These
services could save you money and help prevent costly health problems.
Maryalene LaPonsie and Brandon Ballenger • November 26,
2021
If you have Medicare or
will soon, you probably know the basics of what it covers. But how much do you
know about all the lesser-known benefits that are included with Medicare health
insurance coverage?
They aren’t exactly free,
because Medicare isn’t free.
But these included services have no out-of-pocket costs for many Medicare
beneficiaries.
There are some caveats. For
example, there may be limitations on frequency, and your health care provider
must accept Medicare’s payment conditions. Still, it’s worth knowing these
benefits are in your pocket if you have Original Medicare, which is one of the
two main types of Medicare.
Costs may differ for
Medicare Advantage plans, the other main type of Medicare. These plans are
offered by private insurers that contract with the federal Medicare program and
generally come with their own set of benefits, as we explain further in “14 Added Benefits
in the New Medicare Advantage Plans.”
Following are services
available to Medicare recipients that could save you money and help prevent
costly health problems.
1. Part A premiums
The component of Medicare
called Part A primarily covers hospital stays and inpatient care (whereas Part
B primarily covers services in health care providers’ offices).
Most people don’t have to
pay a monthly premium for Part A coverage so long as they paid Medicare payroll
taxes during their working years.
Specifically, premium-free
Medicare Part A is available to people age 65 and older if they
are eligible for or already receive retirement benefits from Social Security or
the Railroad Retirement Board. It’s also available to anyone of that age who
had Medicare-covered government employment or had a spouse with
Medicare-covered government employment.
2. ‘Welcome to Medicare’ preventive visit
Not to be confused with
an annual wellness visit, the “Welcome to Medicare”
preventive visit available without an out-of-pocket cost must occur within the
first 12 months after someone begins their Medicare Part B coverage.
During this one-time
visit, a health care professional will provide information on preventive
services covered by Medicare and possibly make referrals for other care based
on a review of your medical and social background.
3. Annual wellness visit
The purpose of the annual wellness
visit available to Medicare recipients is to develop or update
a personalized plan to help prevent disease and disability based on your health
situation.
According
to Medicare.gov, the official government website for Medicare, the visit might
also include:
·
A review of your medical and family history
·
Developing or updating a list of your health care providers and
prescriptions
·
Routine measurements — such as height, weight and blood pressure
·
Detection of cognitive impairment
·
Personalized health advice
Just note that costs such
as a deductible might apply if during an annual visit you receive additional
tests or services that aren’t among covered preventive benefits.
4. Vaccines
One influenza shot per
flu season is covered when you have Medicare. The COVID-19 vaccine and
booster are covered, too.
A total of two pneumococcal shots are
also covered. These vaccines protect against pneumococcal disease, which the
U.S. Centers for Disease Control and Prevention describe as any type of
infection caused by Streptococcus pneumoniae bacteria. These can include
pneumonia, meningitis and sepsis.
Vaccines for hepatitis B may
also be covered, depending on your risk.
5. Cancer screenings
Medicare covers
screenings for a variety of health conditions. They include various types of
cancer:
·
Colorectal cancer —
one colonoscopy every 24 or 120 months, depending on your risk
·
Lung cancer —
one low-dose computed tomography scan, or lose-dose CT scan, every year for
certain current and former smokers age 55 to 77
·
Cervical and
vaginal cancer — includes a Pap test, pelvic exam as well as a
breast exam every 12 or 24 months, depending on your risk
·
Prostate cancer —
includes a prostate-specific antigen (PSA) blood test every 12 months for men
over age 50
Some cancer screenings
have eligibility requirements, while others do not.
6. Mental health screenings
When it comes to mental
health, Medicare provides the following free screenings:
·
Alcohol misuse — one screening per year, if you use
alcohol but aren’t considered dependent on it
·
Depression — one screening per year
7. Other health screenings
Beyond cancer and mental
health screenings, Medicare provides a number of free screenings for other
health conditions. They include the following, most of which are free if you
meet certain risk factors:
·
Abdominal aortic aneurysm — one screening in your
lifetime
·
Cardiovascular disease — blood tests every five years
·
Diabetes — up to two screenings per year
·
Hepatitis C — up to one screening per year
·
HIV — up to three screenings per year
·
Obesity — one initial screening
·
Sexually transmitted infections — screenings once per
year
8. Counseling
The following types of
counseling are among those by Medicare for people who meet eligibility
requirements:
·
Alcohol counseling —
up to four sessions per year
·
Smoking and tobacco
counseling — up to eight sessions in a 12-month period
9. Bone density tests
Also known as bone mass
measurements, these tests help determine whether you are at risk for
broken bones. They are free to eligible Medicare recipients every 24 months, or
more often if medically necessary. To qualify, you must meet one or more the
following criteria:
·
Be a woman deemed estrogen-deficient and at risk of osteoporosis
by a doctor.
·
Have X-rays that show possible osteoporosis, osteopenia or
vertebral fractures.
·
Take prednisone or steroid-type drugs.
·
Be diagnosed with primary hyperparathyroidism.
·
Be on osteoporosis drug therapy that must be monitored for
effectiveness.
10. Cardiovascular behavioral therapy
Once a year, Medicare
provides a free cardiovascular behavioral therapy visit with a primary
care provider.
This visit is intended to
help people reduce their risk of cardiovascular disease and includes a blood
pressure check as well as tips about healthy eating. Taking aspirin daily may
also be discussed.
11. Diabetes management training
Those who are diagnosed
with diabetes have access to free self-management training.
Offered on an outpatient
basis, this training occurs mainly in a group setting and covers topics such as
monitoring blood sugar, eating healthfully and administering medication.
Medicare will pay for up
to 10 hours of initial training and, in some cases, two hours of follow-up
training every subsequent year.
12. Nutrition therapy
Those with diabetes or
kidney disease or who have had a kidney transplant within 36 months are
eligible for free medical nutrition therapy. Covered services may include an
initial nutrition and lifestyle assessment, individual and group therapy and
follow-up visits.
13. The ‘What’s Covered’ app
In 2019, Medicare debuted a
free app called “What’s Covered.” You can use the app to look up medical goods
and services and find out whether Medicare covers them.
If you don’t want to
download the app or don’t have a smartphone or internet-connected tablet, you
can use a computer to access Medicare.gov’s Your Medicare Coverage tool, which also
lets you search for an item or service and find out whether it’s covered.
14. Insurance assistance
People who are eligible
for Medicare, as well as their families and caregivers, have access to free
in-depth, one-on-one insurance counseling and assistance from the State Health
Insurance Assistance Programs (SHIP).
The U.S. Department of
Health and Human Services funds SHIPs through
grants to states. There is a SHIP for every state as well as the District of
Columbia, Puerto Rico, Guam and the U.S. Virgin Islands.
A SHIP can be especially
helpful during open enrollment season, although they offer various other services
besides one-on-one assistance with reviewing your Medicare plan options. They
can also:
·
Answer questions about what Medicare does and does not cover.
·
Tell you about out-of-pocket cost assistance programs for which
you might be eligible.
·
Help you understand Medicare’s eligibility criteria.
·
Explain how Medicare coverage works in conjunction with
supplemental insurance policies, Medicaid and other forms of health insurance.
To find the SHIP for your
state, visit the national
SHIP website.
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