Is there a charge for these services?

Under Original Medicare, some services require that you pay a co-pay, or 20 percent of the Medicare-approved amount and your annual Part B deductible ($131 in 2007).  Remember, however, that if you have Medigap supplemental insurance policy, this policy will likely cover that amount.

Are preventive services covered if I’m enrolled in a Medicare Advantage or Medicare Health Plan?

If you are in a Medicare Advantage or a Medicare health plan, you still get all the Medicare covered services, including preventive services.  Your costs for these services will be different from those described below.  You will need to check with your plan for more information.

What are the preventive services covered under Medicare in 2007?

The following list provides a list of Medicare Part B preventive services, who is eligible for these services, how often the service is covered, and whether there is a charge to receive the service.

Service - Initial preventive physical examination (also known as the “Welcome to Medicare” physical exam)
Who is eligible - All person who are new to Medicare.
How often - One time only and within the first 6 months of receiving Medicare Part B.
Cost - You pay 20 percent of the Medicare-approved amount and $131 Part B deductible

Service – Cardiovascular
Who is eligible – All people with Medicare
How often – Every 60 months
Cost – You pay nothing if your doctor or health plan accepts Medicare

Service – Breast Cancer Screening (Mammogram)
Who is eligible – All women with Medicare age 40 and older; and Women with Medicare between ages 35 and 39
How often – Once every 12 months for women age 40 and older; and Medicare pays for one baseline mammogram for women between the ages of 35 and 39
Cost – You pay 20% of the Medicare-approved amount with no Part B deductible

Service – Pap test and pelvic exam
Who is eligible – All women with Medicare
How often – Every 24 months or every 12 months if high-risk or childbearing age and has had an abnormal Pap test in the past 36 months
Cost – You pay nothing for Pap lab test if your doctor or health plan accepts Medicare. For Pap test collection and pelvic exam, you pay 20% of Medicare approved amount with no Part B deductible.

Service – Prostate cancer screening
Who is eligible – All men with Medicare age 50 and over
How often – Every 12 months for digital rectal exam (DRE) and prostate specific antigen (PSA) test
Cost – For DRE, you pay 20% of Medicare-approved amount and Part B deductible. For PSA you pay nothing if your doctor or health plan accepts Medicare

Service – Bone mass measurement
Who is eligible – People with Medicare who are age 50 or older
How often – Every 24 months (more often if medically necessary)
Cost – You pay 20% of the Medicare approved amount and $131 Part B deductible

Service – Colorectal cancer screening
Who is eligible – People with Medicare who are age 50 or older
How often – Fecal occult blood test - every 12 months; Flexible sigmoidoscopy – every 48 months; Screening colonoscopy – once every 120 months (high risk every 24 months); Barium enema (as alternative) – once every 48 months (high risk every 24 months)
Cost – You pay nothing for the fecal occult.  For all other tests, you pay 20% of the Medicare approved amount with no part B deductible

Service – Diabetes screening
Who is eligible – People with Medicare whose doctor says they are at high risk for diabetes
How often – Based on the results of your screening tests, you may be eligible for up to two diabetes screenings per year
Cost – You pay nothing if your doctor or health plan accepts Medicare

Service – Glaucoma Test
Who is eligible – People with Medicare who have diabetes, a family history of glaucoma, are African-American age 50 or older, or are Hispanic-American age 65 or over
How often – Every 12 months
Cost – You pay 20% of the Medicare approved amount and $131 Part B deductible

Service – Flu shot
Who is eligible – All people with Medicare
How often – Once a flu season, or more frequently if medically necessary
Cost – You pay nothing if your doctor or health plan accepts Medicare

Service – Pneumonia shot
Who is eligible – All people with Medicare
How often – Once in a lifetime
Cost – You pay nothing if your doctor or health plan accepts Medicare

Service – Hepatitis B shot
Who is eligible – People with Medicare who are medium to high risk
How often – One series if ordered by a doctor
Cost – You pay 20% of the Medicare approved amount and a $131 Part B deductible