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Prevention Tips

Get the Most out of Medicare

The best way to stay healthy is to live a healthy lifestyle. You can live a healthy lifestyle and prevent disease by exercising, eating well, keeping a healthy weight, and not smoking.

Medicare can help. Medicare covers many preventive services that keep you healthy. Preventive care can find health problems early, when treatment works best, and can keep you from getting certain diseases. Preventive services include shots, lab tests, and screenings. They also include programs for health monitoring, and counseling and education to help you take care of your own health.

MyMedicare.gov

Register at MyMedicare.gov to get direct access to your preventive health information—24 hours a day, every day. You can track your preventive services, get a 2-year calendar of the Medicare-covered tests and screenings you’re eligible for, and print a personalized report to take to your next doctor’s appointment.

Make a Plan With Your Health Care Provider

Your doctor or health care provider may do exams or tests that Medicare doesn’t cover. Your doctor or health care provider also may recommend that you have tests more or less often than Medicare covers them. Medicare pays for some diagnostic tests. A diagnostic test may be recommended when a screening test or exam shows an abnormality. In some cases, you may have to pay for these services. Talk to your doctor or health care provider to find out which preventive services are right for you and how often you need them.

Three Main Types of Preventive Care

Medicare covers three types of preventive care for members:

Welcome to Medicare Visit

Medicare pays for one Welcome to Medicare visit (also known as the Initial Preventive Physical Examination) that must be completed within the first 12-months of the effective date of your first Medicare Part B coverage period.

What to Expect

This visit usually includes:

  • A discussion about your medical and social history, including:
    • Medical/surgical history: illnesses, hospital stays, surgeries, allergies, injuries and treatments
    • Current medications and supplements you’re taking, including calcium and vitamins
    • A review of your family history, including diseases that may be hereditary or increase your risk of developing certain conditions
    • Your history of alcohol, tobacco and drug use
    • Your current diet and level of physical activity
  • A discussion about your emotional health, and personal and family history with depression and other mood disorders
  • An assessment of your ability to safely conduct your daily activities
  • A general examination, including your height, weight, body mass index (BMI), blood pressure and vision
  • Counseling based on your lifestyle and history, and a written preventive care checklist

Learn more about the Welcome to Medicare visit.

Annual Wellness Visit

If you’ve been enrolled in Medicare Part B for 12 months or more, Medicare covers an Annual Wellness Visit.*

What to Expect

This visit usually includes:

  • A Health Risk Assessment to identify potential health risk factors
  • Documentation of your current doctors and other health care providers and suppliers
  • A review of both your and your family’s medical history (illness, diseases, surgeries, etc.)
  • A discussion about your emotional health, and personal and family history with depression and other mood disorders
  • An assessment of your ability to safely conduct your daily activities
  • A general examination, including your height, weight, body mass index (BMI) and blood pressure
  • A written preventive care checklist, including:
    • Age-appropriate preventive services that are covered by Medicare
    • Immunization recommendations for immunizations
    • Counseling about risk factors identified by your health risk assessment, lifestyle, eating and physical activity, tobacco use, family history, etc.

Learn more about the Annual Wellness Visit.

* Your first Annual Wellness Visit must be 12 months or later after your Welcome to Medicare Visit.

Preventive Services

Preventive services are tests and screenings designed to prevent illness or detect it in its early stages. These include Pap tests, flu shots and other immunizations and screening mammograms.

You pay nothing for most covered preventive services when you see a doctor or other qualified health care provider who accepts payment from Medicare (Medicare assignment). However, not all preventive services are covered at no cost to you. If your doctor orders tests or screenings not covered by Medicare, you might have out-of-pocket costs, such as a deductible, coinsurance or both.

Most preventive services are recommended (and covered) based on age, gender and risk factors. To read more about preventive services that Medicare covers, go to the Medicare Preventive Services website and click on the services you’re interested in learning more about.

What You Should Know

If you schedule a preventive care visit and ask your doctor about a specific health concern (such as a suspicious mole) or condition (such as high blood pressure), your doctor might consider and bill it as an office visit instead. In this case, you’d pay the appropriate coinsurance for an office visit.

Find a Primary Care Provider

Partnering with a primary care provider will help you ensure that your preventive screenings and health care are appropriate and well-coordinated.

If you already have a primary care provider that you like and who accepts Medicare, we encourage you to continue your relationship. If you do not have a primary care provider or are looking for one, here’s how to find one.