Affordable Care Act and Medicare Services
Medicare Services Overview
Preventive Services for Medicare Participants
Under the Affordable Care Act, if you have Original Medicare, you may qualify for a yearly wellness visit and many preventive services for free.
Medicare provides preventive benefits to keep you healthy including a yearly wellness visit, tobacco use cessation counseling, and a range of no-cost screenings for cancer, diabetes, and other chronic diseases.
- As of January 1, 2011, many preventive services are covered under Medicare if you get them from a doctor or other health care provider who accepts assignment.
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Annual Wellness Visits: If you are new to Medicare, your “Welcome to Medicare” preventive visit is now covered without cost sharing during your first 12 months of Part B coverage. This exam is a one-time review of your health as well as education and counseling about preventive services and other care. If you’ve had Part B 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.
Several preventive services that qualify are listed below:
- Tobacco Use Cessation Counseling: This benefit is now considered a covered preventive service, whether or not you have been diagnosed with an illness caused or complicated by tobacco use. While the counseling is a covered service, the co-insurance and deductible will apply if you have already been diagnosed with a tobacco related illness.
- Screenings: No more Medicare Part B deductible or copayment for these screenings if certain coverage criteria apply:
- Bone mass measurement
- Cervical cancer screening, including Pap smear tests and pelvic exams
- Cholesterol and other cardiovascular screenings
- Colorectal cancer screening (except for barium enemas)
- Diabetes screening
- Flu shot, pneumonia shot, and the hepatitis B shot
- HIV screening for people at increased risk or who ask for the test
- Mammograms
- Medical nutrition therapy to help people manage diabetes or kidney disease
- Prostate cancer screening (except digital rectal examinations)
- See the full list of preventive services at Medicare.gov
Some Important Details
- For some preventive services, you will pay nothing. You may have to pay co-insurance (a part of the cost) for the office visit when you get these services.
- Your first yearly wellness visit can’t take place within 12 months of your “Welcome to Medicare” preventive visit.
- If you’re in a Medicare Advantage Plan, check with your plan to see if these benefits will also be free for you.
