Most services that Medicare covers require out-of-pocket costs such as copayments and deductibles. However, certain services are provided free, at no cost to the beneficiary.
Generally, once a beneficiary has met their deductibles, Medicare covers around 80% of all approved costs for services and treatments. This leaves the beneficiary responsible for 20% of the costs.
However, Medicare provides some services at no cost to the beneficiary. While they are not actually free services, they are free to the individual. Medicare covers all costs for these services.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part B covers a yearly wellness visit for eligible beneficiaries. These annual appointments allow individuals and their healthcare professionals to update personalized plans to help prevent disease and disability, according to current risk factors.
It is important to note that these annual wellness visits are not physical exams.
A person’s first yearly wellness visit cannot take place within 12 months of their Part B enrollment. They can then take place every 12 months after that.
As long as the healthcare professional accepts Medicare, these visits occur at no cost to the beneficiary. The Part B deductible also does not apply to these appointments, meaning individuals do not have to meet it before Medicare pays for them.
Medicare Part D covers most commercially available vaccines and immunizations. However, Medicare Part B covers certain preventive vaccines.
Part B covers:
Part B covers flu shots annually during flu season. The beneficiary pays nothing for these as long as the healthcare provider accepts Medicare.
For COVID-19 vaccines, Part B covers the initial vaccination and boosters at no cost to the beneficiary.
Medicare Part B covers both the hepatitis B vaccine and the pneumococcal vaccine, based on a person’s eligibility. People can speak with their doctor about these vaccines.
There are certain cancer screenings that Medicare Part B covers, typically at no cost to the beneficiary. These screenings include:
- cervical and vaginal cancer
- breast cancer (mammogram)
- lung cancer
- colorectal cancer
- prostate specific antigen (PSA) test for prostate cancer
Medicare will typically cover cervical cancer screenings, such as pap smears and pelvic exams, once every 24 months at no cost to the beneficiary.
Medicare covers mammograms to screen for breast cancer once every 12 months for those over the age of 40 with no out-of-pocket costs.
For prostate cancer, Medicare covers a PSA blood test once every 12 months for those over the age of 50 at no cost to the individual.
Medicare also covers lung cancer screenings through CT scans once per year for those who are eligible.
Individuals can speak with their doctor about their eligibility for these screenings based on their risk factors and circumstances.
Medicare Part B covers depression screenings at no cost to the beneficiary.
Once per year, a Medicare beneficiary can get a depression screening in a primary care setting such as a doctor’s office. This screening generally consists of a healthcare professional asking specific questions to determine if a person may have depression.
If the healthcare professional feels an individual may be experiencing depression, they can recommend follow-up treatment or give a referral to a mental health professional. Follow-up treatment and mental health services may require out-of-pocket costs such as copayments.
Medicare Part B covers diabetes screening tests for those who are eligible. These screenings may include:
- a fasting glucose test
- a non-fasting glucose test
- A1C tests
- other Medicare-approved glucose tests
Medicare offers up to two screenings each year at no cost to the beneficiary if a healthcare professional determines the individual may be at risk of developing diabetes.
Diabetes screening eligibility
Diabetes risk factors:
- high blood pressure (hypertension)
- obesity
- a history of excess cholesterol or triglyceride levels
- a history of high blood sugar
Conditions that may qualify for diabetes screening:
- being age 65 or older
- having overweight
- having a family history of diabetes, such as parents or siblings
- having a history of gestational diabetes or giving birth to a baby weighing more than 9 pounds
Medicare Part B covers bone mass, or bone density, measurements at no out-of-pocket cost to the individual. Eligible beneficiaries can receive this test once every 24 months to check for their risk of broken bones.
Generally, people are responsible for bone density testing if they are at risk for osteoporosis, taking medications that may affect bone density, or are already taking medications for osteoporosis.
Medicare Part B covers medical nutrition therapy services at no cost for those who are eligible. These services include:
- an initial nutrition and lifestyle assessment
- individual or group nutritional therapy services
- help managing lifestyle factors that can affect diabetes
- follow-up visits to check on progress
Medicare covers an initial 3 hours of services during the first calendar year. It may then cover 2 hours of follow-up services each calendar year after the initial coverage.
To be eligible for the nutrition services, a person must meet at least one of the following requirements:
- have diabetes
- have kidney disease
- had a kidney transplant in the past 36 months
Medicare Part B covers obesity screening and behavioral counseling at no cost to the individual for those who are eligible.
People with a body mass index (BMI) of 30 or more are eligible for these services through Medicare.
Obesity behavioral therapy includes:
- an initial BMI screening
- a dietary assessment
- counseling to help the individual lose weight by focusing on diet and exercise
Medicare Part B covers sexually transmitted infection (STI) screenings and behavioral counseling sessions for those who are eligible.
Eligible beneficiaries pay nothing out of pocket for these services.
STI screening and counseling include:
- STI screening for:
- chlamydia
- gonorrhea
- syphilis
- hepatitis B
- up to two face-to-face behavioral counseling sessions lasting between 20 and 30 minutes
Medicare Part B covers alcohol misuse screenings at no cost to the individual for those who are eligible.
These screenings include questions about a person’s alcohol use so that a healthcare professional can review the responses and check for alcohol misuse.
Individuals who use alcohol but do not meet the conditions for alcohol dependency can receive a screening once per year.
Most services that Medicare covers have at least a 20% coinsurance for the beneficiary.
However, Medicare provides certain services and preventive screenings at no cost to the individual, though some of these services have eligibility requirements. Individuals can speak with a healthcare professional about whether they meet these requirements.