
20% of the Medicare-approved amount, and the Part B deductible
applies. In a hospital outpatient setting, you also pay the
hospital a co-payment.
Note: Medicare coverage of smoking cessation counseling is now
considered a covered preventive service if you haven’t been
diagnosed with an illness caused or complicated by tobacco use.
Starting January 1, 2011, you pay nothing for the counseling
sessions.
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