⑉ Who’s covered? 

Medicare covers a one-time abdominal aortic aneurysm ultrasound for people at risk. You’re considered at risk if you have a family history of abdominal aortic aneurysms, or you’re a man 65–75 and have smoked at least 100 cigarettes in your lifetime. 

⑉ How often is it covered? 

Medicare covers this screening once in your lifetime if you get a referral from your doctor. 

⑉ Your costs if you have Original Medicare 

You pay nothing for this screening if the doctor or other qualified health care provider accepts assignment. 

⑉ Who’s covered? 

Adults with Medicare (including pregnant women) who use alcohol, but don’t meet the medical criteria for alcohol dependency. 

⑉ How often is it covered? 

Medicare covers one alcohol misuse screening per year. If your primary care doctor or other primary care practitioner determines you’re misusing alcohol, you can get up to 4 brief face-to-face counseling sessions per year (if you’re competent and alert during counseling). The practitioner must provide the counseling in a primary care setting (like a doctor’s office). 

⑉ Your costs if you have Original Medicare…

You pay nothing if the doctor accepts assignment. 

Medicare covers bone mass measurements to see if you’re at risk for broken bones due to osteoporosis. Osteoporosis is a disease in which your bones become weak and brittle. In general, the lower your bone density, the higher your risk for a fracture. Bone mass measurement results will help you and your doctor choose the best way to keep your bones strong. 

⑉ Who’s covered? 

Bone mass measurements are covered for certain people with Medicare whose doctors say they’re at risk for osteoporosis, and who have one of these medical conditions: 

• A Woman whose doctor or health care provider says she’s estrogen-deficient and at 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 drug 

⑉ How often is it covered? 

Once every 24 months (more often if medically necessary). 

⑉ Your costs if you have Original Medicare…

You pay nothing for this test if the doctor accepts assignment. 

Breast cancer is the most common non-skin cancer in women and the second leading cause of cancer death in women in the U. S. Every woman is at risk, and this risk increases with age. Breast cancer usually can be treated successfully when found early. Medicare covers screening mammograms to check for breast cancer 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 Medicare…

You 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 2 or more close relatives who’ve had breast cancer).
• You had your first baby after 30.  
• You’ve never had a baby. 

⑉ 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 diet 

⑉ How often is it covered?

Once each year. 

⑉ Your costs if you have Original Medicare? 

You pay nothing if your doctor accepts assignment. 

Medicare covers cardiovascular disease screenings that check your cholesterol and other blood fat (lipid) levels. High levels of cholesterol can increase your risk for heart 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 Medicare? 

You pay nothing for this screening.  

Medicare covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the pelvic exam, Medicare also covers a clinical breast exam to check for breast cancer. 

⑉ Who’s covered? 

All women with Medicare. 

⑉ How often is covered? 

Medicare covers these screening tests once every 24 months, or once every 12 months if you’re at high risk for cervical or vaginal cancer, or if you’re of child-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) once every 5 years if you’re 30-65 without HPV symptoms.

⑉ Your costs if you have Original Medicare?

You pay nothing for the lab Pap test and for the lab HPV with Pap test. You also pay nothing for the Pap test specimen collection and pelvic and breast exams if the 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 was pregnant with you. 

Medicare covers colorectal cancer screening tests to help find pre-cancerous polyps (growths in the colon), so polyps can be removed before they become cancerous and 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 a covered screening colonoscopy. 

⑉ How often is covered? 

• Screening fecal occult blood test—Once every 12 months for people 50 or older. 

• Screening flexible sigmoidoscopy—Once every 48 months after the last flexible sigmoidoscopy or barium enema, or 120 months after a previous screening colonoscopy. 

• Screening colonoscopy—Once every 120 months (high risk every 24 months), or 48 months after a previous flexible sigmoidoscopy. 

• Screening barium enema—Once every 48 months (high risk every 24 months) when used instead of sigmoidoscopy or colonoscopy.

• Multi-target stool DNA test—Once every 3 years for people who meet all of these conditions:

– They’re between 50–85. 

– They show no signs or symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test, or fecal immunochemical test. 

– They’re at average risk for developing colorectal cancer, meaning they have no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis. 

– They have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer. 

⑉ Your costs if you have Original Medicare?

You pay nothing for the fecal occult blood test, if you get a written referral from your doctor, physician assistant, nurse practitioner, or clinical nurse specialist. You pay nothing for the flexible sigmoidoscopy or screening colonoscopy if your doctor accepts assignment. 

Note: If a polyp or other tissue is found and removed during the colonoscopy, you may have to pay 20% of the Medicare-approved amount for the doctor’s services and a copayment in a hospital outpatient setting. 

For barium enemas, you pay 20% of the Medicare-approved amount for the doctor’s services. The Part B deductible doesn’t apply. If it’s done in a hospital outpatient setting, you pay a copayment. 

⑉ Am I at high risk for cervical cancer? ? 

Risk for colorectal cancer increases with age. It’s important to continue with screenings, even if you were screened before you had Medicare. Your risk for colorectal cancer increases if any of these are true: 

• You’ve had colorectal cancer before. 

• You have a close relative who had colorectal polyps or colorectal cancer. 

• You have a history of polyps. 

• You have inflammatory bowel disease (like ulcerative colitis or Crohn’s disease). 

⑉ Who’s covered? 

All people with Medicare. 

⑉ How often is covered? 

Medicare covers one depression screening per year. The screening has to be done in a primary care setting (like a doctor’s office) that can provide follow-up treatment and referrals. 

⑉ Your costs if you have Original Medicare?

You pay nothing for this test if your doctor accepts assignment. 

Diabetes is a medical condition in which your body doesn’t make enough insulin, or has a reduced response to insulin. Diabetes causes your blood sugar to be too high because your body needs insulin to use sugar properly. A high blood sugar level isn’t good for your health. Medicare covers a blood screening test to check for diabetes for people at risk. For people with diabetes, Medicare covers educational training to help manage their diabetes. 

Diabetes screening (fasting blood glucose test) 

⑉ Who’s covered? 

People who are at risk for diabetes and get a referral from a doctor. 

⑉ How often is covered? 

Based on the results of your screening tests, you may be eligible for up to 2 diabetes screenings per year. 

⑉ Your costs if you have Original Medicare?

You pay nothing for this screening.

⑉ Am I at risk for diabetes? 

• You’re considered at risk if you have high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar (glucose). Medicare also covers these tests if 2 or more of these apply to you: 

• You’re 65 or older. 

• You’re overweight. 

• You have a family history of diabetes (parents, brothers, or sisters). 

• You have a history of gestational diabetes (diabetes during pregnancy), or you’ve had a baby weighing more than 9 pounds 

Diabetes self-management training 

⑉ Who’s covered? 

This training is for people with diabetes to teach them to manage their condition and prevent complications. You need a written order from a doctor or other qualified health care provider. 

⑉ Your costs if you have Original Medicare?

You pay 20% of the Medicare-approved amount after the yearly Part B deductible. 

Glaucoma is an eye disease caused by high pressure in the eye. It can develop gradually without warning and often without symptoms. The best way for people at high risk for glaucoma to protect themselves is to have regular eye exams. 

⑉ Who’s covered? 

People with Medicare at high risk for glaucoma. 

⑉ How often is covered? 

Once every 12 months. 

⑉ Your costs if you have Original Medicare?

You pay 20% of the Medicare-approved amount after the yearly Part B deductible.

⑉ Am I at risk for glaucoma 

Your risk for glaucoma increases if any of these are true: 

• You have diabetes. 

• You have a family history of glaucoma. 

• You’re African-American and 50 or older. 

• You’re Hispanic and 65 or older. 

⑉ Who’s covered? 

Medicare covers HBV infection screenings if you meet one of these conditions: 

• You’re at high risk for HBV infection. 

• You’re pregnant. 

Medicare will only cover HBV infection screenings if they’re ordered by a primary care provider. 

⑉ How often is covered? 

HBV infection screenings are covered: 

• Annually only for those with continued high risk who don’t get a Hepatitis B vaccination. 

• For pregnant women:

– At the first prenatal visit for each pregnancy. 

-At the time of delivery for those with new or continued risk factors. 

-At the first prenatal visit for future pregnancies, even if you previously got the Hepatitis B shot or had negative HBV screening results. 

⑉ Your costs if you have Original Medicare?

You pay nothing for the screening test if the doctor accepts assignment. 

⑉ Who’s covered? 

People with Medicare who meet at least one of these conditions: 

• Those at high risk because they have a current or past history of illicit injection drug use. 

• Those at high risk because they’ve had a blood transfusion before 1992. 

• Those born between 1945-1965 

⑉ How often is covered? 

Medicare covers a one-time Hepatitis C screening test. Medicare also covers a repeat screening yearly for certain people at high risk. 

⑉ Your costs if you have Original Medicare?

You pay nothing for the screening test if it is ordered by a primary care provider who accepts assignment 

⑉ Who’s covered? 

Medicare covers HIV (Human Immunodeficiency Virus) screenings if you meet these conditions: 

• You’re 15-65, not at risk and ask for the screening. 

• You’re younger than 15 or older than 65, at an increased risk for the virus, and ask for the screening. 

⑉ How often is covered? 

Medicare covers this test once every 12 months, or up to 3 times during a pregnancy. 

⑉ Your costs if you have Original Medicare?

You pay nothing for this test. 

⑉ Who’s covered? 

Medicare covers lung cancer screening with Low Dose Computed Tomography (LDCT) for people with Medicare who meet all of these: 

• Are 55-77. 

• Are asymptomatic (you don’t have signs or symptoms of lung cancer). 

• Have a tobacco smoking history of at least 30 “pack years” (an average of one pack a day for 30 years). 

• Are either a current smoker or have quit smoking within the last 15 years.

• Get a written order from their doctor or qualified non-physician practitioner.

– (Before your first lung cancer screening, you’ll need to schedule an appointment with your doctor to discuss the benefits and risks of lung cancer screening. You and your doctor can decide whether lung cancer screening is right for you.) 

• The service is provided by a reading radiologist at an appropriate radiology imaging center that meet Medicare standards. 

⑉ How often is covered? 

Once every 12 months. 

⑉ Your costs if you have Original Medicare?

You pay nothing for this service if the primary care doctor or other qualified primary care practitioner meets the appropriate standards and accepts assignment. 

Medicare may cover medical nutrition therapy (MNT) services and certain related services if you have diabetes or kidney disease, or you’ve had a kidney transplant in the last 36 months. Your doctor or other qualified practitioner must refer you for the MNT service. A Registered Dietitian or nutrition professional who meets certain requirements can provide MNT services. Services may include an initial nutrition and lifestyle assessment, one-on-one nutritional counseling, help managing the lifestyle factors that affect your diabetes, and follow-up visits to check on your progress in managing your diet. If you get dialysis in a dialysis facility, Medicare covers MNT as part of your overall dialysis care. 

⑉ Who’s covered? 

Certain people who have any of these: 

• Diabetes 

• Renal disease (people who have kidney disease, but aren’t on dialysis) 

• Have had a kidney transplant within the last 3 years 

Your doctor needs to refer you for this service. 

⑉ How often is covered? 

Medicare covers 3 hours of one-on-one counseling services the first year, and 2 hours each year after that. If your condition, treatment, or diagnosis changes, you may be able to get more hours of treatment with a doctor’s referral. A doctor must prescribe these services and renew your referral yearly if continuing treatment is needed into another calendar year. 

⑉ Your costs if you have Original Medicare?

You pay nothing for these services if the doctor accepts assignment. 

For more information about diabetes and medical nutrition therapy…

Visit Medicare.gov/publications to view the booklet “Medicare Coverage of Diabetes Supplies & Services.” You can also call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. 

Medicare covers a once-per-lifetime proven health behavior change program to help you prevent type 2 diabetes. 

⑉ Who’s covered? 

You must have: 

• Medicare Part B. 

• A hemoglobin A1c test result between 5.7 and 6.4%, a fasting plasma glucose of 110-125mg/dL, or a 2-hour plasma glucose of 140-199 mg/dL (oral glucose tolerant test) within 12 months of attending the first core session. 

• A body mass index (BMI) of 25 or more (BMI of 23 or more if you’re Asian). 

• Never been diagnosed with type 1 or type 2 diabetes or End-Stage Renal Disease (ESRD). 

• Never participated in the Medicare Diabetes Prevention Program. 

⑉ How often is covered? 

The program begins with 16 core sessions offered in a group setting over a 6-month period. Once you complete the core sessions, you’ll get 6 more months of less intensive monthly follow-up sessions to help you maintain healthy habits. You’ll also get an additional 12 months of ongoing maintenance sessions if you meet certain weight loss and attendance goals. 

⑉ Your costs if you have Original Medicare?

You pay nothing for these services if eligible. 

Medicare covers intensive behavioral therapy for people with obesity, defined as a body mass index (BMI) of 30 or more. 

⑉ Who’s covered? 

All people with Medicare may be screened for obesity. Counseling is covered for anyone found to have a BMI of 30 or more. 

⑉ How often is covered? 

Medicare covers behavioral therapy sessions to help you lose weight. This counseling may be covered if you get it in a primary care setting (like a doctor’s office), where it can be coordinated with your other care and a personalized prevention plan. 

⑉ Your costs if you have Original Medicare?

You pay nothing for this service if your primary care doctor or other qualified primary care practitioner accepts assignment. 

Prostate cancer may be found by testing the amount of PSA (Prostate Specific Antigen) in your blood. Your doctor can also find prostate cancer during a digital rectal exam. Medicare covers both of these tests. 

⑉ Who’s covered? 

All men with Medicare over 50 (coverage for this test begins the day after their 50th birthday). 

⑉ How often is covered? 

• Digital rectal examination—Once every 12 months. 

• PSA test—Once every 12 months. 

⑉ Your costs if you have Original Medicare?

Generally, you pay 20% of the Medicare-approved amount for the digital rectal exam after the yearly Part B deductible. You pay nothing for the PSA test. 

⑉ Am I at high risk for prostate cancer? 

Talk to your doctor about whether you’re at risk for prostate cancer.