Medicare Coverage for Preventive Care and Screenings

When health issues are caught early, treatment is often more effective and less costly. Medicare recognizes this and covers a range of preventive care services and medical screenings designed to help keep you healthy.

Preventive care means taking steps to protect against illness before it starts or catching problems early when they’re easier to treat. These measures are crucial to maintaining good health as you age.

What Screenings Does Medicare Cover?

Medicare Part B covers several important screenings that can detect health issues before they become serious problems:

Mammograms

Medicare Part B covers screening mammograms, with coverage that varies by age. When you enroll in Medicare (most enroll at age 65+), you’re eligible for one screening mammogram every 12 months. ¹

There’s no deductible, and you pay nothing for this screening if your doctor accepts Medicare assignment.

If your doctor recommends more frequent mammograms due to your health history, Medicare may cover these additional screenings.

Colonoscopies

Different methods of colorectal cancer screenings may be covered.

This includes:

• Screening colonoscopies once every 24 months if you’re at high risk (or once every 120 months if you’re not at high risk)
• Flexible sigmoidoscopies once every 48 months for most people
• Fecal occult blood tests once every 12 months

Diabetes Screenings

Medicare covers up to two glucose screenings per year if you have risk factors like high blood pressure, obesity or a history of high blood sugar. These simple blood tests can identify diabetes before symptoms appear. Medicare also covers diabetes self-management training and supplies for those already diagnosed with diabetes.

Cardiovascular Screenings

Every five years, Medicare covers blood tests that check your cholesterol, lipid, and triglyceride levels. These tests help assess your risk for a heart attack or stroke.

Annual Wellness Visits and Medicare

Your annual wellness visit is a cornerstone of preventive care under Medicare. This is not a comprehensive physical exam. This visit focuses on creating a personalized prevention plan based on your current health and risk factors.

During your annual wellness visit, your healthcare provider will:

• Review your medical history
• Create a list of your current providers and prescriptions
• Check your height, weight, blood pressure and other routine measurements
• Assess your cognitive function
• Provide personalized health advice
• Develop a screening schedule for appropriate preventive services

Medicare Part B covers one annual wellness visit every 12 months at no cost to you, as long as your doctor accepts Medicare assignment. ²

Vaccines Covered by Medicare

Immunizations are a key part of preventive care, especially as we age. Medicare covers several important vaccines through different parts of your coverage:

Medicare Part B Covered Vaccines:

• Flu shots ³ – One per flu season at no cost
• Pneumococcal vaccines ⁴ – Two different shots that protect against pneumonia and other infections
• Hepatitis B shots ⁵ – For those at medium or high risk (includes people with hemophilia, End-Stage Renal Disease, diabetes or conditions that lower resistance to infection)
• COVID-19 vaccines ⁶ – All recommended doses and boosters
• Exposure-based vaccines – Tetanus and rabies shots when medically necessary due to exposure or injury

Medicare Part D Covered Vaccines:

• Shingles vaccine (Shingrix)⁷ – Coverage depends on your prescription drug plan
• RSV vaccine ⁸ – For eligible adults as recommended by your doctor
• Tdap vaccine ⁹ – Tetanus, diphtheria and pertussis combination vaccine
• Hepatitis A vaccine – When recommended based on risk factors

Coverage for Part D vaccines depends on your specific prescription drug plan. Check your plan’s formulary to understand your costs and pharmacy directory to find in-network providers.

What You’ll Pay (and What You Won’t) for Preventive Care Under Medicare

One of the best features of Medicare’s preventive care coverage is that many services come with no additional out-of-pocket costs when provided by doctors who accept Medicare assignment.

$0 Out-of-Pocket Services

When provided by doctors who accept Medicare assignment, these preventive services typically have no additional cost to you at the time of the service:

• Annual wellness visits (including the “Welcome to Medicare” visit) ²
• Flu shots, pneumococcal vaccines, COVID-19 vaccines and Hepatitis B shots (for those at medium or high risk) ³
• Smoking cessation counseling – Up to 8 face-to-face counseling sessions per year if you use tobacco
• Many screening tests, including: ⁴
• Mammograms (annual screening for women 65+)
• Colonoscopies (screening only)
• Cardiovascular screenings
• Bone mass measurements (for those who qualify)
• Diabetes screenings (for those at risk)
• Depression, obesity and alcohol misuse screenings
• Cervical/vaginal cancer screenings
• HIV and hepatitis B & C screenings
• Prostate cancer screening (PSA test is free; digital rectal exam may have a cost)

Services With Potential Additional Costs

Some preventive services may involve out-of-pocket costs:

• Colonoscopies that become diagnostic (if polyps or other abnormalities are found and removed during a screening colonoscopy, you may need to pay coinsurance for the removal and related services)
• Shingles, Tdap, and RSV vaccines ^7,8,9 (as of 2023, these are now covered at no additional cost if you have Medicare Part D, but you must use a pharmacy or provider in your plan’s network)
• Services from providers who don’t accept Medicare assignment
• Facility fees or doctor’s visit fees if you receive additional non-preventive care at the same visit

Frequency Limits

Medicare covers many preventive services, but most have specific timing requirements:

• Mammograms: Once a year if you’re age 65+
• Bone mass measurements: Once every 24 months (more often if medically necessary)
• Diabetes screenings: Up to twice yearly if you have risk factors
• Colorectal cancer screenings vary by test type and risk level:
• Colonoscopy: Every 10 years (average risk), every 24 months (high risk)
• Fecal occult blood test: Every 12 months
• Stool DNA test: Every 3 years
• Cardiovascular screenings: Once every 5 years
• Annual wellness visit: Once every 12 months

Other Medicare Coverage Options for Preventive Care

Beyond Original Medicare, other types of coverage may affect the costs you pay for preventive care. These options can vary, so it’s helpful to understand how each one works.

Medicare Advantage

Medicare Advantage plans combine your Medicare Part A and Part B coverage into one plan, often with additional built-in benefits. Many of these plans may include:

• Enhanced preventive care services
• Annual physical exams
• Additional routine screenings
• Fitness or wellness programs

Because benefits vary between plans, it’s important to review each plan to understand which preventive services are included.

Medicare Supplement Insurance and Preventive Care

Medicare supplement insurance is offered by private insurers to help cover out-of-pocket expenses under Original Medicare, such as:

• Coinsurance
• Copayments
• Deductibles

While these plans don’t add extra preventive benefits, they can help with costs for Medicare-covered screenings and tests. In most states, Medicare supplement insurance plans are standardized and identified by letters (like Plan G or Plan N), with each offering different levels of coverage.

Find the Right Medicare Plan for Your Medical Screening and Prevention Needs

Preventive care is your first line of defense against serious health conditions. Medicare’s coverage of screenings and preventive services helps you stay healthy and catch potential problems early.

To make the most of these benefits, talk with your healthcare provider about which screenings are right for you based on your age, health history, and risk factors. Mark your calendar for important screenings and don’t skip your annual wellness visit.

If you need help understanding your Medicare coverage for preventive care or want to explore options for additional coverage that help with out-of-pocket costs, contact a licensed agent who can guide you through your choices and help find coverage that fits your needs.

Medicare’s Preventive Care Coverage FAQs

Q1. What is a Medicare wellness visit?

A Medicare wellness visit is a yearly appointment focused on prevention planning, not a physical exam. Your doctor reviews your health history, creates a personalized prevention plan and schedules appropriate screenings. Medicare Part B covers one wellness visit every 12 months at no cost when you see a doctor who accepts Medicare assignment.

Q2. How are Medicare wellness visits different from annual physical exams?

An annual wellness visit focuses on prevention planning rather than a physical exam. Your doctor will review your health risks and create a personalized prevention plan. In contrast, a comprehensive physical exam involves a head-to-toe examination and isn’t covered by Medicare as a preventive service.

Q3. Does Medicare cover annual physical exams?

No, Medicare doesn’t cover routine annual physical exams. However, it does cover a one-time “Welcome to Medicare” preventive visit within the first 12 months you have Part B, and annual wellness visits every 12 months thereafter.5 While these wellness visits include screenings, health history reviews, and counseling on preventive measures, they do not typically include a full physical examination.

Q4. Which cancer screenings are covered by Medicare?

Medicare covers screenings for several types of cancer, including breast cancer (mammograms), colorectal cancer (colonoscopies and other tests), cervical and vaginal cancer (Pap tests and pelvic exams), lung cancer (low-dose CT scans for those at high risk), and prostate cancer (PSA tests).

Q5. Does Medicare provide depression screening coverage?

Yes, Medicare covers one depression screening per year. The screening must be done in a primary care setting that can provide follow-up treatment and referrals if needed.

Q6. What preventive services are not typically covered by Medicare?

Medicare generally doesn’t cover:

• Routine dental exams, cleanings, or dentures
• Routine eye exams for glasses or contacts
• Hearing aids or exams for fitting them
• Routine skin checks
• Routine foot care

Sources

¹ Medicare.gov. Web page: Mammograms. Retrieved April 20, 2025, from https://www.medicare.gov/coverage/mammograms

² Medicare.gov. Web page: Yearly wellness visit. Retrieved April 20, 2025, from https://www.medicare.gov/coverage/yearly-wellness-visit

³ Medicare.gov. Web page: Flu shots. Retrieved April 20, 2025, from https://www.medicare.gov/coverage/flu-shots

⁴ Medicare.gov. Web page: Pneumococcal shots. Retrieved April 20, 2025, from https://www.medicare.gov/coverage/pneumococcal-shots

⁵ Medicare.gov. Web page: Hepatitis B. Retrieved April 20, 2025. https://www.medicare.gov/coverage/hepatitis-b-shots

⁶ Medicare.gov. Web page: Coronavirus disease 2019 (COVID-19) vaccine. Hepatitis B. Retrieved April 20, 2025. https://www.medicare.gov/coverage/coronavirus-disease-2019-covid-19-vaccine

⁷ Medicare.gov. Web page: Shingles vaccine. Retrieved April 20, 2025. https://www.medicare.gov/coverage/shingles-shots

⁸ Medicare.gov. Web page: Respiratory Syncytial Virus (RSV) Shot. Retrieved April 20, 2025. https://www.medicare.gov/coverage/respiratory-syncytial-virus-rsv-shot

⁹ Medicare.gov. Web page: Tdap Vaccine. Retrieved April 20, 2025. https://www.medicare.gov/coverage/tdap-shots

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