Medicare Preventative Services

“Welcome to Medicare” preventive visit

Medicare covers a one-time preventive visit within the first 12 months that you have Medicare Part B (Medical Insurance). This visit is called the “Welcome to Medicare” preventive visit. The visit is a great way to get up-to-date on important screenings and shots and to talk with your doctor about your family history and how to stay healthy.

What happens during the visit?

During the visit, your doctor will:

• Record your medical and social history (like alcohol or tobacco use, your diet, and your activity level).

• Check your height, weight, and blood pressure.

• Calculate your body mass index (BMI).

• Give you a simple vision test.

• Review your potential risk for depression and your level of safety.

• Offer to talk with you about creating advance directives. Advance directives are legal documents that allow you to put in writing what kind of health care you would want if you were too ill to speak for yourself.

Depending on your general health and medical history, your doctor will give you advice on education, and counseling to help you prevent disease, improve your health, and stay well. Your doctor will also give you a written plan (like a checklist) letting you know what screenings, shots, and other preventive services you need.

What should I bring to the visit?

When you go to your “Welcome to Medicare” preventive visit, bring these items:

• Your medical records, including immunization records (if you’re seeing a new doctor). Call your old doctor to get copies of your medical records.

• Your family health history. Try to learn as much as you can about your family’s health history before your appointment. Any information you can give your doctor can help determine if you’re at risk for certain diseases.

• A list of prescription and over-the-counter drugs that you currently take, how often you take them, and why.

Who’s covered, and how often is it covered?

This visit is only covered one time, and you must have the visit within the first 12 months you’re enrolled in Part B.

Your costs if you have Original Medicare

You pay nothing if your doctor accepts assignment.

Yearly “Wellness” visit

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. This includes:

• Health risk assessment (Your doctor or health professional will ask you to answer some questions before or during your visit, which is called a health risk assessment. Your responses to the questions will help you and your health professional get the most from your yearly “Wellness” visit.)

• Review of medical and family history.

• Develop or update a list of current providers and prescriptions.

• Height, weight, blood pressure, and other routine measurements.

• Detection of any cognitive impairment.

• Personalized health advice.

• A list of risk factors and treatment options for you.

• A screening schedule (like a checklist) for appropriate preventive services.

How often is it covered?

Once every 12 months.

Your costs if you have Original Medicare

You pay nothing for this visit if your doctor accepts assignment.

You don’t need to have had a “Welcome to Medicare” preventive visit before getting a yearly “Wellness” visit. If you do get the Welcome to Medicare” preventive visit during your first year with Part B, you’ll have to wait 12 months before you can get your first yearly “Wellness” visit ^{Publication 10110}

NOT an Annual Physical Exam!

Medicare does not cover an annual physical exam – see 15 pages from Medicare to explain the difference. “It’s very important that someone, when they call to make an appointment, uses those magic words, ‘annual wellness visit,’”

An annual physical typically involves an exam by a doctor along with bloodwork or other tests. The annual wellness visit generally doesn’t include a physical exam, except to check routine measurements such as height, weight and blood pressure. ^{CA Healthline.org} *

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How often are Eye exams covered?

Medicare doesn’t cover routine eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses. Medicare Part B (Medical Insurance) covers some preventive and diagnostic eye exams:

Medicare Part B (Medical Insurance) covers a yearly eye exam for diabetic retinopathy

ICD 10

Web MD

by an eye doctor who’s legally allowed to do the test in your state.

Who’s eligible?

All people with Part B who have diabetes are covered.

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount for the doctor’s services, and the Part B deductible applies. In a hospital outpatient setting, you pay a copayment.

Note

To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service. ^{medicare.gov yearly-eye-exam}

cms.gov/VisionServices_FactSheet

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ICD billing codes

92012 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient

92083 — extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees, or quantitative, automated threshold perimetry, Octopus programs G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2).

Preventative Care
Bone Density Osteoporosis

Medicare covers bone mass measurements to see if you’re at risk for broken bones due to osteoporosis. Osteoporosis is a disease in which your bones become weak and brittle. In general, the lower your bone density, the higher your risk for a fracture.

Bone mass measurement results will help you and your doctor choose the best way to keep your bones strong..

Who’s covered?

Bone mass measurements are covered for certain people with Medicare whose doctors say they’re at risk for osteoporosis, and who have one of these medical conditions:.

• A woman whose doctor or health care provider says she’s estrogen-deficient and at risk for osteoporosis, based on her medical history and other findings

• A person with vertebral abnormalities as demonstrated by an X-ray

• A person getting (or expecting to get) steroid treatments

• A person with hyperparathyroidism

• A person taking an osteoporosis drug.

How often is it covered?

Once every 24 months (more often if medically necessary).

Your costs if you have Original Medicare.

You pay nothing for this test if the doctor accepts assignment. ^{Publication 10110}

Costs if you have a Medicare Advantage Plan?

Just as an example – Blue Cross MediBlue Access PPO EOC Evidence of Coverage

In network – No charge, but subject to the qualifying rules above. EOC Page 45

Out of Network – $1,250 annual deductible and you pay 40%

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Mammogram coverage under Medicare

Breast cancer screening (mammograms)

Breast cancer is the most common non-skin cancer in women and the second leading cause of cancer death in women in the U. S. Every woman is at risk, and this risk increases with age. Breast cancer usually can be treated successfully when found early. Medicare covers screening mammograms and digital technologies to check for breast cancer before you or a doctor may be able to find it manually.

Who’s covered?

Women 40 and older are eligible for a screening mammogram every 12 months. Medicare also covers one baseline mammogram for women between 35–39.

How often is it covered?

Once every 12 months.

Your costs if you have Original Medicare

You pay nothing for the test if the doctor accepts assignment.

Am I at high risk for breast cancer?

Your risk of developing breast cancer increases if any of these are true:

• You had breast cancer in the past.

• You have a family history of breast cancer (like a mother, sister, daughter, or 2 or more close relatives who’ve had breast cancer).

• You had your first baby after age 30.

• You’ve never had a baby.

Other pages on our website dealing with cancer and how Insurance and Rx Prescription coverage might pay for it

https://wp.me/P50Eh9-2PK

https://medicare.healthreformquotes.com/sign-medicare/part-hospital-part-b-md-visits/preventative-care/mammograms-breast-cancer/

https://medi-cal.healthreformquotes.com/eligibility/cancer-program/

https://wp.me/P50Eh9-2kn

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Medi-Cal Share of Cost

If you are low income you might check out LIS – Low Income Subsidy – Extra Help to pay the Rx costs that are not covered. LIS may also pay your Part D and Part B premiums and you might also qualify for Medi-Cal.

Part D Rx Low Income Subsidy – LIS – Extra Help

More help – beyond LIS
- Rx Assistance from Manufacturer
- Rx Covered Under Part B

Products: Medicare Preventive Services