Medicare Coverage for Preventive Screenings: A Complete Guide

Overview of Medicare Preventive Screenings

Preventive screenings are vital tools in catching diseases at an early stage, improving outcomes, and reducing long-term health care costs. Medicare coverage for preventive screenings is one of the most powerful benefits offered through Medicare Part B (Medical Insurance).

Covered services include but are not limited to:

• Mammograms (screening)
• Cardiovascular disease screenings
• Colorectal cancer screenings
• Diabetes screenings
• Lung cancer screenings
• Glaucoma tests
• Depression screenings
• Bone mass measurements

These are based on U.S. Preventive Services Task Force (USPSTF) recommendations that have earned a Grade A or B. If eligibility requirements are met and the provider accepts assignment, most of these services are provided at no cost to the beneficiary.

Eligibility and Coverage Criteria

To qualify for Medicare preventive screenings, individuals must meet specific criteria related to age, health risk factors, and recommended screening frequencies.

Core Coverage Factors:

• Eligibility status: Generally, those enrolled in Medicare Part B are eligible.
• Screening frequency requirements: Some tests are allowed annually (e.g., Medicare Wellness Visit), while others are once in a lifetime (e.g., abdominal aortic aneurysm screening for high-risk men).
• Patient cost sharing: Many services are free if provided by a participating provider and the beneficiary meets all conditions.
• Reasonable and necessary: Services must be considered "reasonable and necessary for preventing or detecting illness or disability in early stages."

Documentation Requirements:

• ICD-10-CM diagnosis codes: Used to determine risk profiles and justify the medical necessity of tests.
• HCPCS & CPT codes: Used by providers to bill Medicare for preventive services.
• National Coverage Determinations (NCDs): Define Medicare's stance on specific tests and treatments.

Medicare Part B covers certain telehealth services. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for your doctor or other health care provider's services. For most telehealth services, you'll pay the same amount that you would if you got the services in person.

Example:

• A 67-year-old woman at high risk for diabetes may receive an annual diabetes screening and a depression screening under Medicare Part B without any out-of-pocket cost, assuming eligibility criteria are met.

Initial Preventive Visit (“Welcome to Medicare” Visit)

Newly eligible Medicare beneficiaries are entitled to a one-time “Welcome to Medicare” preventive visit within the first 12 months of enrolling in Part B. This visit is a comprehensive opportunity to create a health baseline.

Services Included:

• Review of medical and social history
• Measurements of height, weight, blood pressure, and BMI
• Education and counseling on preventive services
• Referral for necessary preventive services for Medicare (e.g., mammograms, cardiovascular screenings)
• End-of-life planning if desired

Key Terms:

• Welcome to Medicare preventive visit
• Medicare & You: Medicare’s Preventive Benefits (educational video)
• Doctors’ services, outpatient care, and medical supplies under Part B
• Evaluation of early detection needs for cancer, mental health, and chronic conditions

Unlike the annual Medicare Wellness Visit, the “Welcome to Medicare” visit is a one-time benefit available within the first 12 months of enrolling in Part B. It sets the stage for a strong preventive care plan.

For a detailed overview of what’s included in this visit and other preventive benefits, refer to the Medicare & You handbook.

Annual Medicare Wellness Visit

Once past their first 12 months of Part B enrollment, beneficiaries become eligible for the Medicare Annual Wellness Visit. This service helps update their personalized prevention plan.

What It Includes:

• Health risk assessment
• Review of medical and family history
• List of current providers and prescriptions
• Detection of cognitive impairments
• Screening schedule and health advice

This service, distinct from a full physical exam, is part of Medicare’s commitment to free Medicare screenings under preventive services.

Providers typically use HCPCS code G0439 for billing subsequent Annual Wellness Visits. Like the “Welcome to Medicare” visit, the Annual Wellness Visit has no cost to patients if all criteria are met and it’s performed by a Medicare-participating provider who accepts assignment.

Types of Preventive Services Offered

Here is a list of key preventive services for Medicare beneficiaries:

• Mammogram (screening): Covered every 12 months for women aged 40 and older.
• Colorectal cancer screenings: Coverage varies depending on the method used (e.g., fecal occult blood test, colonoscopy).
• Cardiovascular disease screenings: Covered once every 5 years.
• HIV screening: Covered annually for individuals at increased risk.
• Hepatitis B & C screenings: Covered based on risk factors and exposure history.
• Bone mass measurement: Covered every 24 months for individuals at high risk for osteoporosis.
• Lung cancer screening: Covered annually for individuals aged 50 to 77 with a history of smoking.
• Abdominal aortic aneurysm screening: A one-time screening for eligible men with risk factors (e.g., smoking history, family history).
• Diabetes screening: Covered up to twice per year for individuals at high risk.
• Depression screening: Covered once a year, typically conducted in a primary care setting.

Additionally, immunizations such as:

• Flu shots
• Hepatitis B shots
• COVID-19 vaccines

...are covered under separate Medicare rules, often with no cost to the beneficiary.

While most of these services are covered under Medicare Part B, Medicare Part A benefits may apply if screenings are conducted during an inpatient hospital stay.

Patient Engagement and Preventive Reminders

Helping patients stay on track with their preventive care often takes clear communication, gentle reminders, and support from people they trust.

Recommended Engagement Strategies:

• Preventive service reminders: Systems like MyMedicare.gov and third-party apps can notify patients.
• Health care needs review: Done during Medicare Wellness Visits.
• Patient partnership: Involves shared decision-making and education.
• Referral to a specialist: For high-risk findings (e.g., abnormal mammogram).
• Non-opioid treatment options: Discussed during substance use screenings.

Engagement is improved when patients are treated within a family and community context, supporting both trust and follow-through.

Primary Care Setting Definition

Preventive services under Medicare are generally offered in what is known as a primary care setting. This designation matters because many screenings must be performed in qualifying environments to be covered.

What Qualifies:

• Clinicians such as family doctors, internists, and geriatricians
• Facilities that deliver integrated health care services
• Accessible health care services that assume responsibility for patient care

Routine screenings, flu shots, and counseling are most often delivered in outpatient primary care clinics or community health centers recognized by Medicare.

Updates and Additions to Preventive Services

The list of Medicare preventive screenings is not fixed. CMS regularly evaluates the clinical value of new services, informed by the USPSTF and other bodies.

How It Works:

• New services are reviewed under the National Coverage Determination (NCD) process.
• Regulatory changes are made through formal rulemaking processes and published in the Federal Register. The Medicare Benefit Policy Manual is then updated to reflect those changes.
• Statutory authority is required for benefit expansion.
• CMS publishes updates in the Federal Register and implements coverage via local and national contractors.

Recent additions include respiratory vaccines, opioid use disorder risk screenings, and coverage for HIV PrEP medications.

How to Access and Track Services

Beneficiaries should maintain a Secure Medicare Account at Medicare.gov to:

• View upcoming eligibility for screenings
• Track completed services
• See reminders for Medicare Wellness Visits or immunizations

Most providers use the CMS HIPAA Eligibility Transaction System (HETS) to verify coverage and benefits in real-time, helping reduce billing errors and patient confusion.

Patient Advocacy and Real Support

Medicare’s rules around preventive care can feel confusing and impersonal—but you don’t have to figure it out alone. Solace provides patients with trained health advocates who help cut through the noise and take the pressure off.

What Solace advocates do:

• Confirm eligibility for preventive screenings like mammograms or colonoscopies
• Explain confusing documents like EOBs and denial letters
• Guide patients through appeals or help them find in-network doctors and clinics
• Offer long-term support—someone to follow up, join appointments virtually, and keep care on track

For many people with Medicare, working with a Solace advocate means finally having someone on their side—someone who understands the system and fights for you.

If you're unsure where to begin, services like Solace (as well as nonprofit resources like SHIP and the Medicare Rights Center) can help you get the care you’re entitled to—with less stress and more clarity.

FAQ: Frequently Asked Questions About Medicare Coverage for Preventive Screenings

1. What preventive services does Medicare cover for free?

Medicare Part B covers many free Medicare screenings with no cost to you if your provider accepts assignment and you meet the eligibility criteria. These include mammograms, cardiovascular screenings, diabetes checks, and an annual Medicare Wellness Visit, among others.

2. Who is eligible for Medicare preventive screenings?

Eligibility is based on your age, medical history, risk factors, and Medicare enrollment status. Each service has specific eligibility and coverage criteria, such as screening frequency and required ICD-10-CM diagnosis codes to justify medical necessity.

3. What is the “Welcome to Medicare” preventive visit?

This is a one-time appointment you can schedule within your first 12 months of enrolling in Medicare Part B. It includes a review of your medical history, risk assessment, and personalized preventive services for Medicare planning.

4. How often can I have a Medicare Wellness Visit?

After your initial “Welcome to Medicare” visit, you can get one Medicare Wellness Visit per year. It’s designed to help you stay current on screenings, update your health plan, and monitor chronic conditions.

5. Will I have to pay anything for preventive screenings?

In most cases, no. If your provider participates in Medicare and accepts assignment, and you meet the frequency requirements and other criteria, you won't pay coinsurance or a deductible. However, some tests might involve patient cost sharing if they go beyond what’s considered preventive.

6. How do providers bill Medicare for these services?

Doctors and clinics use standardized HCPCS & CPT codes tied to each preventive service. These codes tell Medicare what was done and help determine if the visit is covered.

7. What happens if my screening shows something abnormal?

If further testing or treatment is needed, follow-up services may fall under diagnostic rather than preventive coverage. That could mean different billing rules and possible out-of-pocket costs. Your provider should explain these clearly.

8. Can I get preventive screenings via telehealth?

Some counseling-based preventive services are available via telehealth, especially when temporary telehealth eligibility rules are expanded. Physical exams and lab screenings generally still require in-person visits.

9. What role does the U.S. Preventive Services Task Force (USPSTF) play?

Medicare uses USPSTF recommendations to determine which services should be covered. Only those rated Grade A or B are generally eligible for full coverage under preventive care guidelines.

10. How can I remember when to schedule my next screening?

Use your secure Medicare account at Medicare.gov to track past services and get reminders. You can also ask your provider to help set up a preventive care calendar during your next Medicare Wellness Visit.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

Recommended Reading:

• What is a Medicare Plan?
• Medicare Plan F vs Plan G: Key Differences and Choosing The Right Path
• What is Medicare Part A?
• What is Medicare Advantage (Part C)?