Your Guide To Medicare Preventive Services.

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Your Guide to MedicarePreventive ServicesC E N T E R SF O RM E D I C A R E&M E D I C A I DS E R V I C E SThis is the official governmentbooklet with important informationabout: What disease prevention is and why it’simportant Which preventive services Medicarecovers and how often Who can get services What you pay – you pay nothing formany services

YOUR GUIDE TO MEDICARE PREVENTIVE SERVICESNow’s the time to get the most out of your Medicare. The best way to stayhealthy is to live a healthy lifestyle. You can live a healthy lifestyle and preventdisease by exercising, eating well, keeping a healthy weight, and not smoking.Medicare can help. Medicare pays for many preventive services to keep you healthy.Preventive services can find health problems early, when treatment works best, andcan keep you from getting certain diseases. Preventive services include exams, shots,lab tests, and screenings. They also include programs for health monitoring, andcounseling and education to help you take care of your own health.If you have Medicare Part B (Medical Insurance), you can get a yearly “Wellness”visit and many other covered preventive services.Whether it’s online, in person, or on the phone, Medicare is committed to helpingpeople get the information they need to make smart choices about their Medicarebenefits.MyMedicare.govRegister at to get direct access to your preventive healthinformation—24 hours a day, every day. You can track your preventive services, get a2-year calendar of the Medicare-covered tests and screenings you’re eligible for, andprint a personalized “on-the-go” report to take to your next doctor’s appointment.How can this booklet help me?This booklet covers Part B‑covered preventive services. The alphabetical list on thefollowing pages gives information about what you pay if you have Original Medicareand see doctors or other health care providers who accept assignment. You’ll paymore if you see doctors or providers who don’t accept assignment. If you’re in aMedicare health plan or have other insurance, your costs may be different. Contactyour plan or benefits administrator directly to find out about the costs.“Your Guide to Medicare’s Preventive Services” isn’t a legal document. OfficialMedicare Program legal guidance is contained in the relevant statutes, regulations,and rulings.The information in this booklet describes the Medicare Program at the time thisbooklet was printed. Changes may occur after printing. Visit or call1-800-MEDICARE (1-800-633-4227) to get the most current information.TTY users can call 1-877-486-2048.Paid for the Department of Health & Human Services.

31SECTIONIntroductionTalk to your doctor or health care providerTalk to your doctor or health care provider to find out which preventiveservices are right for you and how often you need them. Your doctor or healthcare provider may do exams or tests that Medicare doesn’t cover. Your doctoror health care provider also may recommend that you have tests more or lessoften than Medicare covers them. Medicare pays for some diagnostic tests.Your doctor or other health care provider may recommend a diagnostic testwhen a screening test or exam shows an abnormality. In some cases, you mayhave to pay for these services.If a service you get isn’t covered and you think it should be, you may appealthis decision. To file an appeal, follow the instructions on your “MedicareSummary Notice” (MSN). The MSN is an easy-to-read statement that clearlylists your health insurance claims information. For more information on filingan appeal, visit, or call 1-800-MEDICARE(1-800-633-4227). TTY users can call 1-877-486-2048.Things to know when reading this bookletSymbolsRemember–Theservices listed inthis booklet arecovered if youhave MedicarePart B (MedicalInsurance).You’ll see one of these symbols next to each preventive service. It tells you forwhom Medicare covers the service or test.Men onlyWomen onlyMen & women

4Section 1: IntroductionThings to know when reading this booklet (continued)Risk factorsYou’ll see lists of factors that increase your risk of developing a certain disease.If you’re not sure if you’re at high risk, talk to your doctor.Part B deductibleThe Part B (Medical Insurance) deductible in 2019 is 185. This amount maychange yearly.Medicare-approved amountIn Original Medicare, this is the amount a doctor or supplier that acceptsassignment can be paid. It may be less than the actual amount a doctor orsupplier charges. Medicare pays part of this amount and you’re responsible forthe difference.AssignmentAssignment is an agreement by your doctor, provider, or supplier to be paiddirectly by Medicare, to accept the payment amount Medicare approves forthe service, and not to bill you for any more than the Medicare deductible andcoinsurance.Drug coverageMedicare Part D covers prescription drugs that may help you treat a disease orcondition found by preventive screening tests, like high cholesterol. You canreview and compare cost and coverage information of Medicare drug plans byvisiting Generally, you can join a Medicare drug planbetween October 15–December 7. Your coverage will begin on January 1 of thefollowing year. You can get personalized help by visiting, or bycalling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

52SECTIONPreventive ServicesThe alphabetical list on the following pages gives informationabout Medicare preventive services.Abdominal aortic aneurysm screeningWho’s covered?Medicare covers a one-time abdominal aortic aneurysm ultrasound forpeople at risk. You’re considered at risk if you have a family history ofabdominal aortic aneurysms, or you’re a man 65–75 and have smoked atleast 100 cigarettes in your lifetime.How often is it covered?Medicare covers this screening once in your lifetime if you get a referralfrom your doctor.Your costs if you have Original MedicareYou pay nothing for this screening if the doctor or other qualified healthcare provider accepts assignment.Remember–Theservices listed inthis booklet arecovered if youhave MedicarePart B (MedicalInsurance).

6Section 2: Preventive ServicesAlcohol misuse screening and counselingWho’s covered?Adults with Medicare (including pregnant women) who use alcohol, but don’tmeet the medical criteria for alcohol dependency.How often is it covered?Medicare covers one alcohol misuse screening per year. If your primary caredoctor or other primary care practitioner determines you’re misusing alcohol, youcan get up to 4 brief face-to-face counseling sessions per year (if you’re competentand alert during counseling). The practitioner must provide the counseling in aprimary care setting (like a doctor’s office).Your costs if you have Original MedicareYou pay nothing if the doctor accepts assignment.Bone mass measurementsMedicare covers bone mass measurements to see if you’re at risk for broken bonesdue to osteoporosis. Osteoporosis is a disease in which your bones become weakand brittle. In general, the lower your bone density, the higher your risk for afracture. Bone mass measurement results will help you and your doctor choose thebest way to keep your bones strong.Who’s covered?Bone mass measurements are covered for certain people with Medicare whosedoctors say they’re at risk for osteoporosis, and who have one of these medicalconditions: A woman whose doctor or health care provider says she’s estrogen-deficient andat 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 drugHow often is it covered?Once every 24 months (more often if medically necessary).Your costs if you have Original MedicareYou pay nothing for this test if the doctor accepts assignment.

Section 2: Preventive ServicesBreast cancer screening (mammograms)Breast cancer is the most common non-skin cancer in women and the secondleading cause of cancer death in women in the U. S. Every woman is at risk, andthis risk increases with age. Breast cancer usually can be treated successfullywhen found early. Medicare covers screening mammograms to check for breastcancer 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 MedicareYou pay nothing for the test if the doctor accepts assignment.Am I at 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 2or more close relatives who’ve had breast cancer). You had your first baby after 30. You’ve never had a baby.Cardiovascular disease (behavioral therapy)Who’s covered?All people with Medicare.What’s covered?A cardiovascular disease risk reduction visit that includes: Encouraging aspirin use when benefits outweigh risks Screening for high blood pressure Counseling to promote a healthy diet7

8Section 2: Preventive ServicesCardiovascular disease (behavioral therapy) (continued)How often is it covered?Once each year.Your costs if you have Original MedicareYou pay nothing if your doctor accepts assignment.Cardiovascular disease screeningMedicare covers cardiovascular disease screenings that check your cholesterol andother blood fat (lipid) levels. High levels of cholesterol can increase your risk forheart disease and stroke. These screenings will tell if you have high cholesterol.Who’s covered?All people with Medicare when a doctor orders the screening.What’s covered?Tests for cholesterol, lipid, and triglyceride levels.How often is it covered?Once every 5 years.Your costs if you have Original MedicareYou pay nothing for this screening.Cervical and vaginal cancer screeningMedicare covers Pap tests and pelvic exams to check for cervical and vaginalcancers. As part of the pelvic exam, Medicare also covers a clinical breast exam tocheck for breast cancer.Who’s covered?All women with Medicare.How often is it covered?Medicare covers these screening tests once every 24 months, or once every 12months if you’re at high risk for cervical or vaginal cancer, or if you’re ofchild-bearing age and had an abnormal Pap test in the past 36 months.Part B also covers Human Papillomavirus (HPV) tests (as part of Pap tests) onceevery 5 years if you’re 30-65 without HPV symptoms.

Section 2: Preventive ServicesCervical and vaginal cancer screening (continued)Your costs if you have Original MedicareYou pay nothing for the lab Pap test and for the lab HPV with Pap test. You alsopay nothing for the Pap test specimen collection and pelvic and breast exams ifthe doctor accepts assignment.Am I at high risk for cervical cancer?Your risk for cervical cancer increases if any of these are true: You’ve had an abnormal Pap test. You’ve had cervical or vaginal cancer in the past. You have a history of sexually transmitted disease (including HIV infection). You began having sex before 16. You’ve had 5 or more sexual partners. Your mother took DES (Diethylstilbestrol), a hormonal drug, when she waspregnant with you.Colorectal cancer screeningMedicare covers colorectal cancer screening tests to help find pre-cancerous polyps(growths in the colon), so polyps can be removed before they become cancerousand to help find colorectal cancer at an early stage when treatment works best.Who’s covered?All people with Medicare 50 and older, but there’s no minimum age for having acovered screening colonoscopy.How often is it covered? Screening fecal occult blood test—Once every 12 months for people 50 orolder. Screening flexible sigmoidoscopy—Once every 48 months after the lastflexible sigmoidoscopy or barium enema, or 120 months after a previousscreening colonoscopy. Screening colonoscopy—Once every 120 months (high risk every 24months), or 48 months after a previous flexible sigmoidoscopy. Screening barium enema—Once every 48 months (high risk every 24months) when used instead of sigmoidoscopy or colonoscopy.9

10Section 2: Preventive ServicesColorectal cancer screening (continued)How often is it covered? Multi-target stool DNA test—Once every 3 years if you meet all of theseconditions:–– You’re between 50–85.–– You show no signs or symptoms of colorectal disease including, but notlimited to, lower gastrointestinal pain, blood in stool, positive guaiac fecaloccult blood test, or fecal immunochemical test.–– You’re at average risk for developing colorectal cancer, meaning youhave no personal history of adenomatous polyps, colorectal cancer, orinflammatory bowel disease, including Crohn’s Disease and ulcerativecolitis.–– You have no family history of colorectal cancers or adenomatous polyps,familial adenomatous polyposis, or hereditary nonpolyposis colorectalcancer.Your costs if you have Original MedicareYou pay nothing for the fecal occult blood test, if you get a written referral fromyour doctor, physician assistant, nurse practitioner, or clinical nurse specialist. Youpay nothing for the flexible sigmoidoscopy or screening colonoscopy if your doctoraccepts assignment.Note: If a polyp or other tissue is found and removed during the colonoscopy, youmay have to pay 20% of the Medicare-approved amount for the doctor’s servicesand a copayment in a hospital outpatient setting.For barium enemas, you pay 20% of the Medicare-approved amount for the doctor’sservices. The Part B deductible doesn’t apply. If it’s done in a hospital outpatientsetting, you pay a copayment.Am I at high risk for colorectal cancer?Risk for colorectal cancer increases with age. It’s important to continue withscreenings, even if you